Diagnosis and Prognosis of Ovarian Cancer
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Ovarian cancer usually produces no symptoms until it is in an advanced stage. Consequently, it is rarely detected early, in response to early symptoms. In fact, almost 70% of women with ovarian cancer have advanced stage disease when it is diagnosed.
The diagnosis and prognosis of ovarian cancer includes the following:
- ]]>Review of medical history]]>
- ]]>Physical exam]]>
- ]]>Diagnostic testing]]>
Review of Medical History
At your regular checkup and Pap smear, or if you have symptoms, your doctor will ask about your medical history and perform a physical examination. Your relevant history includes your complete menstrual and pregnancy history—age at first menstrual period, regularity of your menstrual periods, number of pregnancies, miscarriages, abortions, use of birth control or fertility drugs, breast feeding, and age of menopause. It also includes your family history of cancers.
During the complete physical exam, your physician will focus on your abdomen and pelvis. A deep manual probing of your abdomen will search for any unusual masses, signs of fluid accumulation, or bowel obstruction. You should indicate any area that is unusually tender.
A pelvic examination is essential. After looking inside your vagina with a speculum, the doctor will probe deeply with one gloved hand inside your vagina and the other pressing into your abdomen from above. By feeling your ovaries, other reproductive organs, and bladder the doctor can usually determine their condition. The examination will likely include a brief probing into your rectum as well. It is uncomfortable but brief. This examination is much more accurate in non-obese women.
Whether or not the pelvic exam reveals abnormalities, further tests may be advisable.
Imaging tests (Ultrasound, CT scan, and MRI scan) – A transvaginal ultrasound, which provides satisfactory images of the pelvic organs, can often be performed in your doctor's office. It requires the use of a portable machine and a probe, which is inserted into your vagina. CT and MRI scanning require much bigger and more expensive machinery available only at hospitals and medical imaging centers. They provide very accurate images of your internal organs.
Lower GI series or barium enema – although intended mainly for intestinal diagnosis, these images sometimes help diagnose problems in the nearby female reproductive organs. You should not eat or drink on the day of the exam. You will take a laxative or have an enema before the procedure, to empty your bowels. In the x-ray suite, after preliminary x-rays, you will receive an enema of barium. This allows your lower bowel to be visible on an x-ray.
Biopsy – suspicious masses in your ovaries may require a biopsy to determine if they are cancerous. For a biopsy, a sample of tissue is removed and sent to a lab for testing. Pieces of the mass can often be taken through small incisions using a laparoscope, which is a thin, lighted telescope that surveys the inside of your abdomen. In some cases, a surgeon may need to perform open surgery to reach the mass. The tissue sample is sent to the pathology lab to be examined for cancer cells.
Tumor markers – you may have blood tests for CA-125 (a tumor marker for epithelial ovarian cancer), or alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) tests for germ cell tumors. These tests may help with the diagnosis and with determining the success of treatments. The CA-125 assay is not as accurate as some other tumor markers. AFP and hCG are both useful for diagnosing and managing germ cell cancers, which are far less common cancers of the ovaries.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (e.g., surgery vs. chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0 – 1) imply a favorable prognosis, whereas high staging classifications (4 – 5) imply an unfavorable prognosis.
Additional tests to determine staging may include:
- Urine and blood tests
- Additional physical exams, including another pelvic exam in the operating room under anesthesia, which keeps you relaxed
- Further imaging studies of other parts of the body, including lungs, bladder, kidneys, and lymph nodes
The following stages are used to classify cancer of the ovary:
Stage I: cancer involves the ovary but has not spread. Few ovarian cancers are discovered at this stage.
Stage II : cancer has spread to nearby areas but is still inside the pelvis.
Stage III: cancer has spread outside of the pelvis to other parts of the abdomen. This includes patients who develop ascites (fluid) in the abdomen.
Stage IV: cancer has spread to other parts of the body.
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation.
The five-year survival rates after treatment for each stage of ovarian cancer are as follows:
Stage 1: 90%
Stage II: 70%
Stage III: Patients diagnosed at this stage had an average 5-year survival of 15 to 20% in the past, but newer drugs and more aggressive treatments have extended the survival for many women.
Stage IV: 1% to 5%
Harrison's Principles of Internal Medicine , 14th ed. McGraw-Hill, 1998.
National Cancer Institute Web site.
Available at: http://www.nci.nih.gov/cancer_information/
Accessed: November 29, 2002
Last reviewed February 2003 by ]]>Francine Foss, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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