The American Cancer Society estimates that over 21,500 new cases of ovarian cancer will be diagnosed in the U.S. in one year, and over 14,000 women will die from ovarian cancer. You can learn more about ovarian cancer in the ovarian cancer overview.
Diagnosing ovarian cancer
In order to find out if cancer of the ovaries is present, the doctor may order one or more tests.
• Pelvic exam – This is typically done as part of an annual exam. The doctor presses on the abdomen to feel for the size and shape of organs and to check for tumors and fluid build-up. The ovaries are difficult to reach, so this test may not be conclusive. A pap test is part of a normal pelvic exam. The pap test is useful in diagnosing cervical cancer, but cannot detect ovarian cancer.
• Blood tests – The lab may test for CA-125, which is a substance found on the surface of ovarian cancer cells. A high level of CA-125 could mean ovarian cancer is present.
• Imaging – Tests including an ultrasound, CT, and MRI can help produce images of structures inside the body. This will allow the doctor to look for signs of a tumor.
• Biopsy – A small sample of tissue is taken and examined under a microscope to see if cancer cells are present. This can be done using a large needle, or through laparoscopic surgery which uses tiny incisions in the abdomen to insert a camera and other instruments to collect the sample.
Cancer cells that are examined as part of a biopsy may be given a grade of one through three. Grade one cancer cells look almost normal and are least likely to spread. Grade three cells look the least like normal cells and are most likely to grow and spread.
Staging ovarian cancer
Part of the process of determining the best cancer treatment is staging the cancer. The doctor will evaluate the size of the tumor, whether the cancer has spread to nearby lymph nodes, and whether it has spread to other parts of the body. When cancer cells travel to other areas in the body, the cancer is said to have metastasized.
The basic stages for ovarian cancer are:
• Stage 1: Cancer cells are in one or both ovaries. Cells may be found on the surface of the ovary or in fluid that is collected from the abdomen.
• Stage 2: Cancer cells have spread from the ovaries to other tissues in the pelvic area. Possible locations are the fallopian tubes or the uterus.
• Stage 3: Cancer cells have spread into the lymph nodes in the surrounding area, and may also be found outside the pelvis, such as on the outside of the liver.
• Stage 4: Cancer cells have spread outside the abdomen and pelvis. Cancer may be found inside the liver, in the lungs, or in other organs.
Treating ovarian cancer
Treatments for ovarian cancer vary depending on the grade and stage of the cancer, and on whether the woman hopes to get pregnant in the future. Options include one or more of these treatments:
• Surgery – The first goal in surgery is to confirm the stage of the tumor and remove as much of it as possible. This is typically done through a laparotomy, which is a wide incision in the abdomen that allows the doctor to check the entire area for other tumors. If ovarian cancer is confirmed, the surgeon may remove both ovaries and the fallopian tubes, the uterus, nearby lymph nodes, and the omentum, which is a thin pad of fatty tissue that covers the intestines. If the cancer has spread, a second goal of surgery is to remove as much of the cancer as possible. This process is called debulking. The intent of debulking is to make sure no tumors larger than 1 cm (approximately 3/8 of an inch) are left behind.
• Chemotherapy – This treatment uses special cancer-killing drugs to destroy cancer cells. The drugs can be given as pills which are swallowed, directly into the blood (IV), or directly into the abdominal cavity (intraperitoneal or IP). Chemotherapy drugs can also damage other cells in the body, which can cause side effects including fatigue, bleeding or bruising, or an increased chance of infection. Chemotherapy is typically given in cycles with some time administering the drug followed by time for the body to recover before the next cycle begins.
• Radiation – High energy X-rays are used to kill the cancer cells. Radiation can be beamed at the appropriate part of the body or can be given in the form of an implant that is placed near the cancer where it releases radiation to kill cancer cells. Radiation is used in combination with surgery and/or chemotherapy, but is seldom used in the United States as the main treatment for ovarian cancer.
These three treatments are often used as a combination of two or all three methods to treat ovarian cancer. The doctor will discuss the options and determine the best treatment for each specific cancer.
Sources:
American Cancer Society
National Cancer Institute
National Institutes of Health: Medline Plus