Treating Ovarian Cancer

What is Ovarian Cancer?
Ovarian cancer is a malignancy in the ovary or ovaries, part of the female reproductive system. The ovaries make hormones - vital to a woman's well-being - and eggs.

How Prevalent is It?
The Ovarian Cancer National Alliance reports that one in about every 57 women will be afflicted. About 23,000 women are diagnosed every year, and of that number, about 15,000 will die. And the numbers have been increasing.

Does This Type of Cancer Run in Families?
There is a definite genetic predisposition toward ovarian cancer in some families. If you have a near relative (mother, sister, daughter) who has been diagnosed with ovarian cancer, you are at higher risk than a woman with no ovarian cancer in her family. Every close family member so diagnosed increases your risk.

Gene mutations (changes in the gene) are behind many ovarian cancers. These may be inherited. They make up 5%-10% of all ovarian cancers. Ovarian cancer may be associated with breast and colon cancers.

How Many Types of Ovarian Cancers Are There?
There are three types of ovarian cancers: epithelial carcinoma, germ-cell tumors, and stromal tumors.

Epithelial Tumors
These tumors originate in the cells that form the outer surface of the ovary. Ovarian epithelial cancer has some serious side effects, such as premature menopause and infertility. You and your doctor may decide on a course of chemotherapy to treat your epithelial cancer. Typically, you will work out a schedule of chemo applications followed by a break. Drugs have different chemo schedules; you and your doctor should examine carefully every one before deciding on a plan.

Germ-cell Tumors
These tumors arise in the egg-producing centers of the ovaries, and account for about 3% of ovarian tumors. They are found most often in teens and young women. They are aggressive, but amenable to treatment: about 90% of these tumors can be cured.

Stromal Tumors
Stromal tumors arise in the connective tissue surrounding the ovary and represent 5-6% of ovarian cancers. The female hormones, estrogen and progesterone are produced here. Stromal tumors do not usually spread, but those that do are more resistant to treatment than other tumors.

How is Ovarian Cancer Diagnosed?
This type of cancer is difficult to diagnose because until it is far advanced, there are usually no symptoms. If any appear, they are likely to be:

• abdominal swelling or abdominal pain

• vaginal bleeding between periods or after menopause

• bloating, gas, indigestion or cramps

• pelvic pain

• loss of appetite

• feeling full after a small meal, or feeling full very easily

• changes in bowel or bladder habits

• weight loss or weight gain

Your doctor may perform tests to aid in his diagnoses. Tests that assess the condition of the pelvic area, ovarian tissues, and blood include:

o Pelvic exam: The vagina, cervix, uterus, ovaries, fallopian tubes, and rectum will be examined, perhaps with a speculum. The patient may also be given a Pap smear of the cervix.

o Ultrasound: High-energy sound waves are applied to the abdomen to create echoes that project an image of interior tissues - a sonogram.

o CT Scan: Makes a detailed image of the questioned area. The image appears on a computer monitor, connected to the x-ray machine. May include the administration of a dye.

o CA 125 assay: This test measures the level of CA 125 in the blood. An elevated level indicates cancer or other illness.

o Barium enema: Also called a "lower GI series." A white liquid is administered via the rectum to coat the lower intestines, then x-rays are taken.

o Intravenous pyelogram: X-rays of the bladder, ureters and kidneys to see if cancer has spread there, or if there are any blockages, using a contrast dye.

o Biopsy: Removing small pieces of tissue for examination under the microscope. The tissue is taken through a small incision in the wall of the abdomen.

How is Ovarian Cancer Treated?
The primary treatments are surgery, chemotherapy, and radiation. These may be employed alone or in combination. Some factors that will contribute to the choices made in regard to treatment are the general state of your health, if you plan to have children, possible side effects, etc.

The various stages of ovarian cancer are:

Stage I: confined to the ovaries.

Stage II: has spread beyond the ovaries, but confined to the pelvis.

Stage III: has spread to the lining of the abdomen and/or lymph nodes.

Stage IV: has spread to the liver, lungs or other organs outside the pelvic area.

The higher the stage number, the more life-threatening the cancer and the harder it is to treat successfully.

If indicated, surgery may be called for to prevent ovarian cancer in women at high risk, to remove tumors of the ovary, and/or to prevent future blockages or bleeding. If the cancer has spread to other organs, your surgery may be extensive.

Early stage cancer in women of childbearing age may call for surgery but the surgeon will attempt to remove only the cancer or as large as possible chunk of the process called "debulking." Doctors are convinced that this will improve your prognosis. You and your doctor should discuss treatment in depth before you agree on a treatment program. Of course you will make sure that your surgeon has plenty of experience doing ovarian cancer surgery.

For early stage ovarian cancer, surgery is the indicated treatment. If the cancer tissue is found to be similar to normal glandular tissue, surgery may end your treatment. The doctor may remove the uterus if it is suspect, the fallopian tubes and perhaps some fatty tissue from the abdominal cavity. Women who want to bear more children should discuss with the doctor the possibility of leaving the ovaries and uterus behind. S/he may take tissue samples from the lymph nodes and/or cavity linings and send them to the laboratory to see if the cancer has spread. If that proves to be negative, chemotherapy may be recommended, or, more rarely, radiation.

Radiation
Radiation treatment for ovarian cancer has fallen out of favor in recent years, due to increased efficacy in combinations of drugs. Radiation is more harmful than chemotherapy for women who wish to preserve one ovary as it can cause infertility.

Doctors are reluctant to use radiation as there is always the potential for damage to other organs, especially if large areas of the body are treated. If ovarian cancer has spread, it may be scattered throughout the abdomen, and chemotherapy rather than radiation will be employed to treat it. However, if the cancer recurs, radiation may be used along with chemotherapy.

Other Treatments

Intraperitoneal Chemotherapy is used to prevent implantation of tumor cells. This therapy uses heat, which is more toxic to cancer cells and increases the penetration of the drugs. Plus it boosts the efficacy of certain chemo drugs.

Some patients may want to try nutritional therapy, naturopathic medicine, image enhancement, mind-body medicine or spiritual counseling.

Systemic chemo involves injecting drugs into a vein, or administering them by mouth. This would seem indicated for a patient whose cancer has spread far and wide.

Recurrent Tumors
Once the initial treatment is over, the tumor(s) may at some time return. These are known as "recurring" tumors. "Persistent" tumors are those that have survived the treatment. These tumors will also be removed, followed by a further course of chemotherapy. This second treatment may be less successful than the first, but if the remission lasted years, the results may be more satisfactory.

Very high doses of chemo used in conjunction with "stem cell rescue" (bone marrow transplant) is sometimes used to treat women with recurring or persistent tumors. However, the side effects are severe, nor has this method been proven to help patients live longer.

Work closely with your doctor to learn all you can about your cancer. An informed decision is a wise decision.