Ovarian Cancer

Symptoms of Ovarian Cancer

Ovarian cancers can usually be treated successfully if they are diagnosed before the cancer has spread to other parts of the body. Patients with early-stage ovarian cancer may not experience symptoms, but those with later stages of the disease often do. 

Symptoms of ovarian cancer include:

• Abdominal swelling or bloating.
• Feeling full quickly when eating or trouble eating.
• Weight loss.
• Pain in the stomach or pelvic area.
• Constipation or other changes in bowel habits.
• A frequent or urgent need to urinate.

Screening for Ovarian Cancer 

Screening is used to look for cancer before a person shows any symptoms of the disease. No screening regimen has been found to be effective for ovarian cancer, but it can sometimes be detected during a regular pelvic exam. If a patient has symptoms, doctors can perform tests that help detect the presence of tumors. 

→ Donors Supporting the CU Cancer Center are Building Towards Early Detection of Ovarian Cancer

Diagnosing Ovarian Cancer

Based on a patient’s symptoms and after an initial physical examination, a doctor may order certain tests to determine whether a patient has ovarian cancer. Though testing procedures can vary based on the type of ovarian cancer the doctor is looking for, common tests for ovarian cancer include: 

Laparoscopy: In this procedure, a doctor inserts a thin, tubular camera through a small incision in the abdomen to view the ovaries and other pelvic organs and tissues. Once inside the abdomen, the camera transmits images to a video monitor, which allows the surgeon to perform biopsies and other necessary procedures.  

Colonoscopy: Used to examine the inside of the large intestine (colon), colonoscopies are conducted with a small, flexible, lighted tube that has a small video camera attached to the end. The tube is inserted through the anus and into the rectum and colon, usually under light sedation or anesthesia. Any abnormal areas can be biopsied during the screening.

Imaging tests: Different imaging procedures can provide information about the extent of ovarian cancer in the body and reveal the presence of infections or other problems. The following imaging tests may be used to help formulate a blood cancer diagnosis:

• Ultrasounds
• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Barium enema X-ray

Biopsy: During a biopsy, a doctor extracts a sample (or multiple samples) of tissue from a suspected tumor site. These are sent to a laboratory for analysis by a pathologist to determine whether the cells in the sample are cancerous or precancerous. There are different kinds of biopsies, and the type of biopsy a patient has is determined by several factors, including the size and location of the tumor, the number of tumors, and the type of cancer suspected. Importantly, not all ovarian cancers can be biopsied before surgery, as this can risk causing tumor spread. 

Stages of Ovarian Cancer 

After diagnosing the presence of ovarian cancer, the doctor will determine what steps are necessary to identify the stage of the disease and what treatment is necessary based on that information. Disease stage is determined by several factors, including where exactly the disease formed, how extensive it is, and whether and how much it has spread. Staging for ovarian cancer can be achieved by taking tissue samples for diagnosis and, more often, by doing surgery to remove affected areas.  

Doctors typically use the International Federation of Gynecology and Obstetrics’ FIGO system and the American Joint Committee on Cancer’s TNM system to determine the stage of ovarian cancer. The TNM system assesses the size and extent of the tumor (T); the involvement of nearby lymph nodes (N); and the presence and extent of spread, or metastasis (M), to other areas of the body, including the lungs, liver, and bones. 

After TNM assessment, the doctor will assign an overall stage number from I to IV. These can be broken down further based on the size of the original tumor and the extent to which the cancer has spread. In general, the lower the stage, the better the prognosis and treatment options.

Stage I: The cancer is located only in one or both ovaries or fallopian tubes and has not spread to nearby lymph nodes, or to distant sites.

Stage IA: The cancer is in one ovary and/or fallopian tube, and the tumor is confined to the inside of the ovary or tube. There is no cancer on the outer surfaces, and no cancer cells are found in the peritoneal fluid (ascites), or washings from the abdomen and pelvis. The disease has not spread to nearby lymph nodes or distant sites.

Stage IB: The cancer is in both ovaries, or both fallopian tubes, but not on their outer surfaces. No cancer cells are found in the peritoneal fluid (ascites), or washings from the abdomen and pelvis. It has not spread to nearby lymph nodes or distant sites.

Stage IC: The cancer is in one or both ovaries or fallopian tubes, and any of the following are present:

• Stage IC1: The tissue (capsule) surrounding the tumor tore or ruptured during surgery, potentially allowing cancer cells to leak into the abdomen and pelvis (also known as surgical spill). 
• Stage IC2: Cancer is on the outer surface of at least one of the ovaries or fallopian tubes, or the capsule (tissue surrounding the tumor) ruptured before surgery, allowing cancer cells to spill into the abdomen and pelvis. 
• Stage IC3: Cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis.  

In all IC cases, the cancer has not spread to nearby lymph nodes or distant sites.

Stage II: The cancer involves one or both ovaries or fallopian tubes and has spread to other organs within the pelvis (such as the uterus, bladder, the sigmoid colon, or the rectum), or there is primary peritoneal cancer. It has not spread to nearby lymph nodes or distant sites. 

Stage IIA: The cancer has spread to or invaded the uterus or the fallopian tubes or the ovaries. It has not spread to nearby lymph nodes or distant sites.

Stage IIB: The cancer is on the outer surface of, or has grown into, nearby pelvic organs such as the bladder, the sigmoid colon, or the rectum. It has not spread to nearby lymph nodes or distant sites. 

Stage III: The tumor(s) involves one or both ovaries or fallopian tubes, or there is primary peritoneal cancer, with tumor outside of the pelvis and/or within the retroperitoneal lymph nodes.

Stage IIIA1: The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer that may have spread or grown into nearby organs in the pelvis. It has spread to the retroperitoneal (pelvic and/or para-aortic) lymph nodes only. It has not spread to distant sites.

Stage IIIA2: The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer that has spread or grown into organs outside of the pelvis. During surgery, no cancer is visible in the abdomen (outside of the pelvis) to the naked eye, but tiny deposits of cancer are found in the lining of the abdomen and pelvis when it is examined under the microscope. The cancer may or may not have spread to retroperitoneal lymph nodes.

Stage IIIB: There is cancer in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer that has spread or grown into organs outside the pelvis. The deposits of cancer are large enough for the surgeon to see with the naked eye, but are no bigger than 2 centimeters in size. The cancer may or may not have spread to the retroperitoneal lymph nodes.

Stage IIIC: The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer that has spread or grown into organs outside the pelvis. The deposits of cancer are larger than 2 centimeters across and may involve the surface of the liver or spleen. It may or may not have spread to the retroperitoneal lymph nodes, but it has not spread to the inside of the liver or spleen, or to distant sites.

Stage IV: Cancer cells are found beyond the abdomen/pelvis and in other parts of the body.

Stage IVA: Cancer cells are found in the fluid around the lungs (called a malignant pleural effusion) with no other areas of cancer spread such as the liver, spleen, intestine, or lymph nodes outside of the abdomen. 

Stage IVB: The cancer has spread to the inside of the spleen or liver, to lymph nodes other than the retroperitoneal lymph nodes, and/or to other organs or tissues outside of the peritoneal cavity such as the lungs and bones. 

Treatments for Ovarian Cancer

The treatment for ovarian cancer is customized to each patient and depends on the size and location of the tumor(s), the stage at which the patient is diagnosed, and the patient’s general health. Ovarian cancer care teams may include multiple health care specialists, including primary care providers, medical oncologists, gynecologic oncologists, and radiation oncologists, as well as nurse practitioners, physician assistants, nurses, psychologists, social workers, and rehabilitation specialists. CU Cancer Center doctors offer specialized care for patients with ovarian cancer. 

Treatments for ovarian cancer include surgery, radiation therapy, chemotherapy, hormone therapy, and targeted drug therapy. Patients may receive one or more of these treatments in combination. Some patients may also be eligible to participate in clinical trials — doctor-led research studies of new or experimental procedures or treatments.

Surgery for Ovarian Cancer

Surgery is one of the primary treatments for ovarian cancer. There are two goals for surgery in the setting ovarian cancer: staging the disease — determining the extent of tumor (whether and how far it has spread) — and debulking, or removing as much of the tumor as possible. The latter in particular is extremely important for long-term treatment success.  

Radiation Therapy for Ovarian Cancer

Radiation therapy uses high-powered energy to kill cancer cells. A doctor who specializes in radiation therapy to treat cancer is called a radiation oncologist. The main type of radiation therapy used to treat ovarian cancer is external-beam radiation therapy (EBRT), which uses a machine located outside the body to focus a beam of X-rays on the area affected by cancer and kill the tumor cells. 

Chemotherapy for Ovarian Cancer

Chemotherapy uses drugs to kill rapidly growing cancer cells. Drugs are either injected into a vein (intravenously, or IV) or taken orally (PO). A typical chemotherapy course for ovarian cancer involves three to six cycles of treatment, usually with a combination of two kinds of drugs that are taken together.

Hormonal Therapy for Ovarian Cancer

Used most often to treat ovarian stromal tumors, hormonal therapy uses hormones or hormone-blocking drugs to fight cancer. Hormone therapies for stromal tumors include:

• Luteinizing-hormone-releasing hormone (LHRH) agonists, which turn off estrogen production by the ovaries.
• Tamoxifen, a drug that stops estrogen from stimulating cancer cell growth.
• Aromatase inhibitors, which can help lower estrogen levels in women after menopause and limit the role of estrogen in stimulating tumor growth. 
  

Targeted Drug Therapy for Ovarian Cancer

Targeted therapies focus on the specific genes, proteins, or tissue environments that contribute to ovarian cancer, limiting damage to non-cancerous cells and tissues.  

The most common targeted drug therapies for ovarian cancer include:

• Bevacizumab: When cancers grow and spread, they have to create new blood vessels to ensure adequate blood supply. Bevacizumab (Avastin) stops this process by attaching to a protein called VEGF, which typically signals new blood vessels to form. This can slow or stop cancer growth. 
• PARP inhibitors: Enzymes known as PARP (poly(ADP)-ribose polymerase) enzymes help to repair damaged DNA within cells. Tumor cells are rapidly dividing and thus at high risk of damaging their DNA. By inhibiting the DNA repair process, these drugs, including agents such as olaparib, rucaparib, and niraparib, make it harder for tumor cells to replicate, which can in turn lead to the death of those cancer cells.
  

The University of Colorado (CU) Cancer Center partners with UCHealth, Children’s Hospital Colorado, and Rocky Mountain Regional VA to provide clinical care. Please make an appointment with one of our clinical partners to be seen by a CU Cancer Center doctor.

UCHealth:

UCHealth Cancer Care - Anschutz Medical Campus
1665 Aurora Court Anschutz Cancer Pavilion
Aurora, CO 80045
720-848-0300

UCHealth Cherry Creek Medical Center
100 Cook Street
Denver, CO 80206
720-848-0000

Rocky Mountain Regional VA Medical Center:
1700 North Wheeling Street
Aurora, CO 80045-7211
303-399-8020