Ovarian Cancer – Diagnosis and Treatment
Diagnosis
Diagnosing ovarian cancer involves several steps. Doctors usually start with a pelvic exam. In this exam, a doctor checks the pelvic organs by gently pressing the abdomen and examining the external genitalia, vagina, and cervix.
Imaging tests help doctors spot unusual growths or masses. Tests like ultrasound or CT scans show the size, shape, and details of the ovaries. Doctors may order a Positron Emission Tomography (PET) scan or chest X-ray if they think the cancer has spread.
Blood tests also help in diagnosis. One important test checks for tumor markers such as CA-125 and HE4. High levels of these proteins might suggest ovarian cancer, but doctors do not rely on them alone for a diagnosis.
Other blood tests can show if the body’s organs are affected or pick up other related markers. If doctors find a mass, they may recommend surgery. Removing and examining an ovary or tissue is the only way to confirm cancer.
A biopsy checks if cells are cancerous and identifies the specific type, such as epithelial ovarian cancer, germ cell tumors, or stromal tumors. Some ovarian cancers are linked to specific gene changes.
Genetic testing can find BRCA1 or BRCA2 mutations and signs of Lynch syndrome. Doctors use this information to assess risk and plan treatment, especially for hereditary ovarian cancer.
Staging helps doctors plan treatment. They use test results to see how far the cancer has spread. The stage ranges from cancer only in the ovaries to stage IV, where it has reached distant areas.
Doctors use the cancer type, tumor markers, genetic results, and stage to guide the next steps for the patient.
Treatment
Operations to Remove Cancer
Ovarian cancer treatment often starts with surgery. The type of operation depends on the stage and where the cancer is located.
Single Ovary and Tube Removal: If the tumor is small and has not spread, doctors may remove one ovary and its fallopian tube. This surgery is called a unilateral salpingectomy and can help women keep the chance to have children.
Both Ovaries and Tubes Removal: When cancer is in both ovaries but nowhere else, doctors remove both ovaries and fallopian tubes. The uterus stays, so pregnancy may still be possible with assisted reproduction.
Ovaries, Tubes, and Uterus Removal: For more advanced cancer, doctors may remove both ovaries, fallopian tubes, the uterus (hysterectomy), lymph nodes near the tumor, and part of the belly tissue called the omentum.
For Advanced Cancer: In late-stage cases, the surgeon removes as much cancer as possible. Sometimes doctors give chemotherapy before or after the operation.
Doctors may use laparoscopy, which uses small cuts and a camera, or open surgery with larger cuts. The choice depends on how far the cancer has spread.
Medicines That Kill Cancer Cells
Chemotherapy uses strong drugs to kill fast-growing cancer cells. Doctors give these medicines in different ways:
- Injected into the bloodstream (through a vein)
- Taken by mouth as pills
- Put directly into the belly during surgery (heated intraperitoneal chemotherapy)
Doctors often use chemotherapy after surgery to target any remaining cancer cells. Sometimes they use it before surgery to shrink tumors.
A typical course includes about six rounds of treatment. Chemotherapy drugs can cause hair loss, tiredness, and nausea, but doctors help patients manage these side effects.
Drugs That Target Specific Cancer Features
Targeted therapy uses medicines that attack weak spots in cancer cells. These drugs work differently from regular chemotherapy and focus on certain parts of cancer cells.
Doctors may test the tumor before starting targeted therapy to see which drugs are likely to work best. Some targeted drugs block signals the cancer needs to grow, while others help the body destroy the tumor.
Benefits:
- These drugs can work even if other treatments stop working.
- They usually cause fewer side effects than standard chemotherapy.
Limits:
- Not every ovarian cancer type responds to these drugs.
Blocking Hormones to Slow Cancer Growth
Doctors sometimes use hormone therapy for ovarian cancer, especially for slow-growing tumors. Certain medicines block or lower estrogen, which can help stop some ovarian cancers from growing.
Types of hormone therapy include:
- Drugs that slow down the body’s production of estrogen
- Medicines that block estrogen’s effects on cancer cells
Hormone therapy can help if the cancer returns after other treatments, or when surgery and chemotherapy are not options.
Using the Body’s Defense System
Immunotherapy helps the immune system find and attack cancer cells. Some ovarian cancer cells hide from the immune system by making protective proteins.
Immunotherapy blocks these proteins, making the cancer visible to the body’s defenders. Doctors may offer this treatment for certain cancer types or if other treatments have failed.
Key facts:
- Not everyone responds to immunotherapy.
- Side effects differ from those seen with chemotherapy.
Care That Eases Symptoms and Improves Comfort
Supportive, or palliative, care focuses on helping the patient feel better during cancer treatment. This care can begin at any time, even while other treatments are ongoing.
Supportive care includes:
- Managing pain, nausea, or tiredness
- Providing emotional support
- Helping with everyday needs
A team of nurses, doctors, and other specialists works together to improve quality of life for the patient and their family.
Supportive care can take place at home, in the hospital, or at a special center. It does not replace cancer treatment but works alongside it to keep the patient comfortable.
Managing Emotions and Finding Help
People diagnosed with ovarian cancer may feel fear, worry, or uncertainty. Talking with friends, loved ones, or joining a support group can help.
Some people find it helpful to speak with others who have similar experiences. Support groups are also available for family members.
Letting others help with daily tasks can reduce stress and fatigue. Common symptoms include fatigue, abdominal pain, pelvic pain, and back pain.
Resting, eating balanced meals, and relaxing can help. For those with risk factors like family history, endometriosis, genetic counseling, or obesity, learning about these can help them feel more in control.
Setting small, achievable goals, such as managing appointments or following up on tests, can provide purpose.
Here’s a simple checklist:
| Ways to Cope | Notes |
|---|---|
| Talk to someone you trust | Support groups can help |
| Accept help from others | Reduces fatigue and stress |
| Set small, practical goals | Helps feel in control |
| Care for yourself | Rest, healthy food, relax |
Understanding risk factors, such as older age, family history of breast or ovarian cancer, and infertility, can help prepare for challenges and manage anxiety.
Getting Ready for Your Medical Visit
Steps to Take Before Your Appointment
Check for any special instructions. Some tests may require you not to eat or drink beforehand.
List your symptoms. Write down every symptom, even if it does not seem related to your ovaries or reproductive system.
Review your health details. Be ready to share your medical history, other health problems, and current medicines, including supplements and vitamins.
Note important life events. Stress or personal changes can affect your health. Include these in your information.
Bring a list of questions and concerns. Writing them down helps you remember what matters most during your visit.
Ask a friend or family member to come with you. They can support you and help recall details from your discussion with the care team.
Consider using a table to keep your details organized:
| Information Needed | Notes/Details |
|---|---|
| Symptoms | (List all symptoms) |
| Current medications/supplements | (List doses and frequency) |
| Major life changes or stress | (Describe briefly) |
| Other health concerns | (Describe or list) |
Key Points to Discuss With Your Specialist
- What could be causing these symptoms in the ovaries or fallopian tubes?
- What kinds of tests will be needed?
- Are there treatment options, and what might be their side effects?
- How could treatment affect future fertility?
- What is the expected outcome?
- How should other health conditions be handled at the same time?
- Is seeing a gynecologic oncologist needed at this point?
Write down any new questions as they come up. Address all topics related to your health, reproductive system, and personal or family cancer history.
Common Questions Your Doctor May Ask
- When did each symptom start? How bad is it?
- Do your symptoms come and go? Or are they always there?
- What makes your symptoms better or worse?
- Does anyone in your family have ovarian, fallopian tube, or breast cancer?
- Are there other types of cancer in your family history?
If you prepare for these questions, you and your doctor can spend more time discussing your concerns and next steps.
