This September, Blue Hills is proud to promote Ovarian Cancer Awareness. Last week, we discussed what Ovarian Cancer is, what its symptoms are, and women at risk.
Below is a quick recap of risk factors, symptoms, and important facts to know:
This week, we'll delve into how women are diagnosed, treatment options, and resources for women and their family members.
Most women that are diagnosed with ovarian cancer are already in the advanced stage of the disease. This is because the symptoms of ovarian cancer are non-specific and can easily be glossed over.
Unfortunately, there is currently no consistent and reliable screening test that can detect ovarian cancer. Contrary to popular belief, the Pap test detects cervical cancer, not ovarian cancer.
As research is still being done on a viable screening test for ovarian cancer, we must help educate women on recognizing symptoms and knowing if they are at risk. There are a few tests that are available that are offered to women who are at high risk and/or experiencing symptoms.
A pelvic exam is usually included as a part of a woman’s regular health exam. The doctor places one or two fingers into a woman’s vagina and another over her abdomen to feel the size, shape, and position of the ovaries and uterus.
This is a test used to examine a woman’s reproductive organs and bladder and can reveal if there are masses or irregularities on the surface of the ovaries and within cysts that form within the ovaries.
Blood Test: CA-125:
CA-125 is a protein produced by ovarian cancer cells. This blood test determines the level of CA-125.
*While the CA-125 is an important test, it is not a key marker for ovarian cancer. Other non-cancerous diseases of the ovaries can increase CA-125 levels and in some cases, ovarian cancers may not produce enough CA-125 levels to cause a positive test.
How am I diagnosed?
If a woman has the signs and symptoms of ovarian cancer, her doctor will perform a combination of the tests above – a pelvic exam, a transvaginal or pelvic ultrasound, a CT scan, and a CA-125 blood test. Used individually, these tests are not definitive, but together are more effective in determining whether a woman has ovarian cancer. The only definitive way to determine if a woman has ovarian cancer is through surgery and biopsy. Doctors will perform surgery after they obtain enough evidence from exams and test results. If a doctor suspects the ovarian cancer might be present, the patient should be referred to a gynecologist oncologist.
Treatment options and decisions should be discussed and made by a patient in consultation with her doctor.
The goal for treatment of ovarian cancer to to surgically remove as much of the cancer as possible. Usually, this is done through a combination of surgery and chemotherapy.
The initial surgery allows the surgeon to look inside the body and visibly see how the cancer has progressed. The surgeon will remove as much of the cancer tissue as possible – also known has debulking. They will also obtain a sample of the tumor – which will be further examined by a pathologist. In many cases, after discussion between the doctor and patient, the ovaries, fallopian tubes, and uterus can be removed during the initial surgery.
It is important to have a gynecologic oncologist perform the surgery as the specialize in cancers of the female reproductive organs. Research has shown that women with ovarian cancer, who are treated by a gynecologic oncologist, tend to fare better than those who do not.
The goal of the initial surgery to:
Obtain an accurate surgical diagnosis
Determine how far the cancer has spread (“staging” the cancer)
Obtain a sample of the tumor, which will be examined by a pathologist (a doctor who specializes in diagnosing a disease by looking at the cells under a microscope)
Debulking to remove as much of the cancer as possible
There are other surgeries known as second-look surgery and surgery for recurrent cancer which you can learn more about here.
Chemotherapy is the treatment of cancer using chemicals designed to destroy cancer cells and/or stop them from growing. The goal is to shrink tumors, destroy cells that may have spread, and control tumor growth.
Chemotherapy can be given many ways:
Orally – by mouth – swallowing a pill that the doctor prescribes
As a shot – injected by a needle into an artery or muscle
Intravenously – given directly into the veins through an IV (intravenous) injection
IP (intraperitoneal) – through a catheter, which is placed in the peritonieal cavity and targeted to that area.
The dosage and frequency of chemotherapy prescribed depends on the cancer type and the chemotherapy.
Other treatment options include radiation therapy and other drugs. Click here to learn more.
During the operation, the doctor will assess how far the tumor has spread to determine the stage of cancer, and will give tissue samples to a pathologist who will determine the grade of the cancer.
After the operation, the doctor will discuss the nature of the chemotherapy that will be given, which will depend on the stage of the disease and how much of the tumor was removed. A doctor might also offer a woman the possibly of enrolling in a clinical trial, if she meets the criteria.
Making a list of questions before an appointment with a doctor can be useful because the shock and stress of the diagnosis can make it hard to remember things and medical care can be complicated and difficult to understand. Taking notes of the doctor’s responses or having a friend or relative with you during appointments can be helpful.
Here are some questions you can ask your doctor (from the Ovarian Cancer Research Fund Alliance or OCRFA):
What is the stage of my disease? Has the cancer spread from the ovaries? If so, to where?
What are my treatment choices? Do you recommend intraperitoneal chemotherapy for me? Why or why not?
Would a clinical trial be appropriate for me?
Will I need more than one kind of treatment?
What are the expected benefits of each kind of treatment?
What are the risks and possible side effects of each treatment? What can we do to control side effects? Will they go away after treatment ends?
What can I do to prepare for treatment?
How long will I need to stay in the hospital? Can I get chemotherapy at my local hospital since it is too far to drive to a major medical center?
What is the treatment likely to cost? Will my insurance cover the cost?
How will treatment affect my normal activities?
Will treatment cause me to go through early menopause?
Will I be able to get pregnant and have children after treatment?
How often should I have checkups after treatment?
If you are newly diagnosed, the OCRFA has a great First Steps page to help you and your family.
Resources from the National Ovarian Cancer Coalition (NOCC):
If you need help with finances, finding a doctor, or emotional support, the NOCC has a great resource page here.