Although ovarian cancer is less common than other cancers, it remains one of the deadliest cancers among women. Each year, 22,000 women are diagnosed with ovarian cancer. In that same year, 14,000 women will die of the disease.
Lower survival rates are partly due to the fact that ovarian cancer is often diagnosed at an advanced stage. Currently, there are no screening tests for early detection of ovarian cancer and symptoms are often non-specific and vague.
Symptoms and diagnosis of ovarian cancer
“Symptoms of ovarian cancer may be subtle, but many individuals can present with abdominal bloating or discomfort, changes in bowel habits, or a feeling of malaise. These symptoms can sometimes last for several months before an individual visits their doctor,” says Michael J. Worley, Jr., MD, a gynecologic oncologist within the Division of Gynecologic Oncology at Brigham and Women’s Hospital.
There is no standard screening test to identify ovarian cancer. Diagnosis of ovarian cancer begins with a physical exam. Based on symptoms and the exam, the physician will then determine what additional tests are necessary. Additional tests may include a pelvic ultrasound, CT scan and/or blood work (such as tumor markers).
A pelvic ultrasound can help identify and characterize a suspicious ovarian cyst. If the suspicion for malignancy is high, a CT scan can be ordered. A CT scan can help determine if the cancer has spread outside of the ovary.
“It’s important to note that imaging can often underestimate the stage of disease. Ultimately, to confirm the diagnosis of ovarian cancer, we need to obtain tissue with a biopsy or surgery. The stage is defined by findings at the time of surgery,” says Dr. Worley.
The importance of surgery in ovarian cancer
Most patients with early-stage ovarian cancer can be treated with surgery and without chemotherapy. However, because there are no screening tests for ovarian cancer and symptoms are often subtle, most ovarian cancer cases (approximately 70 percent) are diagnosed at a more advanced stage.
For patients with advanced-stage ovarian cancer, a combination of surgery and chemotherapy is recommended. Brigham and Women’s Hospital cares for ovarian cancer patients in partnership with Dana-Farber Cancer Institute (DFCI). Surgery is performed at the Brigham and chemotherapy is delivered at DCFI. Ovarian cancer patients also have access to clinical trials offered at Dana-Farber/Brigham and Women’s (information about clinical trials is available from the NCI website).
Challenges in treating ovarian cancer
Many patients with a suspicious-looking ovarian cyst or a mass can be offered a minimally-invasive surgical procedure, such as laparoscopy, a procedure performed through small incisions in the abdomen. Many of these patients can have a mass removed and all of their surgical staging (i.e. lymph node biopsies) performed with a minimally invasive approach.
However, because ovarian cancer typically spreads via dissemination of small tumor fragments throughout the abdominal and pelvic cavity, many organs are often affected and surgical removal requires an open surgical approach.
“Think of the abdominal/pelvic cavity as a large room containing many pieces of furniture. If you pour a jar of marbles in the room, those marbles will disseminate throughout the room and can rest on all of the pieces of furniture. Many organs can be affected with ovarian cancer and the tumor implants have to be addressed at the time of surgery. Surgical removal of all tumor implants is the most influential factor affecting survival and prognosis,” says Dr. Worley.
“Our research has found that a multidisciplinary approach significantly increases the likelihood of a successful surgery — by as much as 20 percent. Our gynecologic oncology surgeons work closely with surgeons who specialize in the liver, pancreas, spleen, or colon, among other areas,” he says.
An open surgical approach is often the best surgical route for patients with ovarian cancer that has spread throughout the abdomen and pelvis, says Dr. Worley Jr. For some patients with extensive disease, initial surgery is not the best option. Often, these patients can be treated with chemotherapy first followed by surgery. For some patients, their disease responds so well that they may be a candidate for a minimally invasive surgery after chemotherapy.
More experience results in better outcomes
Research has shown that when patients have surgery at a center that treats a large number of ovarian cancer cases, patients experience better outcomes, fewer complications and longer survival.
“Our team of gynecologic oncology specialists is one of the most experienced in the United States. We diagnose and treat hundreds of patients with ovarian cancer each year and set treatment guidelines for physicians around the world,” says Dr. Worley.
– Dustin G.