16 Jul Ovarian and Fallopian Tube Cancer
Because the ovaries are so small and buried deep within the body, often the early symptoms of ovarian cancer occur in the abdominal area, leading many general physicians to initially suspect a gastrointestinal or bladder ailment.
Ovarian cancer (which includes fallopian tube and primary peritoneal cancer) is often diagnosed at advanced stage given that its symptoms are vague and non-specific.
What are ovaries?
The ovaries are tiny, almond-shaped organs located on both sides of the uterus. Before menopause, the ovary releases an egg for possible fertilization each month; the ovaries also make estrogen, a female sex hormone.
What is ovarian cancer?
Ovarian cancer is the is abnormal tissues of the ovaries.
What are the symptoms?
- Persistent abdominal bloating
- Early satiety
- Nausea or vomiting
- Changes in bowel habits, especially constipation
- Abdominal pain or pressure
- Sharp pelvic pain
How is it diagnosed?
- Imaging: ultrasound or CT scan
- Labs- tumor markers, such as a ca-125, inhibin B, AFP or HCG.
How does family history play a role?
Approximately 10-14% of ovarian cancer patients carry a hereditary mutation, which increases one’s risk of breast and ovarian cancer. Therefore, any woman diagnosed with ovarian cancer is strongly encouraged to meet with our genetic counseling team. Our Cancer Genetics Screening Program can help high-risk women accurately assess their risk, test for hereditary mutations, and determine appropriate prevention strategies.
What is the treatment?
The Gynecologic Cancer Program’s team of gynecologic oncologists, radiation oncologists, radiologists and pathologists who specialize in gynecologic cancers constructs develop treatment plans based on the individual patient. Treatment may include surgery, chemotherapy, and many times a combination of the two. In some scenarios radiation may be used.
- Clinical trials: As an academic medical center, Froedtert & the Medical College of Wisconsin offer its patients the opportunity to participate in many clinical trials, which offer cutting edge treatment. Patients that are eligible for clinical trials have the opportunity to gain access to new treatments that are not yet available to the public. Clinical trials offer treatment for first line therapy, recurrence, maintenance, and quality of life.
- Radical hysterectomy: During a radical hysterectomy, a gynecologic oncologist removes the patient’s uterus and cervix, upper portion of the vagina, and lymph nodes in the pelvic region. A radical hysterectomy may be performed laparoscopically, with or without the assistance of the da Vinci ® Robotic Surgical System or with an open incision (by laparotomy). The ovaries may or may not be removed as well.
- Surgery: There are two main goals of surgery in the setting of ovarian cancer:
- To determine the stage of the cancer
- Remove as much of the cancer as possible
Typically, the gynecologic oncologist will remove and examine the uterus, fallopian tubes, ovaries, lymph nodes and some tissue from the inside of the abdomen; a specially trained pathologist then examines the organs and tissue under the microscope. This step is important to assist in treatment planning. The gynecologic oncologist also performs “surgical debulking,” which is the physical removal of all tumors that can be safely taken out.
According to the National Institutes of Health, a woman’s chance of survival is substantially increased when a gynecologic oncologist performs the ovarian cancer operation.
- Intravenous chemotherapy: Most often, intravenous (IV) chemotherapy is given in conjunction with intraperitoneal (IP) chemotherapy. The Gynecologic Oncology Group, a national research group, found that patients treated with both forms of chemotherapy have an increased progression free survival. The Gynecologic Cancer Program at Froedtert & The Medical College of Wisconsin is the first such program in the region to offer combined IV and IP chemotherapy.
- Intraperitoneal chemotherapy: Intraperitoneal chemotherapy is the instillation of anticancer drugs directly into the abdominal cavity. The idea is that the anticancer drugs dwell inside of the abdomen, the site of ovarian cancer, killing as many cancer cells as possible while sparing the rest of the body. Intraperitoneal chemotherapy may cause additional side effects, including abdominal pain, bloating, gastrointestinal issues, and increased fatigue.
- Radiation: Although not a first-line treatment for ovarian cancer, radiation therapy may be used in specific settings.