Ovarian and Fallopian Tube Cancer
Ovarian cancer (which includes fallopian tube and primary peritoneal cancer) is the most deadly cancer of the female reproductive system. For years, ovarian cancer was known as “the silent killer” because early symptoms are so vague and non-specific that ovarian cancer was usually advanced before it was properly diagnosed. But research has revealed a cluster of symptoms common to ovarian cancer and women are encouraged to contact a gynecologic oncologist if they notice any of these symptoms persisting over time. A study by the National Institutes of Health reports that women with ovarian cancer fare better when treated by gynecologic oncologists.
While most cases of ovarian cancer occur in older women, young women are more likely to develop malignant germ cell tumors, a rare form of ovarian cancer.
Symptoms and Diagnosis
The ovaries are two tiny, almond-shaped organs that sit on either side of the uterus. Before menopause, the ovary releases an egg for possible fertilization each month; the ovaries also manufacture estrogen, a female sex hormone.
Because the ovaries are so small and buried deep within the body, the early symptoms of ovarian cancer occur in the abdominal area, leading many general physicians to initially suspect a gastrointestinal or bladder ailment. Early symptoms may include:
- Persistent abdominal bloating
- Feel full only a few bites into a meal
- Nausea or vomiting
- Changes in bowel habits, especially constipation
- Abdominal pain or pressure
- Sharp pelvic pain
- Distended abdomen
If ovarian cancer is suspected, an ultrasound or CT scan and blood work may be ordered. Biopsies are not usually taken until the time of surgery.
Women with a family history of breast or ovarian cancer have an increased risk of ovarian cancer. Our Cancer Genetics Screening Program can help high-risk women accurately assess their risk and determine appropriate prevention strategies.
The Gynecologic Cancer Program’s team of gynecologic oncologists, radiation oncologists, radiologists and pathologists who specialize in gynecologic cancers constructs treatment plans based on patients’ symptoms and health status. Surgery is the mainstay of ovarian cancer treatment, but chemotherapy may occasionally be ordered prior to surgery.
Treatment options include:
Surgery. Ovarian cancer surgery has two main goals: to determine the extent of the cancer and to remove as much cancer as possible. A 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 for microscopic disease. This step is crucial because ovarian cancer is frequently found in other organs, even though it appears confined to the ovary; proper surgical staging sets the stage for proper treatment. The gynecologic oncologist also performs “surgical debulking,” which is the physical removal of all tumors greater than a centimeter in size. According to the National Institutes of Health, a woman’s chance of survival is substantially increased when a gynecologic oncologist performs her 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 are more likely to survive. The Gynecologic Cancer Program at Froedtert & The Medical College of Wisconsin was the first such program in the region to offer combined IV and IP chemo. More than 80 percent of our patients now qualify for the combined treatment. Some patients, including those who are very ill at the time of diagnosis, may receive IV chemotherapy prior to surgery.
Intraperitoneal chemotherapy. Intraperitoneal chemotherapy is the instillation of anticancer drugs directly into the abdominal cavity. The idea is that the anticancer drugs bathe the 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 requires the patient’s co-operation (patients must alternate positions during treatment) and may cause side effects, including abdominal pain, extreme tiredness and nerve damage.
Clinical trials. As an academic medical center, Froedtert & The Medical College of Wisconsin offers its patients the opportunity to participate in many clinical trials. Ovarian cancer patients who are eligible for a clinical trial may choose to try new cancer drugs or different combinations of existing treatments.
Radiation. Although not a first-line treatment for ovarian cancer, radiation therapy may be used for disease recurrence.
Learn more about the Gynecologic Cancer Program on the Froedtert & the Medical College of Wisconsin website.