Ovarian epithelial cancer is the most common type of ovarian cancer. It begins in the tissue that covers the ovaries. This information is not about ovarian germ cell tumors or other types of ovarian cancer.
Ovarian cancer – words no woman wants to hear. With no known cause, no accurate screening test, and symptoms that are often vague and misdiagnosed, diagnosis of this cancer tends to happen at a more advanced stage, making it one of the more challenging gynecologic cancers to treat. Having an experienced team led by a gynecologic oncology surgeon and a sub-specialized medical oncologist is important to ensure the most advanced treatment options available. At Rocky Mountain Cancer Centers (RMCC) our experts specialize in evidence-based, cutting-edge, and personalized treatment plans to create the best possible outcomes.
If you have a symptom that suggests ovarian cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history.
Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells.
To plan the best treatment, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.
Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.
Stage IA: The cancer is only inside 1 ovary or fallopian tube. No cancer is found on the ovarian or fallopian tube surface or in the abdomen.
Stage IB: The cancer is in both ovaries or fallopian tubes. No cancer is found on the surface of the ovary or fallopian tube or in the peritoneal fluid or washings.
Stage IC: The cancer is in 1 or both ovaries or fallopian tubes, with any of the following:
Stage IC1: The tumor ruptures while it is being removed surgically, called intraoperative surgical spill.
Stage IC2: The tumor wall is ruptured before surgery, or there is cancer on the surface of the ovary or fallopian tube.
Stage IC3: Cancer cells are found in fluid buildup in the abdominal cavity, called ascites, or in the samples of fluid from the peritoneal cavity taken during surgery.
Stage IIA: The cancer has spread to the uterus and/or fallopian tubes and/or the ovaries.
Stage IIB: The cancer has spread to other tissues within the pelvis.
Stage IIIA1: The cancer has spread to the retroperitoneal lymph nodes, which are found at the back of the abdomen, but not to the peritoneal surfaces.
Stage IIIA1(i): Metastases are 10 millimeters (mm) or smaller.
Stage IIIA1(ii): Metastases are larger than 10 mm.
Stage IIIA2: The cancer has spread microscopically from the pelvis to the abdomen. Cancer may or may not have spread to lymph nodes in the back of the abdomen.
Stage IIIB: The cancer has visibly spread past the pelvis to the abdomen and is 2 centimeters (cm) or smaller, with or without spread to the retroperitoneal lymph nodes. A centimeter is roughly equal to the width of a standard pen or pencil.
Stage IIIC: The cancer has visibly spread past the pelvis to the abdomen and is larger than 2 cm, with or without spread to the retroperitoneal lymph nodes.
Stage IVA: The cancer has spread to fluid around the lungs.
Stage IVB: The cancer has spread to the liver or spleen or to organs beyond the abdomen, including lymph nodes in the groin outside of the abdominal cavity.
Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.
Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:
You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
If the cancer has spread, the surgeon removes as much cancer as possible. This is called “debulking” surgery.
If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.
Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.
Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:
Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.
You may have your treatment in a clinic, at the doctor’s office, or at home. Some women may need to stay in the hospital during treatment.
Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.
Genetic counseling is an important piece of our gynecological oncology program. Ovarian cancers, in particular, are sometimes associated with inheritable gene changes that increase the risk for types of cancer. Most well known is the association between ovarian cancer and mutations in genes BRCA1 and BRCA2, which also increases the risk for breast and prostate cancer. Finding a mutation in one of these genes may not only explain your current cancer but may guide your treatment, and allow us to tailor screening or preventative recommendations for you and for your family members. We recognize that discussing an increased risk for cancer for yourself and your family can be a difficult and intimidating process. Our genetic counselors will help you navigate the testing process and utilize the results to guide your care.
Our physicians collaborate with our nationally recognized supportive care services team to ensure that you and your family are connected to appropriate community resources, support groups and education classes. These licensed oncology clinical social workers are encouraging communicators and educators who provide a safe, supportive and open environment for patients to share feelings, learn coping strategies and explore ways to live as fully and joyfully as possible.
Among its many programs, Colorado Ovarian Cancer Alliance (COCA) provides newly diagnosed women with complimentary comfort kits of educational and support items, free, professionally-led support groups throughout the Denver and Boulder metro area and by phone, and one of the few financial assistance programs nationwide specifically for women in treatment for ovarian cancer. Rocky Mountain Cancer Centers has been a proud supporter of COCA and Jodi’s Race for Awareness for several years.
To find out more about all types of ovarian cancer, please visit the National Cancer Institute website or ask your cancer care team about your individual situation.