Ovarian Cancer Basics: Discussing Risks and Treatment Options
by Sandra Ray, Staff Writer

The American Cancer Society reports that ovarian cancer is the eighth most common cancer among women today. About 3% of all cancers in women are some type of ovarian cancer. Unfortunately, ovarian cancer ranks among fifth in cancer deaths, primarily due to the fact that it is hard to detect until it has advanced beyond the ovaries into other areas of the body. Estimates are that 1 in every 57 women will develop ovarian cancer in the United States.

In the female reproductive system, the ovaries house the eggs needed for reproduction. There are two ovaries, one on each side of the uterus where fertilized eggs are implanted during pregnancy. Another reason for the ovaries importance: they are the main source of female hormones estrogen and progesterone.

There are three different types of tissues in the ovaries, each able to produce a different type of ovarian cancer. By far, the most prevalent type of cancer is found in the epithelial tissue of the ovaries. Epithelial tissue lines the outside of the ovaries and is found in about 85 – 90% of all ovarian cancer cases. It can grow undetected and spread rather quickly to the abdomen and into other parts of the body.Germ cells actually produce the eggs that are formed inside the ovaries. Germ cell tumors accounts for about 5% of ovarian cancer cases today. Stromal cells produce the estrogen and progesterone and account for the remaining 5 – 10% of cancer-causing tumors.

Survival rates for ovarian cancer vary widely largely depending on the stage of the cancer at the time of diagnosis. Stage 1 and 2 cancers have much better survival rates than do stage 3 and 4. The American Cancer Society notes that about 76% of women survive one year after diagnosis and the survival rate drops to 45% at five years. If doctors can diagnose and treat the cancer while it is still in the ovaries, the overall survival rate climbs to 94%, yet fewer than 20% of ovarian cancers are diagnosed at this early stage.

Risk Factors and Testing:

Despite the facts and figures, it is hard to detect ovarian cancer since most of the time it starts without detectable symptoms. Women who have a family history of breast cancer or ovarian cancer should discuss it with their physician so that early testing can be done before ovarian cancer has a chance to grow undetected. Generally the cancer strikes women over the age of 50, with women 65 and older most at risk. It has been found in younger women, however. Women who are overweight or who have used fertility drugs also have an increased risk of developing the cancer. Hormone replacement therapy (HRT) has also been shown to increase the risk for developing ovarian cancer.

Testing for the cancer isn’t that easy either. While regular pap tests can help screen for certain types of cancer, it isn’t a reliable indicator of ovarian cancer. Usually by the time a doctor can detect ovarian cancer with a pap smear, the cancer is already in advanced stages. Regular health exams, however, can help physicians determine if there are changes in the size of the ovaries or uterus. Tumors in the ovaries that are still in the early stages may not be detected early, though.

Women with several risk factors or a personal history of breast cancer could be screened with a vaginal ultrasound and possibly blood tests that screen for “tumor markers.” Tumor markers can include testing for increased amounts of CA-125 or a protein in the blood that is generally higher in women who have ovarian cancer. There are still many clinical trials to develop further lines of research along blood tests so that quicker methods of detection can be brought to light.

Treatment:

Surgery is usually one of the first lines of defense when fighting ovarian cancer. Surgical options depend heavily on how far the cancer has spread and the type of ovarian cancer that is present. Some of these options can include removal of one or both ovaries, a total hysterectomy – which includes removal of the uterus as well as the ovaries – or cutting away the tumors in the tissues, leaving as much of the reproductive system intact as possible.

One thing to remember is that once a surgeon starts to remove tissue, he needs to have approval to remove as much as he feels necessary in order to prevent the cancer cells from spreading. Cancer that is not removed can quickly spread as a result of the surgery. Discuss how much surgery needs to be performed, especially if the woman is still old enough and wants to continue bearing children after treating the cancer. Bear in mind that once the procedure starts the surgeon may need to do more tissue removal than first anticipated and discuss the possibility that the surgery will be more extensive than first anticipated.

Depending on the stage of the cancer and the success of the surgery, chemotherapy and radiation treatment may or may not be necessary. Chemotherapy uses high-powered medications to destroy cancer-causing cells in the body. Unfortunately, chemotherapy does not discriminate between cancer cells and non-cancer cells, so normal cells are often killed during treatment as well. There are a number of side effects of chemotherapy that include nausea, vomiting, anemia (low red blood cell count), hair loss, and decreased white blood cell and platelet counts. Medications are available to combat these side effects, with the exception of hair loss. Generally hair will begin to grow back after chemotherapy is completed.

Chemotherapy is used in the event that doctors were not able to determine if all cancer was removed during surgery. The higher the staging of the cancer, the more likely it is that chemotherapy will be needed. Some tumors, for example, may not be removed completely by surgery and chemotherapy, in conjunction with radiation therapy, can shrink the tumors.

Most, but not all chemotherapy treatments are given intravenously, either through an IV that is inserted at each treatment or through an IV port that stays in the vein and accessed each time a treatment is needed. The port can be removed when chemotherapy is completed. Some chemotherapy treatments are given orally, while others may be given directly into the abdominal cavity or into a muscle (intramuscular). The type of chemotherapy used depends on the type of ovarian cancer being treated. In addition, the number of doses and the frequency also depend on the stage; these factors also take into consideration how quickly a patient can recover from a dose of chemotherapy treatment. Some patients can endure chemotherapy once every three weeks, while others may need slightly longer to recover. Normal cells need the chance to “bounce back” while not allowing cancer cells the same opportunity to recover. The doctor will discuss each of these factors when prescribing a treatment plan for chemotherapy.

Radiation therapy is generally only helpful in treatment if the cancer is still confined to a relatively small area, like the ovaries. Once the cancer begins to spread to other organs, radiation therapy loses its effectiveness since it cannot be sufficiently targeted to help kill the cancer cells.

Role of Clinical Trials in Follow-up Care:   

Because of the relatively small window for effective detection and treatment of ovarian cancer, doctors regularly recommend that women enroll in a clinical trial for follow-up care. Women can help advance the science of treating ovarian cancer at any stage of the disease. Even when the disease advances into the third and fourth stages where traditional treatment methods fail, it is still possible to learn from women in these categories so that further clinical advancements can be made.

Dr. Don Dizon, FACP, Assistance Professor, OB/GYN & Medicine at Brown Medical School notes, “Many of the advances in the treatment of ovarian cancer would not be possible if not for the women who participate in clinical trials. Whether they joined the trials before cancer was detected and taught physicians what to search for or after their cancer was in the treatment stages, doctors could still learn a great deal from them.”

Dizon leads several clinical trials, each in different areas since there are many fruitful avenues for medical exploration in ovarian cancer. Some of these areas include immunotherapy or ways to use the immune system to combat and treat ovarian cancer; quality of life studies for women who are completing treatment; and novel therapeutics for early detection of ovarian cancer. Dizon says, “When ovarian cancer reaches the abdomen, something about the environment there allows it to spread quickly to other parts of the body. Research studies are looking at the effectiveness of applying chemotherapy directly to the abdomen as a method of treatment.” These are only some of the reasons that Dizon recommends that even healthy women get involved in clinical trials.

As far as prevention and early treatment, Dizon notes that there are several trials out there aimed at blood profiling that will hopefully give doctors useful tools for finding ovarian cancer at even earlier stages. Dizon also notes with irony that one of the best methods for preventing ovarian cancer could put women at increased risk for developing breast cancer later. “Without removing the ovaries – one of the only ways known to almost fully prevent ovarian cancer – birth control pills remain one of the best ways to reduce a woman’s risk of developing ovarian cancer. Still, women must weigh the increased risk of breast cancer if they choose this mechanism of prevention.”

Ovarian cancer can and does recur. For this reason, five year survival rates are lower than researchers like when managing a deadly disease. The cancer may not all be removed during the first treatment and could have spread undetected to other areas of the body. Another reason many doctors advocate participation in clinical trials is the possibility of recurrence. Women and caregivers need to be prepared for this possibility when first beginning to look at treatment options and follow-up care.

Caregiver Role:

Caregivers play an important role in the treatment of ovarian cancer. While it may be difficult to discuss, it is important to maintain open lines of communication with family, friends, and others who may be supportive during this time. In addition, caregivers can help relay information to physicians that may seem insignificant to the patient, yet could give important details about what is happening at home as a result of treatment.

Caregivers can help fill the following roles in the treatment “team:”

  • Someone to drive the patient to and from doctor appointments or treatment (chemotherapy and/or radiation)

  • An extra helping hand in the kitchen to prepare and/or freeze meals for the family

  • A listening ear when the patient needs time to “vent” about the struggles of the cancer and its treatment

  • Filling in at school functions for children when the patient is not feeling well enough to attend

These are only a few of the many activities with which caregivers can help during the treatment of ovarian cancer. Perhaps the most important role is one of advocate both at home and in the physician’s office. Advocacy can be a tiring activity and one that patients may not have the strength to perform while they are being treated.

While the outlook for women who develop ovarian cancer is not always discouraging, it is an area that deserves increased attention in the research field today. Since the cancer can grow silently for far too long before it is detected, women need to be vigilant about comprehensive annual exams and reporting even small changes in their health to their family physician. Caregivers can play a role in this process as well by helping place symptoms in perspective and giving new importance to even the smallest of changes in a woman’s health. Learning more about ovarian cancer and being unafraid to objectively balance the information can aid doctors when trying to determine if the symptoms represent normal functions of the body or if it could be a more serious sign.

 

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