By Krishnansu S. Tewari, MD, FACOG, FACS
The Division of Gynecologic Oncology, University of California, Irvine
1. Make sure you see a gynecologic oncologist.
Gynecologic oncologists have undergone extensive and specialized training to care for women diagnosed with gynecologic cancers. They know best how to treat a woman diagnosed with ovarian cancer because they understand the spread patterns of the disease and recognize how important it is to remove as much of the visible cancer as possible that is found inside a patient. In addition, gynecologic oncologists are the experts in ovarian cancer chemotherapy; unlike other doctors who may be accustomed to managing the chemotherapy for cancers that develop throughout the body, gynecologic oncologists are fully specialized to manage chemotherapy for gynecologic cancers only (including ovarian, uterine, and cervical cancer). Visit the official Web site for the Society of Gynecologic Oncologists (www.sgo.org) to learn more about ovarian cancer and find a gynecologic oncologist in your area.
2. There are no reliable screening tests for ovarian cancer for women in the general population.
No effective screening tests for ovarian cancer that can be used on patients in the general population. Pap smears, though effective in screening for cervical cancer, do not detect ovarian cancer. CA-125 blood tests and ultrasound tests can detect ovarian cancer, but they are not effective in finding early-stage cancers. In addition, the CA-125 marker can be abnormally high even when there is no cancer, making it an unreliable screening test.
3. Most cases of ovarian cancer are diagnosed at an advanced stage.
Because there are no effective screening tests and early symptoms are often very subtle, many patients are diagnosed with ovarian cancer when the disease has reached Stage III or Stage IV. The symptoms that patients may experience at this point include bloating, also called ascites (the result of increased abdominal fluid), sensations of pelvic or abdominal pressure, and trouble with their bowels and bladder. All of these signs usually indicate that the cancer has already spread. Interestingly, not all patients with ovarian cancer will have abnormally high levels of the CA-125 blood test. With appropriate surgical and medical treatment, many patients diagnosed with Stage III or Stage IV ovarian cancer can be put into remission.
4. Effective treatment of ovarian cancer requires both surgery and chemotherapy.
Both surgery and chemotherapy are needed to effectively treat ovarian cancer. Patients should seek out the most highly skilled surgeon and the most knowledgeable chemotherapy doctor to address these critical components of care. Gynecologic oncologists are the most skilled in the surgical treatment of ovarian cancer—more so than a general gynecologist, a general surgeon, or even a surgical oncologist. In addition, it is very important that, before undertaking treatment for ovarian cancer, patients undergo a very comprehensive medical evaluation to determine their ability to tolerate surgery and a CT scan of the chest, abdomen, and pelvis to evaluate the extent of the cancer.
5. Surgery may be extensive.
Patients diagnosed with late-stage ovarian cancer should be prepared for an extensive operation, which typically involves removing both ovaries and fallopian tubes, the uterus and cervix, and any other tissues in the abdomen and pelvis that are involved with the cancer. As long as these extensive procedures can be carried out safely, patients tolerate this aggressive type of surgery very well without any long-term complications or life-changing events. Remember, the goal is to remove all of the visible cancer.
In rare situations, a patient may be diagnosed with ovarian cancer but told that it doesn’t look like it has spread from the one affected ovary. In these cases it is also very important that the patient is referred to a gynecologic oncologist, as they will know definitively whether the correct areas in the body were biopsied (including the peritoneum and the correct lymph node chains). If these areas were not biopsied, the gynecologic oncologist may recommend a second operation to properly stage the cancer.
6. Chemotherapy for ovarian cancer is not as bad as you think.
Despite what you may have seen on television or in movies, or even through the experience of a close friend or relative, chemotherapy for ovarian cancer is generally very well tolerated. The most common side effects patients experience when treated with chemotherapy for ovarian cancer are temporary hair loss, some fatigue, and occasionally some numbness and tingling in their fingers and feet. Your oncologist will prescribe you anti-nausea medication and will monitor your immune system with blood tests during the months that you are receiving chemotherapy. Most patients who have jobs will be able to work full-time during the months that they are receiving chemotherapy if they wish to do so.
Occasionally, an oncologist may reverse the typical order of treatment by recommending that the patient’s treatment begin with a few treatments of chemotherapy followed by surgery, which will then be followed by a few more chemotherapy treatments. Chemotherapy that is delivered in this way is called neoadjuvant chemotherapy. An oncologist may recommend this treatment plan when a patient’s general health is so poor that they are unlikely to tolerate an extensive surgery right away, or in cases where a CT scan prior to surgery shows so much cancer that the gynecologic oncologist believes that shrinking the cancer down with a little chemotherapy first may improve the chances of being able to remove all of the visible cancer during surgery.
7. Most patients can be put into remission.
Fortunately, most patients are able to enter into remission when they benefit from the proper and expert use of surgery and chemotherapy. Once in remission, a gynecologic oncologist may use the CA-125 blood test to monitor your remission. Though the test is not a reliable screening tool, it can be used effectively in this way.
8. Ask about clinical trials!
Be sure to ask your gynecologic oncologist about clinical trials. All of the important discoveries in ovarian cancer that have helped patients over the years have resulted from clinical trials, and there are exciting new drugs in the pipeline right now. Depending on where you are being treated for ovarian cancer, there may be a clinical trial that you may be eligible for.
9. A diagnosis of ovarian cancer is not a death sentence!
Most patients with Stage III and Stage IV ovarian cancer will be able to go into remission. Although many patients who are placed into remission will ultimately have a relapse, many of even these patients can be placed into a second remission with additional chemotherapy (sometimes using different drugs) or can have their cancer kept under control with chemotherapy. Participation in a clinical trial is another important option for patients whose ovarian cancer returns.
Some patients will never have a recurrence. It is very important to treat each patient with ovarian cancer as if they are going to be among those that will remain in remission. This requires expertise in both surgery and chemotherapy.
10. September is National Ovarian Cancer Awareness month!
Learn more about this disease and how to become an advocate. Visit the following sites to educate yourself, learn about the availability of clinical trials that may pertain to your case, find information on support groups in your area, and, most importantly, to locate a gynecologic oncologist.
Society of Gynecologic Oncologists
Gynecologic Oncology Group
The Gynecologic Cancer Foundation
Ovarian Cancer National Alliance
National Ovarian Cancer Coalition