Ovarian Cancer Symptoms, Tests/Screening/Diagnosis and Treatment

Symptoms of Ovarian Cancer

Ovarian cancer is difficult to detect, especially, in the early stages. This is partly due to the fact that these two small, almond shaped organs are deep within the abdominal cavity, one on each side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:

• Bloating
• Pelvic or abdominal pain
• Trouble eating or feeling full quickly
• Feeling the need to urinate urgently or often

Other symptoms of ovarian cancer can include:

• Fatigue
• Upset stomach or heartburn
• Back pain
• Pain during sex
• Constipation or menstrual changes

If symptoms persist for more than two weeks, see your physician.

Persistence of Symptoms

When the symptoms are persistent, when they do not resolve with normal interventions (like diet change, exercise, laxatives, rest) it is imperative for a woman to see her doctor. Persistence of symptoms is key. Because these signs and symptoms of ovarian cancer have been described as vague or silent, only around 19% of ovarian cancer is found in the early stages. Symptoms typically occur in advanced stages when tumor growth creates pressure on the bladder and rectum, and fluid begins to form.

• A rectovaginal pelvic examination is when the doctor simultaneously inserts one finger in the rectum and one in the vagina.
• It is helpful to take a mild laxative or enema before the pelvic exam.
• Have a comprehensive family history taken by a physician knowledgeable in the risks associated with ovarian cancer. 5% to 10% of ovarian cancer has a familial link.

Every woman should undergo a regular rectal and vaginal pelvic examination. If an irregularity of the ovary is found, alternatives to evaluation include transvaginal sonography and/or tumor markers. The most common tumor marker is a blood test called the CA-125.

Diagnosing ovarian cancer 
Tests and procedures used to diagnose ovarian cancer include:

• Pelvic examination. During a pelvic exam, your doctor carefully inspects the outer exposed part of your genitals (vulva), and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vagina so that your doctor can visually check your vagina and cervix for abnormalities.
• Ultrasound. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. An ultrasound helps your doctor investigate the size, shape and configuration of your ovaries. To create a picture of your ovaries, your doctor may insert an ultrasound probe into your vagina. This procedure is called transvaginal ultrasound. Ultrasound imaging can create pictures of the structures near your ovaries, such as your uterus.
• Surgery to remove samples of tissue for testing. If other tests suggest you may have ovarian cancer, your doctor may recommend surgery to confirm the diagnosis. During surgery, a gynecologic oncologist makes an incision in your abdomen and explores your abdominal cavity to determine whether cancer is present. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible. In some cases, the surgeon may make several small incisions in your abdomen and insert special surgical tools and a tiny camera, so the procedure won't require a larger incision.
• CA 125 blood test. CA 125 is a protein found on the surface of ovarian cancer cells and some healthy tissue. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of noncancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. For this reason, a CA 125 test isn't usually used to diagnose or to screen for ovarian cancer, but it may be used to monitor how your treatment is progressing.

Staging ovarian cancer
Doctors use the results of your surgery in order to determine the extent — or stage — of your cancer. Your doctor may also use information from imaging tests, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), to determine whether cancer has spread within the abdomen. Your cancer's stage helps determine your prognosis and your treatment options. Stages of ovarian cancer include:

• Stage I. Ovarian cancer is confined to one or both ovaries.
• Stage II. Ovarian cancer has spread to other locations in the pelvis, such as the uterus or fallopian tubes.
• Stage III. Ovarian cancer has spread beyond the pelvis or to the lymph nodes within the abdomen.
• Stage IV. Ovarian cancer has spread to organs beyond the abdomen, such as the liver or the lungs.

Treatment

The treatment of ovarian cancer is based on the stage of the disease which is a reflection of the extent or spread of the cancer to other parts of the body. Staging is performed by the surgeon (gynecologic oncologist) when the ovarian cancer is removed. During the surgical procedure the surgeon will obtain small pieces of tissue (biopsies) from various sites in the abdominal cavity. During this procedure, depending on the stage (extent) of the disease, the surgeon will either remove just the ovary and fallopian tube or will remove both ovaries, fallopian tubes and uterus. In addition, the surgeon will attempt to remove as much of the cancer as possible. Ovarian cancer is staged as follows:Stage I cancer is confined to one or both ovaries. The cancer is Stage II if either one or both of the ovaries is involved and has spread to the uterus and/or the fallopian tubes or other sites in the pelvis. The cancer is Stage III cancer if one or both of the ovaries is involved and has spread to lymph nodes or other sites outside of the pelvis but is still within the abdominal cavity, such as the surface of the intestine or liver. The cancer is Stage IV cancer if one or both ovaries is involved and has spread outside the abdomen or has spread to the inside of the liver.
Treatment Options
There are basically three forms of treatment of ovarian cancer. The primary one is surgery at which time the cancer is removed from the ovary and from as many other sites as is possible. Chemotherapy is the second important modality. This form of treatment uses drugs to kill the cancer cells. The other modality is radiation treatment, which is used in only certain instances. It utilizes high energy x-rays to kill cancer cells. Surgical treatment of ovarian cancer is best performed by a gynecologic oncologist who has been specially trained in the diagnosis and management of gynecologic malignancy. The treatment of ovarian cancer depends on the stage of the disease, the histologic cell type, and the patient's age and overall condition. The histologic cell type and the extent of disease based on the biopsies performed by the gynecologic oncologist during surgery (staging) are determined by the pathologist who analyzes tissues with a microscope.
Treatment of Ovarian Epithelial Cancer
Stage I

Generally women with Stage I ovarian cancer have a total abdominal hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, biopsy of lymph nodes and other tissues in the pelvis and abdomen. Young women whose disease is confined to one ovary are often treated by a unilateral salpingo-oophorectomy (removal of the affected ovary and fallopian tube) without a hysterectomy and removal of the opposite ovary being performed. Omentectomy and the other parts of the staging procedure are performed. Depending on the pathologist's interpretation of the tissue removed, there may be no further treatment if the cancer is low grade, or if the tumor is high grade the patient may receive combination chemotherapy.

Stage II

Treatment is almost always hysterectomy and bilateral salpingo-oophorectomy as well as debulking of as much of the tumor as possible and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After the surgical procedure, treatment may be one of the following: 1) combination chemotherapy with or without radiation therapy or 2) combination chemotherapy.

Stage III

Treatment is the same as for Stage II ovarian cancer. Following the surgical procedure, the patient may either receive combination chemotherapy possibly followed by additional surgery to find and remove any remaining cancer.

Stage IV

Treatment will probably be surgery to remove as much of the tumor as possible followed by combination chemotherapy.