1. Seek Care from a Gynecologic Oncologist
Perhaps the single most important thing you can do is seek care at a cancer center where providers have experience treating ovarian cancer. These centers, often referred to as “high-volume” centers because they treat many patients with the disease, are staffed with physicians who have extensive experience in treating ovarian cancer and provide the expertise you need.
High-volume hospitals and high volume surgeons are more likely to practice and adhere to National Comprehensive Cancer Network (NCCN) Ovarian Cancer Treatment Guidelines; improved survival rates have been associated with patients treated according to NCCN guidelines.
Seeking care with a high-volume provider will also help ensure that you receive an accurate diagnosis, which is incredibly important. In some cases, advanced cancers of the gastrointestinal tract (gastric cancer, colorectal cancer, hepato-biliary cancer, pancreatic cancer) can mimic ovarian cancer, so receiving an accurate diagnosis that will lead to the most appropriate treatment is key.
A gynecologic oncologist is the only specialist/subspecialist trained to diagnose and treat patients with ovarian cancer.
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 individuals with 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. Ask about the Role of Precision Medicine
Unlike traditional chemotherapy, which attacks any cell in the body that is rapidly dividing, precision cancer medicine aims to target specific genetic alterations that allow cancer cells to grow. Most or all ovarian cancers result from abnormal genes or gene regulation. The strategy of precision cancer medicine is to define abnormalities at the most basic genetic level. These abnormalities in the DNA are called genomic alterations and they are responsible for driving cancer cell growth. Once the abnormality is identified, genomic tests are created to measure the specific genes in ovarian cancer that are abnormal or are not working properly. By identifying the genomic changes and knowing which genes are altered in a patient, cancer drugs that specifically attack that gene (or the later consequences of that gene) can be used to precisely target the cancer and avoid affecting healthy cells.
A new class of drugs call PARP inhibitors have recently become available for the treatment of ovarian cancer-learn more here.
8. Ask about Clinical Trials
Ongoing research is being conducted to find new treatments for ovarian cancer. By learning about clinical trials you can identify opportunities that advance the treatment of ovarian cancer and possibly benefit your personal prognosis. Learn more about clinical trials:
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.
An online support community can be a great resource to helpf find a doctor as well as to share information and learn about treatment choices with other individuals in your situation. The CancerConnect Ovarian Cancer online support community is safe, private and fully moderated. Join the conversation here. CancerConnect will link you to ovarian cancer patients being treated at leading cancer centers.
Reference: 10 Things Every Woman Should Know About Ovarian Cancer; By Krishnansu S. Tewari, MD, FACOG, FACS. The Division of Gynecologic Oncology, University of California, Irvine