Ovarian Cancer


The following information was provided by
Glaxo SmithKline - "Oncology;
A Comprehensive Nursing Guide to Ovarian Cancer".
Prevention
Screening
Early detection
Ovarian Cancer Stages
Treatment of Ovarian Cancer
FAQ's on Ovarian Cancer
Ovarian Cancer Clinical Trials
Guidelines for Ovarian Cancer
Resources
Prevention

Prophylactic removal of the ovaries is not a guarantee. Women may still develop primary peritoneal carcinomatosis which behaves in a fashion similar to advanced ovarian cancer. Prophylactic oophorectomy is not currently recommended but may be considered by some women who have had a number of relatives affected and with young age at onset of disease. The potential benefits and risks must be weighed carefully.

Factors which reduce incessant ovulation appear to offer some protection. These include pregnancy greater than one full-term, use of oral contraceptives, and breast feeding. Tubal ligation may also be a protective factor.

Screening

The three screening tests currently in use for the early detection of ovarian cancer are:

  1. Bimanual rectovaginal pelvic examination
  2. CA-125 testing, and
  3. Transvaginal ultrasonography (TVS)

*At this time, there is no specific cost-effective screening test available for the general population.

Early Detection
Recently, the lay public has increased the demand for early detection of ovarian cancer. Women with early ovarian cancer rarely have symptoms; late detection is the rule rather than the exception because the disease is difficult to detect clinically at an early stage. Few specific symptoms are noticed during the initial stages of the disease. Initial non-specific symptoms such as abdominal swelling and abdominal discomfort are most commonly reported. The most common initial complaint is abdominal pain associated with increasing girth. Weight gain localized to the abdominal area may be observed rather than weight loss. Patients may also describe vague gastrointestinal symptoms such as bloating, heartburn, nausea, anorexia, food intolerance or changes in bowel habits, such as constipation. By the time these symptoms become evident, the cancer is usually widespread.
Treatment Options
The modalities used to treat ovarian cancer depend on the stage, grade and amount of residual disease after initial cytoreductive surgery. Protocols can vary between institutions and according to the health status of the individual patients, but the following recommendations were made at the National Institutes of Health Ovarian Cancer Consensus Conference.

Stage I
Surgery alone is adequate for Stage IA and IB. If the tumor is grade III, densely adherent or Stage IC, one of the following may be considered:

  • systemic chemotherapy
  • intraperitoneal P-32 radiation therapy (not used in Canada)
  • total abdominal and pelvic radiation therapy

Since so few women have their disease detected at an early stage, clinical trials for early stage management have been difficult. Only 25% of women with newly diagnosed ovarian cancer present with Stage I disease. Many questions remain about which approaches hold the most promise for influencing outcomes. Even with early detection, about 10% of these women will still die of the disease. Factors related to the risk of relapse and mortality are not clearly established. The following recommendations were made by the National Institute of Health Ovarian Cancer Consensus Panel.

  • patients with Stage IA grade I and most Stage IB grade I tumors do not require adjuvant therapy,
  • all patients with grade 3 tumors require adjuvant therapy,
  • patients with clear cell carcinoma require adjuvant therapy,
  • many but not all women with Stage IC disease require adjuvant therapy.

Stage II
Surgery plus post-operative chemotherapy is recommended for all women with Stage II disease. If post-surgical residual disease is minimal the following systemic chemotherapy regimes are recommended.

TP: paclitaxel plus cisplatin or carboplatin

CP: cyclophosphamide plus cisplatin or carboplatin

CAP: cyclophosphamide adreamycin, cisplatin

Whole pelvic and abdominal radiation may be given in combination with chemotherapy for those at high risk of relapse.

Stage III and IV
Aggressive surgery should be attempted including total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy and debulking as much gross tumor as is possible. Studies indicate that patient survival is related to the volume of disease left at the completion of the primary surgical procedure.

However, radical surgical procedures which include peritoneal stripping and bowel resection for complete removal of all visible residual disease alone does not improve survival.

All Stage III and IV patients are treated with a combination of chemotherapy using one of these regimes:

TP: paclitaxel plus cisplatin or carboplatin

CP: cyclophosphamide plus cisplatin

CC: cyclophosphamide plus carboplatin

CAP: cyclophosphamide, adriamycin, platinum.

Policies and guidelines governing the use of chemotherapeutic agents for ovarian cancer may differ across Canada and each institution's guidelines should be taken into consideration when treatment is recommended.

Resources:
Ovarian cancer information from the National Cancer Institute
Ovarian Cancer Network
National Ovarian Cancer Coalition
Ovarian Cancer Research Book
Ovarian Cancer Profiler; Your Treatment Decision Tool
Iris Science - Ovarian cancer animation
Ovarian Cancer in Canada; Cancer update from Health Canada