The American Cancer Society reports that ovarian cancer is the
eighth most common cancer among women today. About three percent 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 one 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 percent 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 account for about five percent of ovarian
cancer cases today. Stromal cells produce the estrogen and
progesterone and account for the remaining five to ten percent 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 one and two
cancers have much better survival rates than do stage three and
four. The American Cancer Society notes that about 76 percent of
women survive one year after diagnosis and the survival rate drops
to 45 percent 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 percent, yet fewer than 20 percent 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 young 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. 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. 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 is 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 parent 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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