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OVARIAN CANCER

Ovarian cancer is usually asymptomatic (no physical signs or symptoms) in the early stages. When symptoms do appear, they are vague and often nonspecific. The following symptoms appear to be associated with ovarian cancer:

* Prolonged abdominal swelling (caused by fluid)
* Digestive or gastrointestinal symptoms (such as gas, bloating, long-term stomach pain, or indigestion)
* Vague abdominal and pelvic discomfort
* Abnormal vaginal bleeding
* Back pain
* Fatigue

Of course, most women may experience these symptoms from time to time. However, if any of these symptoms persist for longer than a few weeks, it may be an early sign of ovarian cancer and you should consult your doctor. Unfortunately, because the symptoms are so vague, many women don’t see their doctor. As a result, they aren’t diagnosed until the cancer has spread beyond the ovaries into other areas of the body. If a doctor suspects ovarian cancer, he or she may try to determine a woman’s risk for ovarian cancer by taking a complete medical history. He or she may also ask about a family history of ovarian cancer or related cancers, age when menstruation started, number of pregnancies and use of birth control pills or fertility drugs.

If your doctor detects signs of ovarian cancer, he or she may perform a series of diagnostic tests. An ovarian cancer diagnosis can usually be made through a physical examination and a combination of diagnostic exams.

Physical Examination
Your doctor may suspect ovarian cancer if he or she feels a mass or cyst on either side of the uterus during a routine physical examination. There may be increased suspicion if the ovarian cyst or mass feels solid, is larger than two inches, is present on both sides, and/or is found in a postmenopausal woman.

Diagnostic Tests
If a physical examination suggests ovarian cancer, a series of diagnostic tests will be performed. Doctors rely on the results of a series of tests in order to rule out or confirm a diagnosis of ovarian cancer. Following are some of the more common tests used:

* CA125 Blood Test
An elevated level of the protein CA125 in the blood may suggest ovarian cancer. However, this test alone may not be an accurate diagnosis since elevated levels of CA125 are also seen in benign or noncancerous conditions and during the first trimester of pregnancy. In general, the higher the CA125 count, the more likely it is a woman has ovarian cancer. For frequently asked questions about the CA125 blood test, click here.

* Ultrasound
An ultrasound is the most effective non-invasive way for doctors to evaluate the size, shape, configuration, and consistency of the ovaries and to determine whether they are cystic (containing cysts), solid or both.

* Transvaginal Color Flow Doppler
Since an ultrasound does not provide enough information to determine if suspicious conditions are cancerous, doctors often use transvaginal color flow Doppler technology. The blood vessels that supply cancerous tumors with blood are smaller and weaker than normal blood vessels. Transvaginal color flow doppler technology allows doctors to identify these blood vessels. These findings then help physicians determine if a tumor exists and if surgery is needed.

* Computerized Axial Tomography (CAT) Scan
CAT scans help physicians determine if the ovarian cancer has spread into the pelvic and abdominal organs. By using a dye, doctors can see the insides of the intestines and other organs.

* Surgical Biopsies
A surgical biopsy is the only way doctors can confirm a diagnosis of ovarian cancer. During surgery, a biopsy (sample of tissue) is taken from the tumor and then examined. Depending on the extent of the disease, doctors may take a biopsy during a laparotomy (surgery through an abdominal incision) or laparoscopy (surgery done through a lighted tube which is inserted into a very small incision). Physicians may also take the biopsy by performing an aspiration (suction) around the lungs to remove fluid. This fluid is then tested to confirm an ovarian cancer diagnosis. Unfortunately, biopsies cannot confirm the location of the cancer.

Stages of Ovarian Cancer

If tests confirm a diagnosis of ovarian cancer, doctors use a process called staging to determine where the ovarian cancer has spread. You also may want to see a "gynecologic oncologist", who is a doctor that specializes in diagnosis and treatment of cancer of the reproductive organs. For more information about this medical specialty, click here.

Doctors determine the stage of the cancer through surgery and microscopic evaluation of tissues. Staging is very important, since it helps doctors determine the best course of treatment. Also, the stage of a woman’s cancer will help determine her prognosis (outcome of the disease). Five year survival rates are estimated to be 95% for Stage I, 65% for Stage II, 20% for Stage III and 5% for Stage IV. Information about survival rates should be viewed as general, not taking into account individual differences. For information that puts statistics in perspective, from CancerGuide, click here.

Stage I
The ovarian cancer has developed in one or both ovaries but has not spread to any other organs.

* Stage IA: The cancer has developed in one ovary, and the tumor is confined to the inside of the ovary. There is no cancer on the surface of the ovary, and laboratory examination does not reveal any cancer cells around the abdomen or pelvis.

* Stage IB: The cancer has developed in both ovaries and may or may not have spread to the outer surfaces. Laboratory examination indicates that there are no cancer cells in the abdomen or pelvis.

* Stage IC: The cancer is present in one or both ovaries, and one or more of the following are present: (1) cancer on the outer surface of one or both ovaries, (2) if the tumor is cystic (filled with fluid), the capsule (outer wall of the tumor) has burst, or (3) laboratory examination reveals cancer cells in abdominal fluid.

Stage II
The ovarian cancer has spread to both ovaries and to the surrounding pelvic region.

* Stage IIA: The ovarian cancer has spread to the uterus and/or fallopian tubes

* Stage IIB: The ovarian cancer has spread to the nearby pelvic organs such as the bladder, sigmoid colon or rectum.

* Stage IIC: The ovarian cancer has spread to the pelvic organs (as in Stage IIA and IIB), and one or more of the following are present: (1) cancer on the outer surface of one or both ovaries; (2) in the case of cystic tumors, the capsule has ruptured; and (3) laboratory examination has found cancer cells in abdominal fluid.

Stage III
The ovarian cancer has spread beyond the abdominal organs to the lining of the abdomen. The cancer may also have spread to the lymph nodes (glands that fight infection and produce blood cells).

* Stage IIIA: The cancer doesn’t appear to be visible in the abdomen and has not spread to the lymph nodes. However, when biopsies are performed, tiny deposits of cancer are found in the lining of the upper abdomen.

* Stage IIIB: The cancer is present in one or both ovaries, and deposits of the cancer in the abdomen are large enough for the surgeon to see (but smaller than 2 cm across). The cancer has not spread to the lymph nodes.

* Stage IIIIC: The cancer is present in one or both ovaries, and one or both of the following are present: (1) cancer has spread to the lymph nodes; (2) deposits of cancer in the upper abdomen are larger than 2 cm.

Stage IV
This is the most advanced stage of ovarian cancer. The cancer has metastasized (spread) to the inside of the liver, lungs, or other organs located outside of the abdominal area. Doctors may also find ovarian cancer cells in the pleural fluid surrounding the lungs.