“For patients with a new diagnosis of ovarian cancer, surgery significantly impacts their survival,” said Dr. Concepcion Diaz-Arrastia, director of gynecologic oncology and an assistant professor at BCM. “For high-risk women – women who have previously had breast cancer or have a family history of ovarian cancer – surgical removal of the fallopian tubes and ovaries significantly reduces her chances of developing the disease.”
Ovarian cancer is cancer of the ovaries, the female organs most important during a woman’s reproductive age. During a woman’s reproductive years, ovaries release eggs and the major female hormones estrogen and progesterone.
There are currently no screening methods, Diaz-Arrastia said. “There are tremendous efforts to explore identification of new biomarkers and development of new ovarian cancer screening methods.”
Symptoms of Ovarian Cancer
Diaz-Arrastia said symptoms of ovarian cancer are subtle and may include:
- Early satiety or feeling full sooner than usual or after eating less
- Upper gastrointestinal discomfort such as indigestion or heartburn
- Feeling bloated
- Pressure sensation in pelvis including the colon
- Urinary urgency
- Family history of ovarian and breast cancer can increase a woman’s risk of developing ovarian cancer.
Additionally, women who have never had children are at a greater risk of developing the disease, Diaz-Arrastia said.
Surgery to Treat
Treatment of ovarian cancer typically involves surgery by a gynecologic oncologist, followed by chemotherapy.
The role of surgery in ovarian cancer ranges from the removal of the ovarian mass and tissues where ovarian cancer typically spreads for surgical staging of early cancer to cancer debulking or removal of all visible cancer in the abdomen in women with advanced disease. This latter surgical approach for advanced ovarian cancer is unique, and more advantageous, than the surgical options for other cancers like breast, pancreatic and colon, said Diaz-Arrastia.
“The goal of surgery is to take out as much of the cancer as you physically can,” said Diaz-Arrastia. “While this may mean a longer surgery with removal of intestinal segments, it may directly impact survival.”
The remaining disease is effectively treated with chemotherapy after surgery. Since the ovarian cancer is very sensitive to chemotherapy, the treatment is administered intravenously or intraperitoneally (injection of a substance into the body cavity), she said.
For women with a family history or those who test positive for a BRCA1 or 2 genetic mutations, preventive surgery is recommended at an age 10 years younger than the age at diagnosis of the family member with the disease, Diaz-Arrastia said.
The patients desire to have children should be taken into account when deciding on preventive surgery, Diaz-Arrastia said.
Most women will be diagnosed in their late 50s and 60s after childbearing is completed. However, some women are diagnosed much younger.
“With removal of the fallopian tubes and ovaries, there is a great reduction in chances of developing the disease, but there remains a small chance,” said Diaz-Arrastia. “It’s a risk-benefit decision.”
Surgery typically includes removal of both ovaries and fallopian tubes, since cancers can also arise in the fallopian tubes, Diaz-Arrastia said.
It is an outpatient procedure – typically patients go home the same day with three band-aids. In young women, the most common side effects of surgery are the consequences of an early menopause, hot flashes, vaginal dryness and osteoporosis — all treatable with medications.
Visits Well-woman visits include a physical examination of the ovaries. “It’s important for women to keep up with these visits once a year even when cervical cancer screening with a pap smear or HPV test is not scheduled,” said Diaz-Arrastia.