Ovarian cancer is like a stealth bomber, difficult to detect until it’s often too late. But the earlier the deadly disease is found, the sooner you can get ovarian cancer treatment, such as surgery and chemotherapy. Read on for the signs and symptoms of ovarian cancer and advice from top doctors. Plus, what’s your women’s health IQ? Take our quiz to find out...
Nearly 21,000 U.S. women are diagnosed with ovarian cancer each year.
Those are the lucky ones.
Few overt symptoms clue women and doctors to this silent but deadly disease. But when found early, this gynecologic cancer is very treatable, according to the Centers for Disease Control and Prevention. Here are common signs and symptoms of ovarian cancer:
Pelvic or abdominal pain
Trouble eating or feeling full quickly
Urinary symptoms such as urgency (always feeling as if you have to go) or frequency (having to go often)
Fatigue
Upset stomach/nausea that persists
Back pain
Constipation or changes in bowel habits
Menstrual changes
The first step to diagnosing ovarian cancer is usually a pelvic examination to detect any masses or tumors.
A gynecologist might also order a vaginal ultrasound to confirm the presence of a tumor, or look for one that’s too small to feel during the pelvic exam.
During the procedure, a probe is inserted in the vagina or placed on the woman’s abdomen to provide images of the ovaries, uterus and fallopian tubes.
“An ultrasound may be performed by the doctor, a technician or a radiologist,” says Mark Einstein, M.D., director of clinical research for women’s health and gynecologic oncology at Montefiore Einstein Center for Cancer Care, Albert Einstein College of Medicine in New York City.
The doctor also may order a blood test, called a CA-125 (or cancer antigen 125), which “can detect the presence of a tumor marker,” Einstein says.
Elevated levels of certain protein substances may point to cancerous ovarian tumors, according to Einstein.
Ovarian Cancer Treatment
If a tumor is detected or doctors suspect the presence of cancerous cells, the next step is surgery. This procedure is often performed via laparoscopy, a minimally invasive surgery that uses a small lighted tube to explore the abdomen.
A section of the tumor is given to a pathologist for biopsy, who examines it for cancerous cells, says gynecologic oncologist Laura Williams, M.D., assistant clinical professor at Vanderbilt University’s department of obstetrics and gynecology in Nashville, Tenn.
“During that ‘staging surgery,’ a gynecologic oncology surgeon removes as much visible tumor as possible,” Einstein says.
If it’s cancerous, doctors then determine the stage of the cancer – the degree the cancer has spread. There are four ovarian cancer stages:
Stage 1
1a: Cancer is inside one ovary, but not on the outside of the organ. It doesn’t cross the tissue covering the ovary (called the capsule) and isn’t found in fluid taken from the pelvis.
1b: Similar to Stage 1a, but the cancer is inside both ovaries.
1c: The cancer is in one or both ovaries and also on the outside of an ovary, has grown through the ovary’s capsule, or is in fluid taken from the pelvis.
Stage 2
2a: Cancer has spread (metastasized) to the uterus and/or the fallopian tubes but isn’t in fluid taken from the pelvis.
2b: Cancer has spread to pelvic tissues as well as the uterus and fallopian tubes, but isn’t in fluid taken from the pelvis.
2c: Like Stages 2a or 2b, except the cancer is also in fluid taken from the pelvis.
Stage 3
3a: The cancer is in one or both ovaries and has spread to the abdominal lining outside the pelvis. The metastases are so small they can only be seen under a microscope.
3b: Like 3a, except the metastases can be seen without a microscope; however, no tumor is larger than 2 centimeters (0.8 inches).
3c: Same as 3b, but the metastases are larger than 2 centimeters.
Stage 4
This final stage is considered incurable. Patients may have liver and extra-abdominal metastases. Liver and lungs are the most common areas where the cancer spreads. The spleen and brain may also be affected.
Starting Chemotherapy
Sometimes surgery alone can remove an ovarian cancer tumor. But for most women, chemotherapy is the next step in ovarian cancer treatment.
“The only exception is women with very early-stage ovarian cancer, whose cancer is so small and contained that it can be entirely removed in surgery,” says Mehdi Kebria, M.D., a gynecologic oncologist at the OB/GYN & Women’s Health Institute at Cleveland Clinic.
In a small percentage of cases, the doctor may follow the surgical procedure with an ovarian cancer treatment called intraperitoneal hyperthermic chemotherapy (HIPEC), or “hot chemo,” Kebria says.
“This treatment bathes the organs in a heated chemotherapy solution,” Kebria says.
If the cancer has spread to other parts of the body, radiation may also be recommended.
Most women with ovarian cancer will undergo standard chemotherapy, administered through a vein in the arm, or a port near the collar bone or in the abdomen, Einstein says.
Before starting chemotherapy, you’ll have a planning session with your doctor as well as a nurse educator.
“That meeting should cover the number of chemotherapy treatments you’ll receive and the specific chemotherapy drugs recommended for your stage and type of cancer,” Williams says.
Each treatment may take from 2-5 hours, and you may experience the following side effects:
Fatigue. “This is the most common chemotherapy side effect,” Kebria says.
To combat it, try to reduce or limit work hours, ask family and friends for help with household tasks and allow yourself time for daytime naps.
Nausea or vomiting. You’ll probably receive anti-nausea medicine before starting each round of chemotherapy. But if you still feel nauseated, talk to your doctor.
“This can be treated or prevented with the use of medication,” Kebria says.
Mouth sores. Besides the medications your doctor may prescribe for the discomfort, acupuncture may aid dry mouth caused by chemotherapy treatments.
An acupuncture point on the hands increased brain activity that stimulates saliva production in a study published in the July 2008 issue of BMC Complementary Alternative Medicine.
Suppressed immune system. “Eat lean protein, fruits and vegetables daily and get the recommended amount of calcium,” Williams advises. “Chemotherapy [treatments] lower your immune system and ability to fend off germs, so eating well will also help you combat fatigue and fight colds and infections.”
To avoid catching respiratory illnesses, wash your hands frequently (after going to the restroom, shaking hands, handling a grocery store cart or gas pump or anytime you’ve touched something likely to harbor germs).
“Your doctor may also prescribe an injection of red blood cells to help your immune system repair itself,” Einstein says.
Diarrhea or constipation. Over-the-counter remedies can ease diarrhea and constipation, Williams says. If either persists longer than a day or two, call your doctor.
Loss or change in appetite. Chemotherapy drugs suppress the appetite and affect your taste buds, so you might not feel like eating, and even your favorite foods may taste unpleasant.
Stick to bland, mild and lightly seasoned (or unseasoned) foods such as lean protein and fresh veggies to get adequate nutrition.
Hair loss. “If you lose your hair, consider going to your stylist to cut your hair short and have a wig made in advance,” Williams says. “That will limit emotional trauma.”
To better tolerate chemotherapy drugs, patients should “maintain good health and nutrition and adequate hydration,” Kebria advises.
Also, take a daily multivitamin to ensure you’re getting all the recommended nutrients, Williams says.
For more information, visit our Ovarian Cancer Health Center.
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