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What are Ovarian Cancers?
Ovarian, fallopian tube, and primary peritoneal tumors are treated the same way and often grouped together as “ovarian cancers.” Ovarian cancers are often diagnosed at advanced stages due to symptoms that go unnoticed or mistaken for other medical conditions. As such, any discernible signs and symptoms of ovarian cancers should be taken seriously and reported promptly.
There are several kinds of malignant tumors that originate from the tissue covering the ovary or lining the fallopian tube or peritoneum. These include epithelial (serous) ovarian, fallopian tube, and primary peritoneal cancers. Since these tumors have common origins and are treated the same way, they are collectively referred to as “ovarian cancer.”
[see References: 1]
Annually, approximately 20,000 women in the U.S. are diagnosed with ovarian cancer. [2] The majority (approximately 80%) of them are diagnosed at an advanced stage with a tumor that has already spread throughout the abdominal cavity (stage III-IV disease).[3] This is largely because early-stage disease is asymptomatic and there are currently no effective screening tools. [4,5]
Ovarian cancer affects women of all ages; however, it is most commonly diagnosed after menopause. The strongest risk factors are advancing age and a family history of ovarian or breast cancer. Some ovarian cancers are genetically linked through genes, such as BRCA1 and BRCA2, while the cause of most cases remains unknown.
Risk Factors
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Age: Commonly occurs between ages 50-60
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Race: Non-Hispanic, white women
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Family history of ovarian cancer
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Inherited genetic mutations (BRCA1/BRCA2)
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Personal history of cancer, particularly breast cancer
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Estrogen hormone replacement therapy
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Reproductive history and infertility may contribute: Early menstruation (before 12 years of age); Has not given birth to any children; First child after the age of 30 years; No history of oral contraceptives
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Obesity
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Smoking
Signs & Symptoms
Symptoms are often vague & non-specific:
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Abdominal or pelvic pain/tenderness
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Back pain
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Abdominal swelling or bloating
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Fatigue
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Feeling full after a small amount of food
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Shortness of breath
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Bowel changes, constipation
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Urinary symptoms
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Unexplained weight gain/loss
Evaluation
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Physical exam
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Imaging studies: ultrasound, CT scan, MRI scan
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Blood work to include tumor markers
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Testing of abdominal fluid (ascites)
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Surgical biopsy of tumor – fine needle biopsy
Key Facts
Ovarian Cancers
Ovarian, fallopian tube, and primary peritoneal tumors are treated the same way and often grouped together as “ovarian cancers.”
Advanced Diagnoses
The majority of ovarian cancers are diagnosed at an advanced stage after the disease has spread throughout the abdomen.
Treatment Options
Treatment consists of surgery and chemotherapy. The sequence and timing of each portion should be decided together with your surgeon and medical oncologist.
Surgery
The key to achieving the best survival is complete cytoreductive surgery (CRS), in which all visible disease is removed. Having a surgeon who is experienced in removing tumors from both the upper abdomen and pelvis is essential to accomplishing this goal.
CRS/HIPEC
Emerging evidence supports the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery, demonstrating that it is associated with longer progression-free and overall survival.
Diagnosis and Prognosis
Prognosis largely depends on the stage at diagnosis and the amount of residual disease after surgery. Stage IV cancers are commonly only offered palliative treatment. However, recent studies have shown that meaningful survival, similar to stage III cancers, can be achieved with cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC). One study showed a 2-year overall survival of 83% in stage III patients and 76% in stage IV patients. [22] Similarly, a landmark study from the Netherlands comparing survival outcomes between patients who received neoadjuvant chemotherapy (cycles of chemotherapy that are given before surgery) followed by interval cytoreductive surgery with or without HIPEC showed significantly longer survival outcomes with HIPEC. The median overall survival was 33.9 vs 45.7 months in the non-HIPEC vs HIPEC groups, respectively. All patients in these studies had a complete cytoreduction, in which all visible disease was removed. Without a complete surgery, survival shortens to roughly 22 months. [11] Despite this, optimal cytoreduction rates in the literature range between 20-80%, emphasizing the importance of finding an experienced surgical team. [23]
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