Ovarian cancer is a cancer that develops in a woman's ovary. It can be difficult to detect in its early stages. Unlike cervical and breast cancers, there are currently no effective screening methods for ovarian cancer. The majority of women are diagnosed when the cancer is in an advanced stage.

If you are diagnosed with ovarian cancer, you should be referred to a gynecologic oncologist, a doctor who specializes in diagnosing and treating cancers of the female reproductive system.

Ovarian Cancer Risk Factors

Risk of developing ovarian cancer include any of the following:

  • The fewer children a woman has and the later in life she gives birth, the higher her risk of ovarian cancer.
  • Women who have had breast cancer or have a family history of breast or ovarian cancer have an increased risk of ovarian cancer (due to defects in the BRCA1 or BRCA2 genes).
  • Women who take estrogen replacement only (not with progesterone) for 5 years or more may have a higher risk of ovarian cancer. Birth control pills, though, decrease the risk of ovarian cancer.
  • Older women are at highest risk of developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.

Ovarian Cancer Symptoms

Ovarian cancer grows quickly and can progress from early to advanced stages within a year. Paying attention to symptoms can help improve a woman's chances of being diagnosed and treated promptly. Detecting cancer while it is still in its earliest stages may help improve prognosis.

See your health care provider if you have the following symptoms on a daily basis for more than a few weeks:

  • Bloating or swollen belly area
  • Pelvic or lower abdominal pain or feeling of heaviness
  • Difficulty eating or feeling full quickly

Other symptoms that are sometimes associated with ovarian cancer include:

  • Menstrual irregularities
  • Fatigue
  • Indigestion
  • Constipation
  • Urinary urge or frequency
  • Back pain
  • Pain during sexual intercourse

Be aware that these symptoms are very common in women who do not have cancer and are not specific for ovarian cancer. While prompt follow-up with your primary care provider is important when one or more of these are present, there are many other explanations for these symptoms besides ovarian cancer.

Based on symptoms and physical examination, your primary care provider may order pelvic imaging tests or blood tests. If these tests reveal possible signs of cancer, you should be referred to a gynecologic oncologist.

Ovarian Cancer Diagnosis

A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid.

A pelvic examination may reveal an ovarian or abdominal mass.

A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has:

  • Symptoms of ovarian cancer
  • Already been diagnosed with ovarian cancer to determine how well treatment is working

Other tests that may be done include:

  • Complete blood count and blood chemistry
  • Pregnancy test (serum HCG)
  • CT or MRI of the pelvis or abdomen
  • Ultrasound of the pelvis

Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis.

No lab or imaging test has been able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.

Ovarian Cancer Treatment

Early stage ovarian cancer is usually treated with a combination of surgery, to remove the tumors and perhaps the uterus, and chemotherapy. Studies show that gynecologic oncologists have better outcomes when performing cancer surgery than general gynecologists.

For advanced cancer that has spread beyond the ovaries, surgery that is more radical may be necessary. The surgery involves removing uterus, fallopian tubes, ovaries, lymph nodes and possible bowel resection.

Alternative Treatments for Advanced Ovarian Cancer

One of the unique surgical treatment methods we offer at Wake Forest Baptist for ovarian cancer patients is known as a HIPEC procedure. Your doctor may recommend this advanced surgical treatment, if other treatment options have not been effective. During this treatment, your surgeon will perform a cytoreductive and debulking procedure to remove as much cancer as possible. Then a warm chemotherapy bath will be applied to all affected organs to try to kill any remaining cancer tissues.

If your cancer is advanced and metastatic, meaning it has spread; our doctors may recommend a two-pronged approach to chemotherapy. Known as cyclic intraperitoneal chemotherapy, it involves receiving two doses of chemotherapy with each treatment cycle:

  • One dose will enter your body through a vein
  • The other dose will enter your peritoneal cavity, or your abdomen, where the cancer originally grew, through a catheter.

This two-pronged approach attacks the cancer cells through your entire system, as well as their point of origin.

After surgery and chemotherapy, follow instructions about how often you should see your doctor and the tests you should have.