Ovarian Cancer

Mridula Reddy, MD, Medical Oncologist, Discusses Ovarian Cancer Video Transcript

My name is Mridula Reddy and I’m a medical oncologist here at Atrium Medical Center. Overall I think the incidents of cancer are actually going down. As far as treatment goes, there have been so many new advances now especially in areas of targeted treatment where molecular biology has made us all smarter. There have been newer treatments that have come up that actually target certain receptors on cancer cells and those treatments have changed the outlook of cancer.

Difficult Early Diagnosis

Ovarian cancer is known to be a very difficult disease to diagnose especially in the early stages. Part of the reason is that early on women don’t have significant signs or symptoms from the disease so early on their complaints are very vague and nonspecific and they may not even seek medical attention because they don’t feel sick enough. Most cases of ovarian cancer end up being diagnosed later on in the disease course so a lot of patients who come to us are in the advanced stage which means stage 3 or stage 4. That is the difficulty with ovarian cancer.

Diagnosis through Exam and Ultrasound

The diagnosis of ovarian cancer with typically involves a thorough pelvic exam which would be done by a gynecologist and the gynecologist would look for abnormal masses in the pelvic area. That raises suspicion that you have ovarian cancer. The next step is usually an ultrasound. Often this is a transvaginal ultrasound and this looks at the ovaries and looks for abnormalities like a solid mass and any lymph node enlargement in that area or any collection of pelvic fluid or abdominal fluid in that area which again raises suspicion for underlying cancer. The next step is a CT scan of the abdomen and pelvic area and this is to determine the extent of the ovarian cancer. It helps by looking at the ovaries and the surrounding tissue as well as the lymph nodes and we know the extent of cancer based on the findings on the CT scan. It also looks at fluid build up in the abdomen and pelvic cavity as well as looking at abdominal organs such as the liver to see if there is any spread of cancer there. That is very useful information for staging your ovarian cancer and will likely be the next step. There is a blood test we often get for monitoring patients with ovarian cancer and also for initial diagnosis which is called the cancer antigen 125 or CA 125 level. This is often elevated in almost 80 percent of patients with ovarian cancer it will be high. This is something we use during treatment to monitor is the number goes down. It usually does if the treatment is successful, it goes down. And it helps to monitor relapses as well because if the number starts to go up again during your follow up visits, it will raise suspicion for relapse of the cancer.

Ovarian Cancer Symptoms

The symptoms of ovarian cancer are abdominal pain, abdominal fullness or bloating due to fluid build up in the abdominal cavity and often urinary symptoms like urinary urgency or frequency. Patents may experience a lack of appetite and a feeling of fullness when they eat because of the abdominal fluid build up, and respiratory symptoms down the line if they end up with fluid build up around their lungs which we refer to as a pleural effusion.

Ovarian Cancer Treatment

The treatment for ovarian cancer can involve visits with multiple specialties including a surgeon and medical oncologist. The initial part of treatment most often involves surgery. The purpose of surgery is two-fold. Surgery helps determine the extent of the tumor in your body and what a surgeon does when he goes in, in addition to removing the tumor, he will look at the spread of the disease beyond the ovaries into the pelvic cavity into the lymph nodes surrounding the area and look at fluid in the abdominal and peritoneal cavities and see if that is also showing cancer cells. All that information is very important to determine what treatment course you will have further after the surgery is done. After the surgeon has looked at all these findings, we determine a treatment stage and that often determines whether you are going to have chemotherapy subsequently or require additional surgery down the line or if you can be observed and not need any further treatment. The surgeon will try to remove as much of the tumor as possible because what we call ‘optimal site  reduction’ means removing tumor to where there is less than a centimeter of tumor left behind in your body. That has shown to improve survival more than anything else. The volume of disease that is left behind, the amount of tumor left behind, will correlate directly with your survival. The less tumor that is left behind the better your survival will be. After surgery is accomplished, we often have you go to a medical oncologist who will look at the disease stage and determine if you need further treatment with chemotherapy. Chemotherapy can be given through the IV and also into the abdominal cavity and depending on the stage of the cancer we choose an option of giving IV chemotherapy and that goes on for a few months before the treatment is completed. After this you will be on surveillance and your doctors will watch you very closely to make sure your cancer does not relapse. That’s the idea of giving chemotherapy following surgery which is to treat any remaining cancer cells and kill them before they cause a relapse in the ovarian cancer.

Screening and Testing at Atrium Medical Center

Screening for ovarian cancer is not routinely recommended for women who are at average risk for ovarian cancer. The lifetime risk for the general population of women to develop ovarian cancer is about 1.4 percent. There have been trials looking at a combination of using transvaginal ultrasound as well as the tumor marker we call the CA 125 level to see if doing these on an annual basis will detect ovarian cancer sooner and lead to improved survival. Now the three trials that looked at the combination of the transvaginal ultrasound and the CA 125 level did not show any decrease in mortality from ovarian cancer. The recommendation now is not to screen average risk women for ovarian cancer. If you were to have a history of ovarian cancer in your family and have what we call hereditary ovarian cancer syndromes, for example the breast/ovarian cancer syndrome which is associated with a BRC mutation, your risk for developing ovarian cancer is much higher, often described in the range of 35 to 40 percent. The screening parameters would be different if you had the history of hereditary ovarian cancer or breast cancer in your family. You would need a transvaginal ultrasound as well as a CA 125 level and the screening would be made about five to 10 years before the earliest age at which the diagnosis was made in your family member. That is the recommendation for patients who have the hereditary cancer syndromes. For average risk women there are no standard recommendations to screen for ovarian cancer unlike with breast cancer where you do get annual mammograms. A lot of this testing for diagnosis and screening all can be done at one time when you come to Atrium Medical Center. You do not have to go to separate visits or separate offices to get all of this testing which is a great benefit to patients who are in the middle of trying to get a diagnosis and getting a treatment plan in place.