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Your Ovarian Cancer Journey: Diagnosis, Staging And Treatment

The thought of having ovarian cancer will likely set your head spinning. It’s time for deep breaths and baby steps. Your doctor, ideally a gynecologic oncologist who specializes in treating cancers of women’s reproductive organs, will guide you through each step. Gynecologic oncologist Michael Guy, MD, explains the diagnosing, staging and treatment processes that are most common to ovarian cancer patients.

How Will My Cancer Be Diagnosed?

Your cancer will be diagnosed based on a tissue sample (biopsy). An interventional radiologist may perform an  image-guided biopsy and report the results to your physician. Or your doctor may take a biopsy when performing a laparoscopy, (your doctor makes small incisions and inserts special instruments to view the pelvic region) or when making a larger incision in the pelvis (a laparotomy). In addition, typically CT scans of the chest, abdomen and pelvis will be taken to evaluate the extent of the cancer. 

Dr. Guy explains that ovarian cancer is one of the hardest diseases to identify early because symptoms in the early stages can be mistaken for other conditions. 

Click play to watch the video or read video transcript.

What Happens Next?

Your treatment will include surgery and chemotherapy, with the goal of reducing signs and symptoms of the cancer. Your treatment will be individualized based on your specific condition. The goal of surgery is to remove all visible disease. Based on your exam, your ability to perform daily activities, and your test results, your doctor will recommend one of these next steps:

1. Surgery and chemotherapy. Through an incision in the pelvis (laparotomy), your surgeon will remove any visible cancer, as well as the ovaries, uterus, and cervix. He will also take tissue samples from your pelvic and abdominal regions. After surgery, you’ll undergo chemotherapy.
2. Neoadjuvant chemotherapy (NACT). Chemotherapy is the first treatment (instead of surgery). If it’s effective, as seen on repeat CT scans, your doctor will perform surgery to remove the remaining visible cancer. After surgery, you will continue on additional chemotherapy.
3. Laparoscopy. Occasionally, this minimally invasive technique is used by your doctor to see the extent of disease and decide whether to perform surgery or proceed with NACT.

What Are Cancer Stages?

Staging is an indicator of how much cancer is in your body and where it’s located.

Stage I means the cancer is in one or both of your ovaries or fallopian tubes, but hasn’t spread any further than that.

Stage II means the cancer also has grown into your pelvic organs like the uterus, bladder, colon, or rectum.

Stage III means the cancer has spread to the lining of your abdomen and/or your lymph nodes. Lymph nodes are small bean-shape structures throughout your body that fight infection. There are hundreds of lymph nodes in your body.

Stage IV means the cancer has spread beyond the pelvis and abdomen to places like your liver, spleen, lungs, or other organs.

Your treatment will include surgery and chemotherapy, with the goal of reducing signs and symptoms of the cancer.

Deciding On Further Treatment

As you discuss any future treatment plans with your doctor, be prepared to ask questions. You’ll want to know how the treatment will make you feel both short-term and long-term. Will there be any permanent side effects?

Your doctor may recommend chemotherapy to kill or slow the cancer’s growth. Usually, “chemo” medicine is given through an IV, and each treatment session lasts several hours. The treatment period varies with each patient, but chemo typically lasts for about six months. Your doctor will determine how often you’ll receive chemo. The side effects of chemo depend on which medicines you get. Ask your doctor about the side effects before agreeing to a treatment plan.

When your chemotherapy treatment ends, your doctor will periodically test to determine if cancer is still present or if it has returned. You may receive scans that detect cancer’s presence. Or you may have your blood tested for tumor markers. An elevated level of tumor markers could be a sign that your cancer has recurred.

Radiation therapy (high energy x-rays that kill cancer cells) is a common cancer treatment, but it is rarely used to treat ovarian cancer. However, it may be recommended to ease your symptoms.

What About Clinical Trials?

Clinical trials are research studies that help find new ways to treat cancer. They can give you access to the newest treatment methods. The National Comprehensive Cancer Network believes that clinical trials offer the best management for any patient with cancer, and they encourage patients to participate in clinical trials. Learn more about joining a clinical trial.

Source: National Ovarian Cancer Coalition; American Cancer Society; National Cancer Institute; Centers for Disease Control and Prevention; Michael Guy, MD Premier Gynecologic Oncology

Michael S. Guy, MD

Premier Gynecologic Oncology

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