Ovarian Cancer

OVERVIEW

Ovarian cancer is a gynecologic cancer that attack the ovaries, the two organs on each side of the pelvis that produce eggs and the female hormones estrogen and progesterone. Most ovarian cancers (90 percent) begin with a tumor in the epithelial cells, which cover the surface of the ovaries.

One in every 60 women develops ovarian cancer some time in her lifetime. It is the fifth deadliest cancer in women because it is often diagnosed when the cancer is advanced and treatment is more difficult or less successful.

In 2007, the American Cancer Society estimates that 22,400 women will be diagnosed with ovarian cancer in the United States. In order to prevent more women from developing ovarian cancer in the future, The Cancer Center's Division of Gynecologic Oncology has established a prevention program called the Maureen Fund for Ovarian Cancer for women at high risk of developing ovarian cancer. The Maureen Fund provides ultrasound screenings, risk assessments, blood tests, genetic screening, a tumor registry, and educational services. Another preventive program, the Hereditary Cancer Risk Assessment Program - a collaboration of The Cancer Center, the Betty Torricelli Institute for Breast Care, and the medical center's Departments of Surgery, Medicine, and Obsetrics/Gynecology - identifies women at risk for ovarian, breast, colon, and endometrial cancers. The program provides screenings and preventive services to reduce women's' risk for these related cancers.

If you are diagnosed with ovarian cancer, The Cancer Center provides some of the most innovative treatment methods available today and in clinical trials. These include stem cell translantation, immunotherapy, photopheresis, intraperitoneal chemotherapy, and combinations of chemotherapeutic medications. 

The Cancer Center's Division of Gynecologic Oncology also provides:

  • minimally invasive laparoscopic surgical procedures
  • a twice-monthly gynecologic oncology clinic
  • sophisticated diagnostic testing and imaging studies
  • clinical trials to investigate new medications and treatment methods
  • monthly meetings of the Gynecologic Tumor Board, where cases are discussed and treatment plans are developed by a multidisciplinary team of cancer specialists
  • a full range of support services

 

PREVENTION

The Maureen Fund for Ovarian Cancer aims to reduce the number of women developing ovarian cancer. The Maureen Fund provides ovarian cancer screenings and prevention service for high-risk women. The goal is to detect ovarian cancer early when it is most treatable. The program's services include risk assessments, blood tests for the CA 125 protein (which is commonly elevated in women with ovarian cancer), ultrasound screenings, genetic screenings, genetic counseling, and a tumor registry for patient records, follow-up, and banking of malignant tissue samples from patients for research purposes. For more information, call (201) 996-4287.

If you have a personal or family history of colorectal, ovarian, or endometrial cancer, you may be at increased risk of developing breast cancer. Our Hereditary Cancer Risk Assessment Program offers genetic counseling and testing services to determine each patient's risk. A medical management plan is developed for each patient and may include various methods to reduce risk factors, including medication, prophylactic surgery, diet, exercise, smoking cessation, and other recommendations for a healthy lifestyle. Various issues are discussed, such as privacy, insurance, psychosocial, and family issues. We keep up to date on patients through our high-risk registry. For more information or to make an appointment, call (201) 996-5264.

 

RISK FACTORS

Risk factors for ovarian cancer include:

  • increased age
  • the use of the fertility drug clomiphene citrate without achieving pregnancy
  • a greater number of menstrual cycles throughout life because of early onset menstruation, menopause after age 50, having a child after 30, or no pregnancies
  • a family history of breast and/or ovarian cancer
  • a personal history of breast or colon cancer

 

SYMPTOMS

Ovarian cancer can be difficult to detect because the ovaries lie deep in the pelvic cavity. Ovarian cancer is sometimes called a "silent killer" because its symptoms can be vague or confused with other common symptoms. Symptoms of ovarian cancer include:

  • swelling of the stomach
  • gastrointestinal problems (gas, bloating, long-term stomach pain, indigestion)
  • bleeding between periods or after menopause
  • pelvic pain
  • a feeling of pressure in the pelvis
  • leg pain

 

OVARIAN CANCER TREATMENT OPTIONS

Ovarian cancer is a difficult cancer to treat and should be undertaken by a board-certified gynecologic oncologist. The main ovarian cancer treatment options are surgery, chemotherapy, and radiation therapy. A combination of treatments may be used. Researchers at The John Theurer Cancer Center are investigating a number of innovative new treatment methods, including stem cell transplantation,  photopheresis, intraperitoneal chemotherapy, and immunotherapy with cancer vaccines.

Surgery

Surgery to treat ovarian cancer is a complex procedure and should only be performed by a board-certified gynecologic oncologist. There are several different surgical approaches to treat ovarian cancer. Your physician will decide which is best depending on the stage, type, grade of the cancer, any spread of cancer, whether you are of childbearing age and wish to bear children, your overall health, your age, and other factors:

  • unilateral or bilateral oophorectomy (removal of one or both ovaries)
  • unilateral or bilateral salpingectomy (removal of one or both fallopian tubes)
  • unilateral or bilateral salpingo-oopherectomy (removal of one or both ovaries and fallopian tubes)
  • cytoreduction (debulking) surgery (removal of as much tumor as possible even though all of it cannot be removed) to improve the prognosis

Stem Cell Transplantation

The use of stem cell transplantation to treat ovarian cancer is under investigation at The Cancer Center. Michele L. Donato, M.D., our medical director of the blood and marrow collection facility for stem cell transplantation, treated more than 200 women with ovarian cancer in her previous position at M.D. Anderson Cancer Center at the University of Texas in Houston. Since joining Hackensack University Medical Center in 2005, she has expanded the number of clinical trials that are evaluating the use of stem cell transplantation to treat ovarian cancer. The Cancer Center's Adult Blood and Marrow Stem Cell Transplantation Program is one of the nation's 10 largest programs. Each year more than 200 stem cell transplants are performed here.

Chemotherapy

Chemotherapy may be used to treat ovarian cancer. The treatment is usually administered intravenously in six cycles using a combination of drugs. Physicians in the Division of Gynecologic Oncology are also using intraperitoneal (IP) chemotherapy to treat some patients with advanced ovarian cancer. IP chemotherapy is typically used following surgical removal of the ovaries. IP chemotherapy involves introducing chemotherapy agents directly into the patient's abdominal cavity, where the medication can destroy any remaining cancerous cells. Because ovarian cancer easily spreads to other organs in the abdominal cavity, it is often necessary to treat the entire area.

Over the past 10 years, there have been a number of clinical trials to evaluate the effectiveness of IP chemotherapy for the initial treatment of advanced ovarian cancer. A Gynecologic Oncology Group research study of 415 women revealed that those who were treated with IP chemotherapy survived for 15.9 months longer than women treated with standard IV chemotherapy. However, because serious side effects can occur, this treatment is carefully evaluated for women who meet certain criteria.

One of The Cancer Center's hematologist/oncologists, Donna McNamara, M.D., is heading a clinical trial to evaluate the drug Avastin to treat ovarian cancer. Avastin is an angiogenesis inhibitor that stops the growth of new blood vessels that "feed" tumors. The drug also opens up blood vessels that are already there to allow greater access for chemotherapy to reach the tumor and destroy it. Avastin has already been approved by the Food and Drug Administration to treat lung and colon cancers and is now being studied for its effectiveness in treating ovarian cancer.

Photopheresis

Photopheresis is an innovative adjuvant (additional) treatment to stem cell transplantation that is under investigation by one of our hematologist/oncologists, Michele L. Donato, M.D., for patients with ovarian cancer. The Cancer Center is one of only a few sites in New Jersey where this treatment is available. Photopheresis is the use of ultraviolet light therapy to treat graft-versus-host disease (GVHD), a common and potentially fatal complication of stem cell transplantation. GVHD occurs when donor T cells used in stem cell transplantation stage an immune response to the "foreign" organs in the recipient's (host's) body and attack them. Photopheresis involves isolating T cells, treating them with medication, and then exposing them to ultraviolet light. The light prevents the T cells from dividing and reproducing. The T cells are then put back into the patient's blood and reinfused back into the patient's body. The treated T cells temper the immune response and prevent it from being too aggressive against the patient.

Radiation Therapy

Radiation therapy is rarely used as a primary treatment for ovarian cancer. External beam radiation therapy may be used as an adjuvant (additional) therapy to shrink the tumor before surgery or to eradicate any cancer cells remaining after surgery. Clinical trials are under way at The Cancer Center to study the use of whole body irradiation to the entire abdominal cavity because ovarian cancer spreads easily to other organs in this area.