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At Boston Medical Center (BMC), the care of patients with ovarian cancer is a collaborative, multidisciplinary process. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits. The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality of life.
As the primary teaching affiliate of the Boston University School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.
In addition to ovarian cancer, BMC’s gynecologic oncologists have expertise in treating many types of female pelvic cancers, including cancers of the uterus, cervix, vulva, and trophoblast (placenta). Patients with a diagnosis or strong suspicion of cancer are given appointments within 72 hours.
What Is Ovarian Cancer?
Ovarian cancer is a type of cancer that begins in the ovaries. The ovaries are part of the female reproductive system. They are located on either side of the uterus in the pelvic region of the body. The ovaries produce eggs (called ova) and are the primary source of several female hormones.
There are three main types of malignant (cancerous) ovarian tumors:
- Epithelial (surface) cell tumors begin in the cells that cover the outer surface of the ovary. They are the most common type of ovarian tumor.
- Germ cell tumors begin in the cells that form the eggs (ova) and are fairly rare.
- Stromal cell tumors begin in the cells that help keep the ovary together and produce the female hormones. This type of tumor is also rare.
Many ovarian tumors are benign (noncancerous) and never spread beyond the ovary. The cancerous tumors are more dangerous because they can spread to other parts of the body.
Symptoms of Ovarian Cancer
The symptoms of ovarian cancer are often vague and non-specific. However, women with ovarian cancer often report signs and symptoms that include
- Abdominal bloating or swelling
- Feeling full
- Frequent urination
- Pelvic pain
- Loss of appetite and weight loss
- Shortness of breath from fluid build-up around the lungs
Patients with concerns about any of the signs and symptoms listed above are urged to consult their physician immediately.
Causes of Ovarian Cancer
Although the exact causes of ovarian cancer remain unknown, certain risk factors—things that increase an individual's chances of developing a cancer—have been identified. While risk factors may be useful in identifying high-risk individuals, they do not determine whether an individual develops a disease. Some risk factors, such as diet, are within an individual’s control, while others, such as age, are not.
Some risk factors for ovarian cancer include
- Age: Older women have a greater risk of developing ovarian cancer. Most women who develop ovarian cancer are over age 50.
- Family history: If women have immediate family members with ovarian cancer, they have an increased risk of the disease. Family histories of breast and colon cancers can also increase the risk of ovarian cancer.
- Genetic syndromes: There are several inherited gene mutations (changes to a cell’s genetic makeup) that may increase a woman’s chances of developing ovarian cancer. For example, mutations in either the BRCA1 or the BRCA2 genes increase your risk for both ovarian and breast cancers and can be passed on through generations. View more information on the BRCA1 and BRCA2 genes here.
- Obesity: Women who are obese have an increased risk of developing ovarian cancer.
- Having children: Women who have given birth have a decreased risk of developing ovarian cancer. A woman’s risk continues to drop with each additional full-term pregnancy.
Currently, there are no screening procedures in place to detect ovarian cancer. However, patients with a strong family history of ovarian or breast cancer may be eligible for genetic counseling. For more information, patients can visit Genetic Counseling or talk to their physician to request a referral.
Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because it is used to determine the most appropriate treatment options for patients. The stages of ovarian cancer range from Stage I (the least severe stage) to Stage IV.
Stage I: Cancer is present in one or both ovaries.
Stage II: Cancer is present in one or both ovaries and has spread to other organs in the pelvic region (e.g., the uterus, fallopian tubes, bladder, sigmoid colon, or rectum).
Stage III: Cancer is present in one or both ovaries and has advanced beyond the pelvis to the lining of the abdomen and/or the lymph nodes in the back of the abdomen.
Stage IV: Cancer has spread to organs outside of the peritoneal (abdominal) cavity. Cancer cells in the fluid around the lungs also mean Stage IV ovarian cancer.
(American Cancer Society 2015, Society of Gynecologic Oncology 2014)
American Cancer Society. 2015. Detailed Guide: Ovarian Cancer. PDF.
Society of Gynecologic Oncology. 2014. FIGO Ovarian Cancer Staging. PDF. https://www.sgo.org/wp-content/uploads/2012/09/FIGO-Ovarian-Cancer-Staging_1.10.14.pdf
Treatments & Services
Surgery for Ovarian Cancer
Most patients will have surgery performed as part of their treatment plan. The goal with surgical treatment is to remove as much of the cancer as possible (a process called debulking). If ovarian cancer is diagnosed at an early stage, then the surgeon (gynecologic oncologist) has a greater chance of removing all of the cancer and curing the patient. If patients are diagnosed at later stages, they may require one or more surgical procedures.
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV).
Diagnostics and Tests
Ovarian cancer is often diagnosed in the late stages when the disease is already advanced. This is because the symptoms are vague and often attributed to other conditions, which delays diagnosis. Sometimes, these common symptoms are more severe in women with ovarian cancer, but this isn't always the case. Early-stage diagnosis is beneficial because it improves survival rates. Therefore, it is important for women to be aware of overall changes in the way they feel and see their physician if they notice any new symptoms that don't improve over time.
If a primary care physician suspects that ovarian cancer might be the cause of his or her patient’s symptoms, he or she will be refer the patient to a gynecologist or gynecologic oncologist, a physician who specializes in treating conditions of the ovaries, uterus, and cervix.
Starting with her first visit to BMC, the patient will receive coordinated, multidisciplinary care that is managed by a gynecologic oncologist. At this time, specialists will use one or more of the following methods to diagnose ovarian cancer.
If a cancer diagnosis is made, multiple specialists will review the patient’s case at a biweekly Tumor Board meeting. This interdepartmental review process guides recommendations for treatment. In consultations with the patient and her primary care physician, the best course of treatment is planned based on the type and extent of the cancer and the patient’s overall health.
Physical Exam for Ovarian Cancer
Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will include examining any specific areas of concern, especially as they relate to the reason for your visit to the office. The physical exam may include feeling the pelvic area to find enlarged ovaries or fluid in the abdomen area (ascites).
Imaging Tests for Ovarian Cancer
A variety of imaging tests may be done to help diagnose ovarian cancer. These imaging tests may include ultrasound or CT scans.
Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses high-frequency sound waves to produce images of structures within the body. The images can provide valuable information for diagnosing and treating a variety of diseases and conditions. Most ultrasound examinations are done using a sonar device outside the body, though some ultrasound examinations involve placing a device inside the body.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut.
BMC’s comprehensive ovarian cancer team includes physicians who work in surgical oncology specific to gynecology, medical oncology and radiation oncology. The team’s patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.
Gregory Russo, MD
Attending Physician, Department of Radiation Oncology, Boston Medical Center
Clinical Assistant Professor of Radiation Oncology, Boston University School of Medicine
BMC offers a number of clinical trials specifically for ovarian cancer patients. Promising new techniques in the diagnosis, treatment, and care of patients with ovarian cancer are tested in these studies. The number and types of clinical trials available are constantly changing.