SYMPTOMS, TREATMENT & STAGING

 

SYMPTOMS

Understand that a pelvic exam is not an effective screening tool for ovarian cancer.  In addition, in its early stage, epithelial ovarian cancer often causes no symptoms.  Stromal cell tumors can show signs early (specifically granulosa cell tumors) as noted below, although how physicians can best use this data for screening purposes is yet to be determined. While more research is needed to determine effective, accurate screening methods for all types, be very familiar with your body, noting the following changes that you should discuss with your gynecologist if they persist on a daily basis for 2 to 3 weeks:

  • abdominal bloating

  • pelvic pressure/pain

  • abdominal pain, often sudden/severe in the case of granulosa cell tumor

  • feeling full quickly/difficulty eating

  • urinary urgency or increased frequency

    • Additional factors in your history to note are:

      • starting your menstrual cycle before age 12 (granulosa cell tumor)

      • vaginal bleeding after menopause (granulosa cell tumor)

      • sudden halt in regular menstrual cycle (granulosa cell tumor)

      • infertility (granulosa cell tumor)

      • excessive facial and body hair growth (granulosa cell tumor)

FOR MORE INFORMATION ON SYMPTOMS, see THE RESOURCE GUIDE PROVIDED BY THE FOUNDATION FOR WOMEN'S CANCER


TREATMENT OPTIONS

Surgery (debulking): the first line of defense for all of the types of ovarian cancer, with the goal to be the complete removal, or debulking, of all visible and detectable tumors.  In the case of granulosa cell tumors, this can be the ongoing form of treatment for recurrence, as long as the patient and physician agree on this method.

Chemotherapy/radiation therapy: often the next course of action for most types of ovarian cancer following surgery.  In the case of granulosa cell tumors, if it is at an early stage when detected (typically Stage 1), then surgery with monitoring of blood (serum) tumor markers and CT scans can be done instead of chemotherapy/radiation therapy. 

Hormonal therapy: can be the next course of action following surgery for granulosa cell tumors.  Because these tumors have receptors for estrogen and/or progesterone, the goal of this treatment option is to reduce the levels of these hormones in the body, thereby slowing the growth of the tumors.

Complementary and alternative therapies: these consist of non-conventional methods, such as significant changes in diet, the use of supplements (i.e. vitamins, herbs, minerals), acupuncture, light therapy, etc.  Complementary therapy is used along with the prescribed therapy advised by your physician.  Alternative therapy is used instead of the prescribed medical therapy advised by your physician.  Some are used to treat the cancer, while others are used to treat the side effects of both the cancer and conventional therapies. Because the U.S. supplement industry is not regulated, the content and concentration of the advertised substance may not be consistent with what is actually advertised.  In addition, some of these therapies may negate the effect of your prescribed therapy, or even accelerate their effects in a harmful manner.  It is advised to seek a naturopath and to talk with your oncologist about any therapies that you wish to use that fall into this category.  For a detailed list of several of these therapies, along with their side effects and uses, consult the Memorial-Sloan Kettering guide.

Clinical trials:  there are a number of reasons why a woman may decide to participate in a clinical trial, and there are a myriad of things to consider about where the study fits in her overall treatment plan.  What are the possible side effects?  How long will the study take?  What does it hope to accomplish?  Discussing this decision with one's doctor, and doing thorough research about the trial itself, is paramount.  For more information on finding a clinical trial, see the most recent information provided by the American Society of Clinical Oncology.

This is your body, and you have the right to advocate for yourself.  When possible, find a physician who spends the time to listen carefully to what you have to say, and who gives detailed, easy to follow explanations.  Tremendous pressure can come from your physician, family, friends, and even strangers on the best course of action for you to take.  Learn as much information about your diagnosis and treatment options as you can. Get as many medical opinions as you feel that you need, and have the time, to seek.  Some of the things that you may wish for your oncologist to tell you are:

  • the type of ovarian cancer that you have
  • the stage of your cancer
  • all viable treatment options
  • expected side effects
  • prognosis

for more information on treatment options and other critical data, see the patient guide provided by the national comprehensive cancer network


 Photo courtesy of Kyle Broad

Photo courtesy of Kyle Broad


STAGING

Stage I: The cancer is found in one or both ovaries. Cancer cells also may be found on the surface of the ovaries or in fluid collected from the abdomen.

Stage II: The cancer has spread from one or both ovaries to other tissues in the pelvis, such as the fallopian tubes or uterus. Cancer cells may also be found in fluid collected from the abdomen.

Stage III: The cancer has spread outside the pelvis or nearby lymph nodes.
Most commonly the cancer spreads to the omentum (an apron of fatty tissue that hangs down from the colon and stomach), diaphragm, intestine and the outside (surface) of the liver.

Stage IV: The cancer has spread to tissues outside the abdomen and pelvis. Most commonly the cancer has spread to the space around the lungs. If the cancer spreads inside the liver or spleen, it is considered stage IV.

for more information, see the 2014 figo staging data provided by the society of gynecological oncology