About Ovarian Cancer
Cancer of the ovary is the second most common gynecologic malignancy. The average age of diagnosis is 63 years old. A woman’s lifetime risk of ovarian cancer is 1.4%.
Signs and Symptoms
The symptoms of ovarian cancer are usually vague, especially in early stages. Symptoms usually include:
- abdominal bloating or swelling
- abdominal or pelvic pain or pressure
- loss of appetite, difficulty eating or feeling of fullness
- urinary problems
- abdominal distension (similar to bloating)
- unexplained and sudden weight loss
- weakness and/or unexplained onset of fatigue
- persistent fever
- unusual changes in fingernails, hair, and/or skin, including unusual rashes
- lump or swelling of lymph nodes (either in armpit and/or neck)
- pain with intercourse
- urinary frequency
- formation of ascites (collection of fluid in the abdomen, contributing to bloating & shortness of breath)
- gas and/or diarrhea
- nausea and vomiting
- pubertal development, and abnormal hair growth (with tumors that secrete hormones)
- genetics factors such as BRCA1/2 gene mutation and Lynch Syndrome
- caucasian race
- early age of first menses
- late onset of menopause
- never having children
- familyhistory of ovarian cancer
- endometriosis – Endometriosis has been shown to increase the risk of certain types of ovarian cancer, mainly endometrioid, clear cell, and low grade serous carcinoma. Unfortunately at the present time there is no special test to find out which patient with endometriosis will develop cancer. Thorough evaluation of these patients specifically with surgical management of their endometriosis is essential.This is an area of research in which Dr. Farr Nezhat has published extensively.(Click here to read Dr. Farr Nezhat’s latest research on ovarian cancer).
Screening and Diagnosis
The diagnosis of ovarian cancer can only be made through surgery. Based on the latest research, biopsies of the fallopian tubes may help catch some forms of ovarian cancer because many forms of ovarian cancer actually arise from the fallopian tubes, and not the ovaries. Unfortunately there is no good test to diagnose or screen for ovarian cancer. Usually the patient’s entire clinical picture has to be considered, including symptoms, blood tests such as Ova-1 and CA-125, which can be elevated in some ovarian cancers, and imaging tests. If there is a suspicion for ovarian cancer, a diagnostic laparoscopy is required to visualize the ovaries and abdominal cavity, take biopsies and remove suspicious growths.
Prevention: Reduced risk of ovarian cancers when fallopian tubes are removed
A counterintuitive reversal of opinion has also occurred with respect to removing the fallopian tubes. This is because researchers have recently discovered that the majority of ovarian cancers actually begin developing inside the fallopian tubes and not the ovaries. Therefore, if a woman has completed her family and is undergoing pelvic surgery for any reason, it’s a good idea to remove the fallopian tubes because it decreases the risk of ovarian cancer (if your doctor deems that the benefits outweigh the risks associated with surgery). And because the fallopian tubes are not involved in the production of hormones, this means that women who have them removed have no hormonal disruptions as they would with the removal of the ovaries.
The treatment of ovarian cancer is to first remove the cancer. For very early stages, this usually involves removing one or both ovaries. Because later stages of ovarian cancer usually spread within the abdominal cavity, this often means that the ovaries, uterus, cervix, fallopian tubes, appendix and other involved structures need to be removed. The more complete the removal, the better the prognosis. After surgery, chemotherapy is usually required to treat any microscopic disease and to decrease the risk of recurrences.
Contrary to popular beliefs, ovarian cancer can be treated minimally invasively
The removal of ovarian cancer previously required a large incision along the entire length of the abdomen. However, Drs. Camran and Farr Nezhat were the first to completely remove even the largest ovarian tumors laparoscopically and robotically, thus obviating the need for the large and painful incisions of yesteryear which often significantly increased the morbidity of patients who were already medically vulnerable due to their cancer. And, because laparoscopy provides better visualization of the abdominal cavity, it actually allows surgeon to remove even more cancerous growths than was possible using the traditional surgical technique of laparotomy.
Years ago, when Drs. Nezhat first accomplished these unprecedented surgeries, many thought it was absolutely impossible to perform such complex surgeries in a minimally invasive manner. Today, however, Drs. Nezhat have proven that minimally invasive techniques for all stages of ovarian cancer are not only possible but beneficial for the patient’s prognosis and recovery.
Contrary to popular beliefs, gynecological cancers can be treated minimally invasively
The removal of gynecological cancers previously required a large incision along the entire length of the abdomen (laparotomy), often hip bone to hip bone. These painful surgical methods of yesteryear often led to serious, life-threatening complications that often caused more injury (and mortality) than the cancer itself. However, Drs. Camran and Farr Nezhat proved that such debilitating large incisions were no longer necessary when they became the first to completely remove even the largest gynecological tumors (including para aortic lymph node dissection) laparoscopically and robotically. And, because laparoscopy provides better visualization of the abdominal cavity, it actually allows surgeons to remove even more cancerous growths and perform even more complete lymph node dissections than was possible using the traditional surgical technique of laparotomy.