Ovarian Cancer White Paper

Ovarian cancer begins on the outside surface of the ovaries.  It is most common in the postmenopausal years and in ten percent of cases it is associated with the presence of an inherited abnormal gene.  Ovarian cancer is often curable when it is detected before cells have spread beyond the site of origin. The problem is that the ovaries lie deep inside the pelvis which makes it difficult to detect before cells are cast off the surface of the ovary.  When that happens the cells may attach to intrabdominal structures including the intestines and the omentum. It is quite rare for ovarian cancer to spread beyond the intraabdominal structures.

The first symptoms of ovarian cancer can be vague and non-specific but some symptoms are usually present.  These typically include a feeling of bloating, fullness, and a loss of appetite.  Bladder symptoms are also common, particularly increased frequency of urination.  Back pain is frequently reported as well.

When ovarian cancer is suspected a pelvic examination and sonogram are helpful .  Many blood tests have been developed but they are frequently misleadingly normal when curable cancer is present and greatly abnormal when benign conditions are present .

The initial diagnosis and assessment of ovarian cancer is performed surgically.  Many retrospective research studies have shown that accuracy and effectiveness of the initial operation for ovarian cancer is highly dependent on the surgeon’s skill and training and should ideally be done by a gynecologic oncologist.  This is because ovarian cancer has a subtle pattern of spread which requires a special skillset. When early stage cancer is suspected, minimally invasive surgery with a short hospital stay is often the best approach to remove the cancer and establish the stage of the disease.  This is often best done by using a surgeon controlled surgical robot.  Special Gynecology and Oncology was the first  to employ this technology in ovarian cancer cases in Utah in an effort to comprehensively stage early disease  while minimizing recovery time.

When advanced disease is present it is advisable to prepare for a more extensive operation with the goal of removing all visible tumor using more comprehensive procedures.

When the disease has spread beyond the ovary, cancer treatment medication  is often given a few weeks later.  In the past, this has been limited to traditional chemotherapy, however we are developing  and using other medical treatments  and it seems possible that these treatments may supplant chemotherapy in the future.

Regardless of the treatment methods used, it is important to maintain a close working relationship with your gynecologic oncologist so that problems can be anticipated and avoided.  By using this approach, ovarian cancer has taken on the characteristics of a chronic disease state with many effective treatments  using different modalities.  The results are seen in the slow but steady improvement in survival and decrease in treatment side effects seen over the past decade.