By Sandra Ray, Staff Writer
According to the latest
statistics from the American Cancer Society, ovarian cancer ranks
number eight on the list of cancers to affect women. It is also
ranks as the fifth most deadly. Ovarian cancer is largely silent
until it has spread beyond the ovaries. There are few tests that
reliably detect ovarian cancer, making regular screenings important,
coupled with providing your family doctor with information about how
your body feels in relation to your overall health. Sometimes
symptoms speak louder than tests when it comes to ovarian cancer.
Treatment options vary widely,
depending on the staging of the disease. Almost all will involve
some type of surgery to remove the affected tissue. The extent of
chemotherapy and radiation therapy is determined by the stage of the
cancer and the patient’s options for successful treatment.
In Stage I
epithelial ovarian cancer, surgical treatment generally involves
removal of one or both ovaries. Since the disease has not spread
beyond the ovaries at this point, chemotherapy may not be required.
Doctors may try to preserve at least one ovary in women who are
young enough to still have children as long as it does not appear
that the disease has spread. A complete hysterectomy is also an
option to physicians at this stage. Doctors will also biopsy nearby
tissue to be assured that the cancer has not spread further. A
biopsy of the lymph tissue is also included since cancer spreads
most rapidly through the lymphatic system.
Some doctors will recommend a
low level of chemotherapy if they feel that the cancer is likely to
recur. Keep in mind that less than 20 percent of all ovarian cancer
cases are detected at this early stage, making chemotherapy and
other treatment forms more likely as the seriousness of the cancer
increases. This stage also has the best prognosis at five years,
with approximately 90 percent of women surviving according to
statistics released from the University of Maryland Medical Center (UMMC).
With Stage II cancer, the
disease has spread beyond one or both ovaries and into the stomach
area. It is more aggressive and will require surgery in order to
remove tissue affected by the cancer. Almost all surgeons will
perform a complete hysterectomy and biopsy surrounding tissue to
determine the extent of the cancer. Lymphatic tissue biopsies are
Chemotherapy will definitely be
included in the treatment plan since the disease could have spread
further than the cells detected in the surgery. The types of
chemotherapy vary and usually include a combination of more than one
type. Radiation therapy enters into the treatment mix at this point
as well, with some doctors using it while others prefer to use
chemotherapy only. Prognosis for this stage is still fairly high,
with five year survival rates as high as 60 to 80 percent.
Stage III ovarian cancer is
treated much the same as stage II cancer, although the chemotherapy
involved is much more aggressive. Radiation therapy becomes more
likely at this stage, especially given that the cancer is much more
aggressive and has spread further into the body. Since the prognosis
drops significantly with stage III ovarian cancer, doctors will use
combination chemotherapy during their treatment.
Surgery becomes possible both
before chemotherapy and after. The second round of surgery is done
primarily to ensure that all of the cancerous tissue has been
removed and none has escaped undetected, either by the first surgery
or by the chemotherapy sessions. Survival rates drop significantly
with stage III ovarian cancer, report UMMC, with a five year
survival rate of 20 percent.
Stage IV ovarian cancer has the
poorest prognosis according to UMMC with only 10 percent of women
surviving after five years. Doctors concentrate heavily on surgery
and chemotherapy in order to treat the disease. More than one round
of both types of treatment is often utilized since the disease has
metastasized or spread into many different areas of the body by now
and can rapidly grow undetected by doctors.
Radiation Therapy Issues:
When assessing the role of
radiation therapy, patients and caregivers need to understand the
reason why it is used or not used in specific cases. Ovarian cancer
cells actually respond quite well to radiation therapy and tend to
shrink quickly. Radiation therapy, however, can cause problems for
healthy cells n the affected area. For example, when treating
ovarian cancer that has moved into the abdomen, doctors do not like
to “radiate” the entire abdominal area for fear that healthy tissue
will be destroyed by the treatment. (Years ago, this type of
approach was used, and it has since lost its popularity.)
If a doctor feels they can focus
the area that needs to receive radiation, it is definitely
considered as a treatment option. If, however, the whole abdomen
needs radiation, the doctor will more likely resort to using
different types of chemotherapy to treat the disease rather than
risk destroying tissue through radiation and increasing the amount
of toxicity in the body.
Treating Recurrent Cancer:
Treating the disease the first
time does not guarantee that the disease is gone entirely.
Researchers in Rockville, MD reported in 2000 that that “emergence
of drug-resistant tumors during therapy for ovarian cancer remains
an obstacle to improving long-term outcomes.” In other words, more
types of ovarian cancer are becoming resistant to the type of
chemotherapy drugs available on the market today making the disease
more likely to either continue to spread or to recur after the first
round of treatment is completed.
One reason that ovarian cancer
is a likely candidate for recurring is due to its low rate of early
detection. In cancers other than stage I cancers, the disease has
spread outside the ovaries and pelvis, making it more difficult to
determine its extent. Doctors at Johns Hopkins Pathology estimate
that between 70 and 90 percent of women who are first treated for
ovarian cancer will have their cancer recur.
These findings make continuing
follow-up treatment with the oncologist and the patient’s
gynecologist especially important. Early detection is, of course,
one of the best ways to treating ovarian cancer if it does recur.
Tests to detect its recurrence include blood tests for the CA125
protein or tumor marker, CT and PET scan imaging, as well as the
possibility of additional surgical procedures.
When doctors decide to treat a
recurring case of ovarian cancer, there are many factors that need
to be taken into consideration. Some of these include:
How long ago did
the patient end their first round of treatment? Patients who
ended their treatment only months prior have a lower prognosis
than does the patient who managed several years in remission.
How did the
patient respond to chemotherapy the first time? Since there are
varying tolerances to chemotherapy, those patients who had
issues relating to toxicity and low red blood cell count will
have different treatment issues than those patients who had
neither of those issues.
Where has the
cancer recurred? While it is possible to treat cancer that has
recurred in the abdomen area, patients who had or are still
having difficulties relating to GI issues may have fewer
treatment options than patients who are not facing these
Is quality of
life more important than treatment of the disease? Doctors will
admit that not all recurrences of the disease are treatable,
although almost all are willing to try those options until it
becomes evident that the treatment simply will not work. Some
patients and caregivers may decide that quality of life is more
important than the type of treatment that will have to be
endured in order for the disease to move into remission again.
These areas are but a sampling
of those issues that doctors consider when deciding when to restart
treatment and the type of treatment that is used when it is
restarted. Communication at this point becomes critical between the
doctor, patient, and caregiver to decide the best course of action.
Caregivers play an increasingly
important role in the treatment of ovarian cancer. From discussing
treatment options to helping patients understand the staging and
treatment options available, the caregiver has a great deal of
responsibility. Research and communication are the keys to
understanding the disease, its progression, and the type of
treatment needed at any one particular point.
Focusing on the patient and
their need to make sense of their prognosis and treatment is only
one role that the caregiver can play during treatment. There are
several others. These can include support, research, communicating
with physicians, and helping decide next steps, especially if the
cancer recurs. Since ovarian cancer is silent with only few symptoms
present in the initial stages, caregivers may experience the same
types of frustration as the patient who encounters a diagnosis of
advanced ovarian cancer. Getting rest and respite for the caregiver
is much-needed and often encouraged by doctors who are working with
A positive treatment team can
make a tremendous difference in the patient’s outcome. While gains
have been made with regard to the success in treating ovarian
cancer, there is still much work that needs to be done.
Communicating with the treatment team all symptoms and managing
expectations of therapy can contribute to a patient’s definition of
success at any point in the process.