Cancer Type Category: Ovarian Cancer

What are the risk factors for ovarian cancer?

There are two primary risk factors for ovarian cancer:

• Age: Ovarian cancer is more common in women over the age of 50.
• Family history: You are at higher risk of ovarian cancer if a close female relative has been diagnosed with it. This could be your mother, sister, daughter, or grandmother.

What is family history?

When several family members have had ovarian cancer, we say the disease “runs in a family.” There is a pattern. The pattern can mean an inherited mutation is causing ovarian cancer. Inherited mutations are also called genetic mutations. That means there are changes that happen in genes and are passed down from parents to children.

Mutations in the following genes are linked to ovarian cancer:

• BRCA
• RAD51C
• RAD51D
• BRIP1

Genetic Counseling for Ovarian Cancer

When you come to Siteman, we will offer you genetic testing and counseling to see if these mutations could be driving your cancer. Our genetic counseling team includes doctors, oncology nurse specialists, psychologists, and board-certified genetic counselors.

Identifying a genetic mutation can lead to improved treatment for you and can alert other family members who could be at risk.

Getting a genetic test is simple. All it takes is a blood draw at a laboratory. But it can be hard to decide whether or not to get the test in the first place.

At Siteman, we recommend that patients meet with a trained genetic counselor both before and after the test. The counselor’s job is to give you the tools to decide if testing is the right option for you. If you choose to get tested, the counselor will also help you prepare for whatever results you might receive. 

Ovarian cancer prevention and monitoring

Women with cancer-causing genetic mutations have a number of options. They might decide to have their ovaries taken out to prevent cancer from occurring. Or, they might decide to keep their ovaries but make a plan with their doctors to monitor for signs of cancer. Your genetic counselor and physicians will discuss these options with you and are always ready to offer guidance. 

What’s my risk of getting ovarian cancer?

The best way to evaluate your risk of ovarian cancer is to have a conversation with your ob-gyn. However, there are also online tools you can use to quickly assess your risk and start a conversation with your physician later on.

Your Disease Risk is an effective tool that was developed by physicians and scientists right here at Siteman. It can provide you with an estimation of your risk, as well as targeted suggestions to help you manage it. 

We understand that you probably have many questions and concerns as you prepare for treatment for ovarian cancer. There is no question too small or simple to ask. Your care team will be with you every step of the way, ready to help.

At Siteman, WashU Medicine physicians will design a treatment plan that is unique to you. It will be created for your cancer, your lifestyle, your age, and your goals. If you still hope to have children, there are steps we can take to make that possible later on. At your first appointment, we will set treatment goals aimed at helping you feel better now and in the future.

Most patients with ovarian cancer will be treated with a combination of surgery and medications.  

Surgery for Ovarian Cancer

Surgery is often the first line of treatment for ovarian cancer patients. For patients with early-stage cancers, surgery may be the only treatment necessary.

When you come to Siteman for ovarian cancer surgery, you will be in good hands. Our surgeons will lead your care. They treat hundreds of patients with ovarian cancer each year. They are at the top of their field and are skilled at removing ovarian tumors safely.

You may have one of the following procedures:

• Ovary removal: This procedure is called a salpingo-oophorectomy. Your surgeon will remove the ovary affected by cancer as well as the fallopian tube. You may have this procedure if the cancer is at an early stage and limited to one ovary. 
• Removal of the uterus, ovaries, and fallopian tubes: This is called a “total hysterectomy.” Most patients with ovarian cancer will have this procedure. 
• Omentectomy: This is a procedure to remove the layer of tissue covering the organs in your belly. This layer is called the “omentum.” Sometimes, ovarian cancer can spread to the omentum. Your surgeon may remove the omentum while doing another procedure. 
• Cytoreductive surgery: This procedure is done when ovarian cancer has spread beyond the ovaries and into the belly. The surgeon will remove all visible tumor tissue within the abdomen and pelvis. Patients often have their ovaries, uterus, and fallopian tubes removed as well. WashU Medicine physicians at Siteman helped pioneer this procedure and are highly skilled at performing it safely and effectively.  
• Heated Intraperitoneal Chemotherapy (HIPEC): This is a special treatment that is done at the same time as a surgical procedure. During HIPEC, your team will place a high dose of a heated chemotherapy directly into your belly (abdomen) to kill cancer cells.  

What is minimally-invasive surgery for ovarian cancer?

Minimally-invasive surgery is done through several small incisions, instead of one large one. Your surgeons will use special tools and cameras to do the surgery inside your body. It is possible to remove the ovaries and  the uterus without making a large incision.

Benefits of minimally-invasive surgery include:

• Less blood clots
• A lower risk of infection
• Less time in the hospital
• Quicker recovery time 

Not all patients can have a minimally-invasive surgery. It depends on many factors. One major consideration is how the tumor interacts with major blood vessels. WashU Medicine physicians at Siteman will try to do minimally-invasive surgeries whenever possible.

Drug Therapy for Ovarian Cancer

Most patients with ovarian cancer will take medications to help treat their cancer. These might include:

• Chemotherapy: Chemotherapies are powerful medicines that kill cancer cells wherever they are in the body. Patients with ovarian cancer typically receive chemotherapy through an IV.  Researchers at Siteman are working to find new combinations of chemotherapies that have fewer side effects and may even be  more effective. 
• Targeted Therapy: Targeted therapies are medications that stop cancer cells from growing and multiplying. They can be helpful to some ovarian cancer patients. If your cancer is caused by a BRCA mutation, your physician may suggest targeted medications called PARP inhibitors that stop cancer cells from repairing their DNA. Ovarian cancer patients take targeted therapies as pills or through an IV.    

When is radiation therapy used to treat ovarian cancer?

Sometimes, patients with ovarian cancer may benefit from radiation therapy. Your doctor may recommend radiation therapy if your cancer has spread to other parts of your body (metastasized). Radiation therapy can help eliminate these cancer cells.

Fertility Preservation

Undergoing treatment for ovarian cancer often causes women to lose their fertility. Many patients with ovarian cancer have already gone through menopause. This means that they were already unable to have children. But younger patients have not gone through menopause yet. These patients may still hope to have children, and the treatment they need can challenge that hope.

Siteman has services that can support and preserve fertility for these patients.

We offer services and procedures through WashU Medicine’s Fertility and Reproductive Medicine Center. These experts can help patient pursue parenthood through: 

• Egg banking
• Embryo storage

Before you can be treated for ovarian cancer, you need a correct diagnosis. When you come to Siteman, we will review all of the tests and exams you’ve had to make sure your diagnosis is right. We will also order additional tests so we can understand your tumor. We study its molecules, cells, and behavior. That way, we’ll be able to design the most effective treatment plan possible.   

What are the symptoms of ovarian cancer?

The symptoms of ovarian cancer can be difficult to recognize. Some patients know something is “off” but decide to ignore it. They could have:

• Pain in the pelvis or abdomen 
• Feeling bloated 
• Going to the bathroom a lot 
• Feeling full quickly when eating 
• Not feeling hungry 
• Losing or gaining weight 
• Feeling very tired 
• Vaginal bleeding that occurs after menopause 
• Bleeding that does not seem related to a period 

When to see a doctor

If you have any bleeding after menopause, it is not normal. Be sure to see your ob-gyn as soon as possible if this happens to you. Vaginal bleeding doesn’t necessarily mean that you have cancer. There are non-cancerous conditions that also cause bleeding after menopause. But it’s important to find out what is going on.

Diagnosing Ovarian Cancer

If your doctor believes you could have ovarian cancer, they will ask you to have certain exams and tests.

At Siteman, we know that medical tests can make people anxious and uncomfortable. We want you to feel safe with us and will do everything we can to earn your trust. If there’s anything you need for your comfort, please let us know. 

Exams and tests to diagnose ovarian cancer: 

• Pelvic exam: Your doctor or ob-gyn will gently press on your lower belly. They are seeing if they can feel anything abnormal. 
• Ultrasound: A technician will use a small, hand-held probe to look at your ovaries and other organs.  
• Blood tests: A doctor will check samples of your blood for substances released by cancer cells. 
• Imaging scans: These scans take pictures of the inside of the body. They might show if a tumor is present or if cancer has begun to spread. You might have a CT scan, an MRI, or a PET scan. 

What are the types of ovarian tumors?

There are three main types of ovarian tumors. They are: epithelial, germ cell, and ovarian stromal tumors.

  
Most ovarian tumors are not cancerous.

Epithelial tumors

Most ovarian tumors are epithelial tumors. They develop in epithelial cells, which form the outermost layer of the ovaries. There are three different types of ovarian epithelial tumors: 

• Not cancerous, or “benign” 
• Cancerous, or “malignant” 
• “Low malignant potential,” which means there is a possibility the tumor could become cancerous 

It’s important to know that most epithelial tumors are benign. 

Germ cell tumors

Germ cell tumors develop in the cells that become eggs within the ovary, or “germ cells.” They can be either cancerous or non-cancerous. Cancerous germ cell tumors are rare, making up only 2 percent of ovarian cancers.

Ovarian stromal tumors

Ovarian stromal tumors can be cancerous (malignant) or non-cancerous (benign). Malignant ovarian stromal tumors are the rarest cause of ovarian cancer and make up only 1 percent of cases. They develop in cells in the ovaries that produce hormones, like estrogen and progesterone. 

Staging Ovarian Cancer

Once cancer has been found, it’s important to determine how advanced it is and how far it has spread in the body. This is called staging the cancer.

Ovarian cancers are assigned Stages from 1(I) to 4 (IV). Stage 4 is the most advanced. 

• Stage 1 (I): Cancer cells are only in the ovaries or fallopian tubes. 
• Stage 2 (II): Cancer cells have moved beyond the ovaries and are in the lower belly, or pelvis. 
• Stage 3 (III): The ovarian cancer has spread outside of the pelvis to other parts of the belly or to lymph nodes. 
• Stage 4 (IV): Cancer is more widespread in the body. It has spread to organs such as the liver, spleen, or lungs, for example. 

It’s never easy to be diagnosed with ovarian cancer.  

At Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine, our team of WashU Medicine physicians, specialist nurses, psychologists, and other professionals are ready to help you. We have the experience and tools to help you feel better now and achieve the best possible results for your future.

About Ovarian Cancer

The ovaries are two small glands located on either side of the uterus. Their job is to store egg cells and release them as part of the menstrual cycle. When a baby girl is born, her ovaries already contain all of egg cells she will ever have in her life.

Ovarian cancer happens when a cell in one of the ovaries becomes abnormal and starts to grow and multiply out of control. Over time, these abnormal cells can form a lump called a tumor.

Most ovarian cancer develops after women have gone through menopause. It doesn’t cause obvious symptoms in its early stages. Many patients don’t realize something is wrong until the cancer is already advanced.

Why Choose Siteman

At Siteman Cancer Center, we’ve cared for thousands of patients like you. We have the experience and tools to help patients even when their diagnosis is challenging. Many ovarian cancer patients who come to us want a second opinion or are interested in a clinical trial. Our ongoing research programs and trials mean that you will get the most advanced, evidence-based care available.  

Team-based, Specialist Care

When you become a Siteman patient, you will be treated by a team of WashU Medicine physicians. These physicians focus on treating patients with ovarian cancer, cervical cancer, and uterine cancer. They are called “gynecologic oncologists.” These physicians are called “gynecologic oncologists.” They also study these cancers in the laboratory. Our goal for research is to find better approaches for treatment. They will use what they learn in the lab to help you. 

Minimally-Invasive Surgeries

Surgery for ovarian cancer can be complicated. At Siteman, WashU Medicine physicians will always prioritize your safety and comfort. They will try to make smaller incisions in order to lower your risks and help you recover faster. These types of surgeries are called “minimally invasive.”

Genetic Counseling

Sometimes, ovarian cancer is caused by an abnormal gene you’ve inherited from one of your parents. This is called a “genetic mutation.” When you come to Siteman, we will offer you genetic testing and counseling to see if a mutation caused your cancer. This can help your physicians design a better treatment plan for you. It can also benefit other members of your family who may not be aware they are at risk.

Clinical Trials

Every technique and treatment we use today as “standard of care” for cancer was tested in a clinical trial first. Clinical trials are research studies that evaluate new drugs and procedures. They allow patients to access new treatments before they are available everywhere.

Siteman Cancer Center offers more clinical trials than any other facility in the region. When you come to Siteman, your team will see if any trials could be a good match for you. Clinical trials create new options for patients. They improve outcomes and quality of life during and after treatment.  

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