Diagnosing Ovarian Cancer and Treatment Options

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Diagnosing ovarian cancer is very important to determine the stage of the disease, which then also very crucial for the doctor in deciding the appropriately treatment options to cure the disease. In the previous article, we have clearly understood that diagnosing the disease at a much earlier stage is significantly helpful to encourage the successful of the treatment and prognosis of patient. 

You might also like to know more about symptoms and risk factors of ovarian cancer (conditions that put you at higher risk of developing the disease) in here, before continuing!

Unfortunately, there are usually less signs or even almost no symptoms that occur at very early stage /early stage. This is one of major reasons of why the disease is not easy to be diagnosed /detected at early stages - in fact, the disease is still often diagnosed at later stages. 

Furthermore, there is still no specifically reliable screening test to find the disease as early as possible. And some symptoms of ovarian cancer also can be generated by other health conditions. Therefore, diagnosing the disease is usually not enough with one or two tests. 

Diagnosing ovarian cancer

The diagnosis usually begins from the symptoms that occur, general health and medical history of patient. Your doctor may ask about your abdomen (tummy) and then may also perform some internal examinations.

For further tests, then patient usually will be referred to a registered gynaecologist. If the specialists are concerned that a patient may have cancer in the ovaries, they will arrange some appropriately tests to find a clearly diagnosis.

And the following are some common procedures /tests to diagnose ovarian cancer:

Some procedures to examine your pelvic!

The pelvic examination may only use a manual technique or also with a speculum to visually check the cervix and genitals (vulva) of patient. Speculum is a kind of small device that can be inserted into the female genital. 

CA 125 blood test

CA 125 is a kind protein that can be found on the cells of ovarian cancer. High level of CA 125 in the blood is often associated with ovarian cancer. 

But CA 125 also can be found on the surface of some healthy tissue. And elevated CA 125 levels also can be caused by certain noncancerous conditions (such as pregnancy, fibroids, pelvic inflammatory disease, and endometriosis). Therefore, having high CA 125 level doesn’t mean that you definitely have ovarian cancer. Other appropriately tests are usually needed to confirm a clearly diagnosis. 

In essence, CA 125 blood test is not a completely reliable procedure to diagnose ovarian cancer. But it can be used to find that there is a kind of inflammation. Sometimes, it is also useful to monitor the progress of the treatment. 

In addition, in fact many patients with ovarian cancer at early stages don’t have abnormal CA 125 levels. The elevated CA 125 levels usually occur in the advanced stages (about 90 percent (9 out of 10 patients) with later stages of the disease have raised CA 125 levels).

Ultrasound test

It is a kind of test to visually check the inside body of patient.  It can produce images of the inside organ by using high-frequency sound waves, so thus doctors can analyze the shape, size, and configuration of the patient’s ovaries.

In other words, ultrasound test is helpful for the doctors to get to know whether the ovaries have normal size, normal in texture, and whether or not they have ovarian cysts!

If your specialist still in doubt whether or not you have ovarian cancer, you may be asked to repeat some appropriately tests (like ultrasound test) in the next months.

CT-scan test

This test is usually needed to visually check your ovaries more clearly. In general, it is a kind of X-ray test that purposed to get several pictures of the inside of the body from different angles. Then these pictures will be fed into the computer to result more detailed pictures of your ovaries.

Before taking CT-scan test, patient is usually asked to:

1. Avoid drinking /eating for about four hours before the test!
2. Drink a special prescribed liquid for about a few hours before taking the test!
3. Take other appropriately procedures before the test!

Staging ovarian cancer

Before deciding the treatment plan, first doctors need to clearly diagnose the type and stage (whether the cancer has spread or still completely inside the ovaries). 

Furthermore, it is not always possible to clearly find and diagnose the type of ovarian cancer until after patient has had surgery. Surgeon will take a sample tissue during surgery, which then can be closely analyzed in the lab.

The following are some common tests and procedures to determine the type of stage of ovarian cancer:

X-ray and ultrasound scan

To find whether or not the cells of cancer have spread to the lungs or whether there is a pleural effusion (a fluid build-up around the lung), you may be asked to take a chest X-ray test. 

And your specialist may also recommend an ultrasound scan /CT-scan to get to know whether there is any sign of cancer cells elsewhere in the abdomen /tummy. Even sometimes a patient may also be asked to take a MRI test, but it is often unnecessary.

Image guided biopsy

This test is used to take a sample tissue of the body that as close as possible represents the spread of ovarian cancer (it can be a sample tissue from inside the abdomen, ovaries, or other different places). 

Image guided biopsy usually also involve a scan test (like ultrasound scan or CT-scan test) for the guide of specialist to put the needle. Patients may get some different needle puncture sites to take some different samples of tissue from different places of the body. 

But sometimes image guided biopsy is not suitable in some women. For instance, a patient who has unreachable tumor with image guided biopsy – therefore she may need to take a laparoscopy test!

A small camera inserted into the inside body (laparoscopy test)

Laparoscopy is a helpful option to closely examine the cells of ovarian cancer without needing a big surgery, because the specialists can use a small camera to visually check inside the body of patient. 

In this procedure, doctors usually will make a small cut in the abdomen then the flexible tube that has a small camera will be inserted through the abdominal cavity. Furthermore with keyhole surgery, it is also possible for doctors to take a sample tissue of affected ovaries which then will be closely examined in the lab.

Taking abdominal fluid

For patients who also complain about swollen abdomen /tummy, it can be a sign that cancer cells may have spread. However, swollen tummy also can be caused by other noncancerous conditions.

The swollen tummy in patients with ovarian cancer is often associated with fluid build-up in the tummy (or often called as ‘ascites’). To find a clearly diagnosis, the specialist usually will take a sample of abdominal fluid which then will be closely analyzed in the lab.

** Additionally, you will not take all tests mentioned here! Because the tests that you will take are usually closely dependent on the symptoms that you have, the tests that you have had so far, etc! 

And below are helpful tips about some important questions that you should ask to your doctor before taking any test:

1. What the tests /procedures are you going to do?!
2. What is the goal of each test?!
3. Will the procedures that you need to take be effective to diagnose ovarian cancer?
4. Will you know the answer about a kind of the treatment you need to take after these tests?
5. How about with side effects of each test? Are these tests painful or not?
6. Can you be an out-patient? Or should you stay at hospital during the test - if so, how long?!
7. Can you bring your family /someone when you have these tests? 
8. How long to get the result of the test?
9. And who will you ask about your test result, who will give you the test results?

Ovarian cancer treatment options

Surgery is one of the most common choices for almost all patients with ovarian cancer. The type and stage of the disease are significantly factors that influence the amount & type of surgery or other appropriately treatments that you will need to take! Read also the previous post about stages of ovarian cancer!

Other factors that usually can affect the decision of the treatment that you have are your overall health and the grade of cancer cells (a variable to analyze about the progress of cancer cells to grow and spread).

Chemotherapy is another common choice to treat the disease. It is often used and prescribed after surgery. But for patients with low grade stage I (at very early stage), they may not require further treatment after surgery – though some of them may also still need to take radiotherapy treatment.

The following are general information about options of the treatment for ovarian cancer:

Treatment options for very early stage

If the tumor is still categorized into a borderline tumor or low grade (which usually occur at very early stage), patient usually needs to take a surgery that only removes the affected ovary! 

Fortunately, borderline tumors are easier to be treated and they are also unlikely to come back (this is very beneficial for patients who still have a plan for pregnancy, because the unaffected ovary is very possible to be left behind).

But for women with menopause or have had menopause or women who don’t have a plan to get pregnant, doctors may recommend to remove both ovaries (including for the unaffected ovary) in order to significantly reduce the risk of developing recurrence cancer in the ovaries.

Options of treatment for ovarian cancer at early stage

To completely eliminate the risk of cancer cells being left behind, both ovaries and womb of patients with stage I ovarian cancer should be removed during surgery – according to a guideline from the National Institute for Health and Clinical Excellence (NICE).

Your doctor may also recommend omentum removal (this procedure is also called as ‘omentectomy’ to remove a sheet of fatty tissue in the abdomen). Because there is a chance for ovarian cancer cells to also spread into the omentum!

Sometimes, the specialists may also need to remove some biopsies from different areas of the body (such as sheet of diaphragm, certain tissues in the pelvis & abdomen, and lymph nodes in the abdomen & pelvis) where the cancer cells could have spread.

And after surgery, doctors may also prescribe chemotherapy in order to kill any remaining cells of cancer and reduce the risk of the cancer cells to come back. This procedure is also often called ‘adjuvant chemotherapy’!

How about with the treatment options for later stages (stage II, III, and IV)?

In these stages, the cells of cancer have spread more widely, and therefore more treatment is needed. To completely cure the cancer, patients are also more likely to get more than one surgery - depending on the general health of patient, whether the cells of cancer have spread to another organ (how far they have spread), and how fast the cancer cells are growing! 

Stage II

For this stage, the treatment options usually involve:

1. Removal of ovaries, fallopian tubes, and uterus.
2. Partial removal (resection) of tumor in the area of pelvic.
3. And partial removal of any other structures that are affected by the cancer.

Adjuvant chemotherapy procedure is also usually used after surgery. But taking chemotherapy before surgery may be recommended if surgeon believe that the chance of removing all cancer is good. This procedure is called neoadjuvant option, which usually more purposed to shrink the cells of cancer so thus they will be easier to remove. 

Stage III

In general, the treatment options for this stage is still almost similar to the stage II treatment, but with more aggressively chemotherapy and doctors may also consider some experimental treatments to find a better result.

Some patients may also be advised to take a direct abdominal treatment (a kind of treatment option that is referred to as ‘peritoneal therapy’). This procedure is more difficult, but may provide a better result to improve survival.

Stage IV

It is the most advanced stage, and therefore it is more difficult to be treated. Moreover, patients with this stage are more likely to be not well enough to take a big operation. Multi-agent chemotherapy may be prescribed to shrink cancer cells as much as possible - this option is also purposed to slow they down!

Furthermore, doctors may also consider taking some clinical trials (such as the use of biological therapies with chemotherapy) to find a better result. Patients may also be asked to take appropriately radiotherapy to ease /relieve the symptoms that occur – depending on where in the parts of the body the cancer cells have spread.

*** Consult more with a doctor for more detailed information!