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    Ovarian Cancer Treatment in Northwest Indiana

    Ovarian cancer is a type of gynecologic cancer that begins in the tissue that covers the ovaries, which are the reproductive glands that produce eggs (ova). While there are different types of ovarian cancer, such as germ cell and stromal tumors, ovarian epithelial cancer is the most common, accounting for about 90% of ovarian cancer patients. This cancer typically occurs in postmenopausal women (approximately age 50 and up).

    Ovarian cancer has no standard screening test, and its symptoms are often vague and misdiagnosed. Symptoms of ovarian cancer can include pelvic or abdominal issues, such as bloating, urinating frequently, irregular periods or unexpected vaginal bleeding (after menopause), indigestion, fatigue, and pain in the back, abdomen, or pelvis. Since symptoms are similar to some female reproductive conditions and other common illnesses, ovarian cancer can be difficult to diagnose at an early stage. Because of this, ovarian cancer is typically detected at a later stage, making it one of the most challenging types of gynecologic cancers to treat.

    At Northwest Cancer Centers, our gynecologic oncologists work with each patient to recommend a personalized treatment plan.

    Learn more about ovarian cancer diagnosis, staging, and treatment options.

    cancer diagnosis

    Diagnosing Ovarian Cancer

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    staging cancer

    Stages of
    Ovarian Cancer

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    cancer treatment options

    Treatment for Ovarian Cancer

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    cancer diagnosis

    Diagnosing Ovarian Cancer

    If you have one or more symptoms suggesting ovarian cancer, it’s important to consult with your doctor so that they can determine whether it is due to cancer or another cause. Your doctor may ask about personal and family medical history, and you may have one or more of the following tests:

    • Physical exam: Your doctor checks general signs of health and may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
    • Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells and does not diagnose ovarian cancer. The Pap test detects cervical cancer.
    • Blood tests: Your doctor may order blood tests for signs that indicate cancer may be present. The lab will check the level of several substances in your blood, including CA-125. CA-125 is found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman’s response to ovarian cancer treatment and for detecting its return after treatment.
    • Transvaginal ultrasound: Transvaginal ultrasound (TVU) is a procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce waves off the organs to make echoes. A computer then creates a picture (sonogram) from the echoes, which may show tumors caused by ovarian cancer.

    When cancer is suspected, a biopsy is likely performed on tumors that are found. Non-cancerous ovarian cysts are rather common, so it’s important to know if this is a non-cancerous cyst or one that will require cancer treatment. In many cases, the mass is completely removed, and then a biopsy is performed; however, a biopsy can be performed that only removes a small sample of fluid and tissue to be evaluated by a pathologist. This doctor will be able to determine if cancer cells are present.

    If cancer is found, it’s important to schedule a consultation with an oncologist who specializes in gynecologic cancers. They are going to do some additional testing to see how far the cancer has spread.

    Tests Used to Determine How Much Cancer is Present

    Tests for determining the extent of cancer will provide other information for the gynecologist oncologist to use as part of the treatment plan.

    Other tests may be required if cancer is found, such as:

    • PET Scan: The positron emission tomography scan (PET) is an imaging test used to find malignant (cancerous) tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein, and then the PET scanner makes a picture of where the glucose is being used in the body. Since cancers use glucose at a higher rate than normal tissues, malignant tumor cells will show up brighter in the picture.
    • CT and/or MRI Scan: Computerized tomography (CT) and magnetic resonance imaging (MRI) scans are two procedures that provide more detail than conventional x-rays. Although they are similar in the fact that they show cross-sectional pictures of the body, they differ in their techniques. CT scans use multiple x-rays taken at different angles to get a series of pictures, while MRIs use magnetic fields and radio frequencies.
    • Biomarker testing of the tumor: In some cases, your doctor might recommend running tests on a tumor to identify specific genes, proteins, and other factors that are considered to be unique to the tumor. This may also be called molecular testing of the tumor. Genetic changes in the tumor cells are called somatic mutations. Women who have been diagnosed with ovarian cancer but do not carry a germline mutation are highly encouraged to undergo somatic tumor testing.
    • Chest x-ray: X-rays of the chest can show tumors or fluid.
    • Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
    • Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.

    staging cancer

    Stages of Ovarian Cancer

    To plan the best ovarian cancer treatment for each patient, the oncologist needs to know the grade of the tumor and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether cancer has spread to other organs, and if so, to what parts of the body.

    Often, surgery is performed before staging is defined. The surgeon takes many samples of tissue from the pelvis and abdomen to look for ovarian cancer.

    The Stages of Ovarian Cancer

    Doctors assign the stage of cancer using the FIGO system. They are as follows:

    Stage I

    The cancer is only in the ovaries or fallopian tubes.

    Stage IA: The cancer is only inside 1 ovary or fallopian tube. No cancer is found on the ovarian or fallopian tube surface or in the abdomen.

    Stage IB: The cancer is in both ovaries or fallopian tubes. No cancer is found on the surface of the ovary or fallopian tube or in the peritoneal fluid or washings.

    Stage IC: The cancer is in 1 or both ovaries or fallopian tubes, with any of the following:
    • Stage IC1: The tumor ruptures while it is being removed surgically, called intraoperative surgical spill.
    • Stage IC2: The tumor wall is ruptured before surgery, or there is cancer on the surface of the ovary or fallopian tube.
    • Stage IC3: Cancer cells are found in fluid buildup in the abdominal cavity, called ascites, or in the samples of fluid from the peritoneal cavity taken during surgery.

    Stage II

    The cancer involves 1 or both of the ovaries or fallopian tubes and has spread below the pelvis, or it is peritoneal cancer.
    Stage IIA: The cancer has spread to the uterus and/or fallopian tubes and/or the ovaries.


    Stage IIB: The cancer has spread to other tissues within the pelvis.

    Stage III

    The cancer involves 1 or both of the ovaries or fallopian tubes, or it is peritoneal cancer. It has spread to the peritoneum outside the pelvis and/or to lymph nodes in the retroperitoneum (lymph nodes along the major blood vessels, such as the aorta) behind the abdomen.

    Stage IIIA1:The cancer has spread to the retroperitoneal lymph nodes, which are found at the back of the abdomen, but not to the peritoneal surfaces.
    • Stage IIIA1(i): Metastases, or areas of spread, are 10 millimeters (mm) or smaller.
    • Stage IIIA1(ii): Metastases are larger than 10 mm.
    Stage IIIA2: The cancer has spread microscopically from the pelvis to the abdomen. Cancer may or may not have spread to lymph nodes in the back of the abdomen.

    Stage IIIB    : The cancer has visibly spread past the pelvis to the abdomen and is 2 centimeters (cm) or smaller, with or without spread to the retroperitoneal lymph nodes. A centimeter is roughly equal to the width of a standard pen or pencil.

    Stage IIIC:     The cancer has visibly spread past the pelvis to the abdomen and is larger than 2 cm, with or without spread to the retroperitoneal lymph nodes.

    Stage IV

    The cancer has spread to organs outside of the abdominal area.
    Stage IVA: The cancer has spread to fluid around the lungs.


    Stage IVB: The cancer has spread to the liver or spleen or to organs beyond the abdomen, including lymph nodes in the groin outside of the abdominal cavity.

    Ovarian Cancer Grades

    Oncologists also describe ovarian cancer by its grade. The grade compares how much cancer cells look like healthy cells when viewed under a microscope. This comparison of cells helps the doctor predict how quickly the cancer may spread. It can also help your health care team make better decisions about your treatment plan.

    Ovarian cancer grades are as follows:

    • Grade 1: The tissue is well differentiated. This means the cells look and are organized within the tumor-like normal cells. In most cases, these tumors grow slowly.
    • Grade 2: The tissue is moderately differentiated. It shares features between well and poorly differentiated. Grade 2 is not as commonly used as the other two grades.
    • Grade 3: The tissue is poorly differentiated or undifferentiated. This means that all or most cells appear very abnormal and have no normal tissue structure. Oftentimes, these tumors grow fast and spread rapidly.

    cancer treatment options

    Ovarian Cancer Treatment Options

    Your gynecologic oncologist will work with you to discuss the ovarian cancer treatment options and the expected results. Most women are treated with surgery and chemotherapy. Radiation therapy is used in rare cases. Ovarian cancer treatment can affect cancer cells in the pelvis, abdomen, or throughout the body.

    Treatment for ovarian cancer may include one or a combination of the following treatments:

    Local therapy

    Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other body parts, local therapy may be used to control the disease in those areas.

    Intraperitoneal chemotherapy

    Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis

    Systemic chemotherapy

    When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.

    You may want to know how treatment may change your normal activities. You and your oncologist can work together to develop an ovarian cancer treatment plan that meets your medical and personal needs.

    Surgery

    Laparotomy is the typical surgical procedure used to remove ovarian cancer. The surgeon makes a long cut in the wall of the abdomen. If ovarian cancer is found, the surgeon will remove the affected ovary but could also remove other areas depending on the spread of cancer cells:

    • both ovaries and fallopian tubes (salpingo-oophorectomy)
    • the uterus (hysterectomy)
    • the omentum (the thin, fatty pad of tissue that covers the intestines)
    • nearby lymph nodes
    • samples of tissue from the pelvis and abdomen

    If cancer has spread, the surgeon removes as much of the tumor as possible. This is called “debulking” surgery.

    If you are pre-menopausal with early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their oncologist to have only one ovary, one fallopian tube, and the omentum removed.

    Chemotherapy for Ovarian Cancer

    Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.

    Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:

    • By vein (IV): The drugs can be given through a thin tube inserted into a vein.
    • By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
    • By mouth: Some drugs for ovarian cancer can be given by mouth.

    Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used. You may receive your treatment in a clinic, doctor’s office, or at home. Some women may need to stay in the hospital during treatment.

    Targeted Therapy for Ovarian Cancer

    Targeted therapy is a special type of chemotherapy that uses drugs or other substances to identify and attack specific cancer cells, rather than all cells like traditional chemotherapy. Because this treatment specifically seeks out cancer cells, normal cells are less likely to be damaged.

    While each type of targeted therapy works differently, they all alter the way cancer cells grow, divide, repair, and interact with other cells.

    • Monoclonal antibody therapy is a type of targeted therapy in which the antibodies attach to the substances and kill cancer cells, block their growth, or keep them from spreading.
    • Bevacizumab is a monoclonal antibody that may be used with chemotherapy to treat ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that has recurred.
    • Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) are targeted therapy drugs that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied to treat ovarian epithelial cancer that remains after chemotherapy.

    Targeted therapies may be used in different combinations depending on the cancer stage and the patient's health. Targeted therapy may be prescribed as oral pills or administered intravenously.

    Immunotherapy for Ovarian Cancer

    Immunotherapy is a cancer treatment that uses our body's immune system to recognize, target, control, and eliminate certain cancer cells. Oncologists might recommend immunotherapy for patients with resistance to chemotherapy, with recurrent ovarian cancer, or with ovarian cancer Stage 2 or higher.

    Pembrolizumab (Keytruda) and dostarlimab (Jemperli) are a type of immunotherapy called immune checkpoint inhibitors. They work by helping the body recognize and attack cancer cells, boost immune cells that destroy cancer, and improve the body's immune response.

    Radiation Therapy for Ovarian Cancer

    Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment uses radiation to kill cancer cells or prevent them from growing, and it is typically given at a hospital or clinic. Each treatment takes only a few minutes.

    Is Ovarian Cancer Passed Down Through Genetics?

    There can be a genetic link that increases the risk of developing ovarian cancer. An inherited genetic mutation of the BRCA1 or BRCA1 gene is correlated with the development of early and aggressive breast cancers and ovarian cancer. About 10% of ovarian cancers are related to this mutation.

     

    This genetic mutation can be passed from either the mother or father’s genes. Even if one family member tests positive for the mutation, it doesn’t automatically mean you have it too. Be open with your oncologist about your family history to determine if genetic testing is right for you or possibly your loved ones. 

     

    You’re at a higher risk of ovarian cancer if you have a close relative who was diagnosed with ovarian cancer, such as your mother or your sister. You should also look at your aunts or grandmothers on either your father's or your mother's side. If they have or had ovarian cancer be sure to tell your oncologist.

    Find Ovarian Cancer Care in Northwest Indiana

    The medical oncologists and gynecologic oncologists at Northwest Cancer Centers work with you to ensure you are recommended the most effective treatment plan for your ovarian cancer. We have locations in the northwest Indiana area, including Crown Point, Dyer, Hobart, Michigan City, and Valparaiso. We also offer second opinions on diagnosis and treatment plans for ovarian cancer. Take the time to evaluate your options and choose the cancer care team you feel most comfortable with.

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