What do you need to know if you get an ovarian cancer diagnosis? What questions should you ask your doctor?
About 21,410 women will be diagnosed with ovarian cancer in 2021, according to the American Cancer Society. “The rate at which women are diagnosed with ovarian cancer has been slowly falling over the past 20 years,” according to the ACS. Approximately 13,770 women will die of the disease during the year.
Overall, ovarian cancer accounts for more deaths than any other cancer involving the reproductive system of females, according to the ACS. The disease ranks fifth in cancer deaths among women. Overall, women have a 1 in 78 chance of getting ovarian cancer, and their odds of dying from the disease are about 1 in 108.
The disease is typically diagnosed in older women. The median age for women who are diagnosed is 63. That means half of women who are diagnosed with the disease are younger than 63 and half are older, according to the Ovarian Cancer Research Alliance. Most women are diagnosed when they are in their 50s through their 70s, says Dr. Edward Tanner, chief of gynecologic oncology at Northwestern Memorial Hospital in Chicago.
“Occasionally, women will be diagnosed with ovarian cancer in their 20s to 30s, but this is rare,” Tanner says. “The symptoms of ovarian cancer are often subtle and confused with other symptoms commonly found in women during menopause.”
Possible symptoms of menopause that may be confused with signs of ovarian cancer can include:
— Frequent urination.
— Feeling more full than usual after eating a meal.
How Ovarian Cancer Is Diagnosed
Unfortunately, the disease can progress without symptoms or only subtle signs when it’s still confined to the ovary. In some cases, an early-stage ovarian cancer will be detected by a pelvic exam by a health care provider. “In most cases, the diagnosis will be made after an imaging test like an ultrasound or CT scan is ordered due to concerning symptoms,” Tanner says. “A biopsy will usually be needed to confirm the diagnosis.” An ovarian cancer diagnosis may also be confirmed with a blood test.
Concerning symptoms can include:
— Abdominal pain.
— Frequent urination.
Ovarian Cancer Treatment
Because the disease is usually detected in the late stages, after it’s progressed beyond the ovaries, a combination of surgery and chemotherapy is the typical treatment for ovarian cancer, says Dr. Robert DeBernardo, section head of gynecologic oncology at Cleveland Clinic. He’s also the Laura J. Fogarty endowed chair in uterine cancer research.
Getting a diagnosis of ovarian cancer is understandably anxiety-producing. Obtaining clarity on the meaning of the diagnosis and possible treatment options is important, says Dr. Jessica Shepherd, a gynecologist and women’s health expert based in Dallas.
To understand their options and what they should expect as they begin treatment, women diagnosed with ovarian cancer should talk to their health care providers.
Here are six questions women diagnosed with ovarian cancer should ask their physician:
— What are the different types of ovarian cancer?
— What kind of specialist should I see?
— How many ovarian cancer patients do you treat annually?
— What is the treatment recommendation?
— What is the prognosis?
— How will this affect my fertility?
1. What are the different types of ovarian cancer? The most common type of ovarian cancer are the epithelial ovarian tumors, which account for 85% to 90% of such cancers, Shepherd says. Epithelial tumors start from the cells that cover the outer surface of the ovary.
Within these types, there are several subtypes of ovarian cancer which include:
— Serous carcinoma, 52%.
— Endometrioid carcinoma, 10%.
— Mucinous carcinoma, 6%.
— Clear-cell carcinoma, 6%.
Another subtype is ovarian low malignant potential tumors. This is an ovarian epithelial subtype that occurs when abnormal cells form in the tissue covering the ovary. They are so named because the tumors have a low likelihood of turning into cancer. These tumors tend to grow slowly and affect younger women. They also typically don’t spread beyond the ovary, and usually respond well to treatment, Shepherd says. Other similar subtypes that resemble epithelial ovarian cancer include primary peritoneal carcinoma and fallopian tube cancer. Ovarian sarcomas, Krukenberg tumors and ovarian cysts collectively account for 3% of ovarian cancers.
Germ cell tumors are mostly benign and comprise less than 2% of ovarian cancers.
2. What kind of specialist should I see? Once you’ve been diagnosed with ovarian cancer, it’s important to establish what kind of specialist you should be treated by. For this disease, you should see a gynecologic oncologist, rather than a medical oncologist or any other specialist, DeBernardo says. Outcomes are better for ovarian cancer patients who are treated by gynecologic oncologists, he says. These physicians are better able to assess and treat ovarian cancer. There are not many gynecologic oncologists in some regions of the country, which may require a lengthy drive to the nearest one. “It’s worth it,” DeBernardo says.
3. How many ovarian cancer patients do you treat annually? This is an important question to ask because outcomes for patients are much better at high-volume centers than at facilities that treat just a handful of such patients annually, DeBernardo says. Physicians at high-volume centers have more experience conducting surgery and chemotherapy that is the typical treatment for ovarian cancer. “High-volume centers also have access to the latest treatments, research and clinical trials,” he says.
4. What is the treatment recommendation? Because the disease is typically diagnosed in its late stage, most ovarian cancer patients will require surgery, which usually includes the removal of the ovary. “Many patients will also require removal of the other ovary, uterus, lymph nodes and the omentum, a fat pad in the abdomen,” Tanner says. “If the cancer has spread, patients should be considered for tumor debulking (surgical removal of as much of the tumor as possible) to remove all visible cancer.” This can occur before or after chemotherapy has been administered. For women who are still considering fertility, a normal ovary and uterus might be retained under certain circumstances, which you should discuss with your doctor.
5. What is the prognosis? Unlike many other cancers, whose severity is assessed on a numeric basis (Stage 1, Stage 2, etc.), ovarian cancer is graded by how far it’s spread.
Here are the three stages of ovarian cancer, according to the American Cancer Society:
— Localized: There is no sign that the cancer has spread outside of the ovaries.
— Regional: The cancer has spread outside the ovaries to nearby structures or lymph nodes.
— Distant: The cancer has spread to distant parts of the body, such as the liver or lungs.
The ACS also shares charts showing the five-year relative survival rates for specific stages of ovarian cancer. “For example, if the 5-year relative survival rate for a specific stage of ovarian cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed,” according to the ACS website.
Based on statistics collected from ovarian cancer patients from 2010 to 2016, the survival rates were:
— Localized, 93%.
— Regional, 75%.
— Distant, 31%.
— All stages combined, 48%.
6. How will this affect my fertility? Depending on your age, you may want to know how an ovarian cancer diagnosis will impact your fertility, Shepherd says. You may have the option of harvesting your eggs prior to the surgery or having a procedure in which the surgeon removes one ovary but not the other.
More from U.S. News
Questions to Ask When You’re Diagnosed With Ovarian Cancer originally appeared on usnews.com
Update 02/16/21: This story was published at an earlier date and has been updated with new information.