Ovarian Colorado
Information for Providers
Making The Diagnosis
Population screening for ovarian cancer is not feasible at this time and there are currently no laboratory tests available to confirm the diagnosis. If there are concerns about ovarian cancer, the workup generally involves a complete medical and family history, as well as a physical including a pelvic and rectal exam. If the exam is normal but the symptoms persist for more than a couple of weeks, then transvaginal sonogram (TVS) would be the first test ordered. A CA-125 could also be ordered.
If a mass is detected or suspected, a TVS is to be ordered. Measurement of CA-125 may be helpful, since elevated values are associated with ovarian cancer, but these levels can be elevated with other conditions as well. The CA-125 levels are elevated in over 80% of women with advanced epithelial cancer, and can be increased in 25-50% of women with Stage I disease. However, this test has poor specificity, especially in premenopausal women.
Types Of Ovarian Cancer
EPITHELIAL TUMORS can be benign or malignant. They account for 65% of all ovarian tumors, benign and malignant. Epithelial ovarian carcinomas represent 80-90% of all ovarian cancer and are associated with a poor prognosis. Microscopically, they are characterized as serous, mucinous, endometrioid, and clear cell. If the cell type is undifferentiated, it tends to grow and metastasize more quickly.
GERM CELL TUMORS are usually benign. However, malignant germ cell tumors represent 5% of all ovarian cancer, and are most commonly seen in women in their teens and twenties. Prior to the availability of combination chemotherapy, this cancer was often fatal. Now, more than 90% of affected women can be cured and remain fertile.
STROMAL TUMORS account for approximately 5% of ovarian cancer. They arise from connective tissue and are considered low grade malignancies. The majority of these tumors are diagnosed at Stage I. Overall, they are rare.
Staging Of Ovarian Cancer
The Gynecological Cancer Foundation recommends that staging be done by a gynecological oncologist, based on evidence that nearly half of women with early ovarian cancer were inadequately staged by obstetrician-gynecologists or general surgeons. Staging is done at the time of surgery and is based on the extent of the disease.
STAGE I:
Cancer is contained in one or both of the ovaries
STAGE II:
Cancer involves one or both ovaries as well as organs of the reproductive and/or other organs in the pelvis.
STAGE III:
Cancer involves one or both ovaries and involves cancer spreading beyond the pelvis to the lining of the abdomen and/or the cancer has spread to lymph nodes.
STAGE IV:
Cancer involves the one or both ovaries and distant metastasis to other organs of the body have occurred. Also finding ovarian cancer cells in the pleural fluid of the lungs is an indication of stage IV disease.
