Ovarian Cancer: Taking on the ‘Silent Killer’

Dubbed the “silent killer” because its vague symptoms make early detection difficult, ovarian cancer has been a target for research and expanding treatment options. Emma L. Barber, MD, a gynecologic oncologist at Northwestern Medicine, discusses ovarian cancer and how research is helping advance treatment options.

Detecting Ovarian Cancer

Ovarian cancer develops in the cells of the ovary, the female reproductive organs that produce eggs and the hormones estrogen and progesterone. There are more than 30 types of ovarian cancer, but they typically fall under three classifications depending on the type of tissue affected:

• Epithelial cell: The cells that cover the surface of the ovary. While most ovarian epithelial tumors are benign, malignant tumors of this kind are the most common and dangerous form of ovarian cancer.
• Stromal cell: This type forms in the structural tissue of the ovary and produces hormones.
• Germ cell: This is a rare form of ovarian cancer that forms in the eggs in the ovary.

Symptoms of ovarian cancer can include:

• Feeling full early (even after just a few bites of food)
• Persistent pelvic or abdominal pain
• Frequent bloating
• Urinating more often or more urgently

Because ovarian cancer symptoms tend to be vague and associated with other issues like gastrointestinal problems, it can be difficult to detect early in its most curable stages. If symptoms persist for more than two weeks, discuss them with your physician.

Scientists have discovered another reason ovarian cancer may evade early detection. “Research has shown that epithelial or high-grade serous ovarian carcinomas (HGSOC), the most common subtype, typically start in the fallopian tube, rather than the ovary,” says Dr. Barber. “This makes sense because by the time we locate a cyst, it has already spread.”

Dr. Barber explains there is a lot of research being done on early detection, and she cautions that the Pap smear currently detects cervical cancer, not ovarian cancer.

Life After Diagnosis

Diagnostic testing is used to confirm ovarian cancer. This can include an ultrasound, CT scan or highly specialized X-rays.

Patients who have been recently diagnosed with ovarian cancer will typically undergo a combination of both surgery and chemotherapy. However, for patients with metastatic cancer, meaning it has spread to other parts of the body, treatment may vary. Hyperthermic intraperitoneal chemotherapy (HIPEC), a regional cancer therapy, may be used. With HIPEC, tumors are removed surgically, and then chemotherapy medication is inserted directly into the abdominal cavity to kill the remaining cancer cells.

Paving the Way for Better Treatment

The increased amount of research on ovarian cancer has led to more complex treatment options, and that’s a good thing, explains Dr. Barber. Physicians are now better able to tailor individualized treatment to each patient rather than using a similar approach for everyone. Genetic testing can provide additional insight into what therapies may or may not work for the specific type of cancer.

“Genetic testing includes both testing the genetics of the patient to look for hereditary mutations and testing the genes of the cancer itself — genomics or somatic mutations — to look for gene mutations in the tumor,” says Dr. Barber. “These mutations can help us select targeted medications, including maintenance treatments like PARP inhibitors that can slow the return or progression of cancer.”

Learn more about cancer care, including genetic testing for BRCA mutations and how they impact your risk and treatment for ovarian cancer.