A diagnosis of ovarian cancer can raise a lot of questions. It can also raise many new medical terms, which your doctor or a member of your care team can explain. Here are some terms to know.
What are the types of ovarian cancer?
Epithelial ovarian cancers
These cancers, which account for the majority of ovarian cancers, occur in the epithelial tissue, which forms the outer lining of an ovary. They include cancers that begin in the lining of a fallopian tube or the peritoneum, the tissue that covers abdominal organs. These cancers include high-grade serous carcinoma and low-grade serous carcinoma, as well as endometrioid, clear-cell, and mucinous carcinomas. Although these are all epithelial ovarian cancers, each has different molecular features and different responses to chemotherapy.
Nonepithelial ovarian cancers
These include germ cell cancers, which develop in the egg cells within an ovary. They also include cord-stromal cancers, which arise in tissue that supports the ovary.
What are the screening tests for ovarian cancer?
There currently are no recommended screening tests for ovarian cancer in individuals who do not have symptoms and aren’t at high risk for the disease. Some organizations recommend these tests for those at high risk.
Transvaginal ultrasound (TVUS)
This test uses sound waves to view the uterus, fallopian tubes, and ovaries, and identify the presence of a mass or tumor.
CA-125 blood test
This test measures the amount of a protein called CA-125, which is often elevated in women with ovarian cancer. It is used following an ovarian cancer diagnosis to determine how well treatment is working or to see if the disease has recurred following treatment. CA-125 was discovered in the 1980s by Dana-Farber’s Robert Bast, MD, and Robert Knapp, MD.
Germline testing
This involves testing tissue for the presence of inherited mutations or changes in genes such as BRCA1 and BRCA2 that can increase the risk of developing ovarian cancer. People who test positive for such changes may then decide to take steps to reduce their risk.
Somatic testing
Somatic testing analyzes tumor tissue for abnormalities that have cropped up in key genes and proteins associated with cancer. The results of such tests can help doctors choose the best treatment for each patient. A molecular malfunction known as homologous recombination deficiency, or HRD, for example, can be used to predict a patient’s response to certain therapies.
Tumor markers
Also called biomarkers, tumor markers are substances made by a tumor or by immune system cells responding to a tumor. They can be found in the blood and may indicate how advanced or aggressive a tumor is or how well a treatment is working. Examples of tumor markers in ovarian cancer are:
- CA-125
- HE4, used to measure response to treatment and monitor patients for recurrence.
- Alpha-fetoprotein (AFP) and Beta Human Chorionic Gonadotropin Beta-hCG, used in ovarian germ cell tumors to determine cancer stage and predict outcomes after diagnosis.
- Inhibin A & B, a hormone that may be elevated in some types of ovarian cancer. It is used to gauge treatment effectiveness and cancer recurrence.
Treatments for ovarian cancer
All patients diagnosed with ovarian cancer should be seen by gynecologic surgical oncologist to determine if surgery is appropriate. Surgical procedures include:
Oophorectomy
Many ovarian cancer patients undergo surgery to remove as much of the tumor as possible. An oophorectomy – the surgical removal of one or both ovaries – is one of those surgical options. A unilateral salpingo-oophorectomy is the removal of one ovary and fallopian tube; a bilateral salpingo-oophorectomy is the removal of both ovaries and fallopian tubes.
Hysterectomy
A hysterectomy is a surgical procedure to remove the uterus and, sometimes, the cervix. A total hysterectomy is the removal of both the uterus and the cervix, while a partial hysterectomy removes only the uterus. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are all removed.
For advanced ovarian cancer, treatments include:
Chemotherapy
The backbone of therapy for appropriate patients, depending on the stage of the tumor, is chemotherapy. The drugs utilized include carboplatin and paclitaxel, and at time bevacizumab.
Maintenance therapy
Maintenance therapy is term for treatments given to patients after the completion of chemotherapy to prevent a cancer from coming back or to delay its recurrence. Such therapies include:
PARP inhibitors
PARP inhibitors are used to treat patients whose ovarian cancer cells have a malfunction in repairing their DNA. The drugs block a key DNA-repair pathway, causing so much DNA damage to build up that the tumor cells die.
Bevacizumab
Bevacizumab is an antibody-based therapy that works by blocking a tumor’s ability to form new blood vessels. In some cases, it is used with chemotherapy and also as a maintenance therapy.
About the Medical Reviewer
Dr. Campos received her MD from Georgetown University in 1992, and then completed residency training at Georgetown Medical Center. Between 1995 and 1998, she completed a fellowship in hematology-oncology at Brigham and Women's Hospital, in Boston, and in 2000 received her MPH from Harvard Medical School. She serves on committees for the American Society of Clinical Oncology, the Gynecological Oncology Group, and the National Comprehensive Cancer Network. She is board-certified in internal medicine, oncology, and hematology.
Good post. My wife’s diagnosis has led me to an avalanche of new learning, but brachytherapy has never come up in any of my reading or any conversation with any of the doctors we’ve met. Maybe it’s not part of the treatment protocol up here in Canada, or perhaps it’s used in specific cancers other than the one she has.
Confusingly, point 1. is most probably NOT the case. Most epithelial ovarian malignancies do arise from the Fallopian tube.
I have ovarian stage 111c with reluctance. I need information can someone help me out? PLEASE
Hello, Sherry.
Sorry to learn of your ovarian cancer diagnosis. First, you might get the facts on ovarian cancer, and set up an appointment with an oncologist, if you have not done so already. If you live near a comprehensive cancer center such as Dana-Farber, you can seek care from a doctor who specializes in ovarian cancer. Or you can seek a second opinion from an expert.
In addition, you might benefit from an online community of others in your shoes. In this community you can share experiences and learn from one another.
Very best wishes to you for the journey ahead.