An Expert Discusses Ovarian Cancer Basics, From Staging to Treatment

To coincide with the observation of Ovarian Cancer Awareness Month in September, CURE spoke with Dr. Ryan Kahn to discuss key aspects of the disease, from diagnosis to treatment.

Kahn is a gynecologic oncologist at Miami Cancer Institute, part of Baptist Health Cancer Care.

When discussing Ovarian Cancer Awareness Month, what are the early signs or symptoms of ovarian cancer that women should be aware of?

Ovarian cancer is hard to find early, often because it doesn't cause symptoms until the disease is large enough to actually cause the symptoms. And unlike other cancers, such as colorectal cancer, where we have colonoscopies, or breast cancer, where we have mammographies, unfortunately, right now for ovarian cancer, we don't have great screening modalities. We're working on getting better at trying to pick this up earlier, but right now, we don't have anything on a population-wide level like we do for some of the other cancers.

So, a key acronym to remember, and something that's been out there is, is “BEAT,” so bloating for B, E for early satiety, or the feeling of fullness earlier, A for abdominal pain or pelvic pain, and T for toilet changes, so changes in urination or bowel movements. So, these are all symptoms that women may experience early on or as the cancer progresses. Unfortunately, these are all non-specific symptoms. So, if you are having these symptoms on a consistent basis for weeks on end, it's important to report them to your physician right away. Prompt attention to these symptoms may improve the odds or early diagnosis of ovarian cancer.

How is ovarian cancer usually diagnosed?

The key is, if ovarian cancer is suspected, it's important to see a gynecologic oncologist. This is a doctor who's trained to treat cancers of the female reproductive system. This specialist because could also help ensure that you're receiving the right treatments as well as the right imaging tests.

Tests for ovarian cancer are usually three different things: imaging, biopsy and blood tests. The imaging could be ultrasound, CT scan, MRI or a PET CT, and this is all just depending on level of suspicion as well as symptomatology. The biopsy usually takes place at the time of surgery. This could also be done prior to surgery through interventional radiology or imaging in minimally invasive procedures to receive the biopsy. And the biopsy is key, because the tissue is necessary to make sure that this is ovarian cancer that we are treating and not metastatic disease from elsewhere. And as far as blood tests, tumor markers, C125 is the most common we see with some of the more common forms of ovarian cancer. So, a combination of all three of these are usually used for testing for ovarian cancer.

What are the current treatment options available for patients that are diagnosed with this disease, and how do they differ depending on stage?

Treatment plans and methods will differ a depending on the type of ovarian cancer, so the histology or down to the cellular level, how these ovarian cancers differ, but also stage, how far, if it has spread from the ovary, and if so how far. Most women with ovarian cancer will undergo some type of surgery to remove the cancer. Now, if we don't suspect that the ovarian cancer has spread beyond the ovaries, then this is a staging procedure where we take little pieces and biopsies of different areas at the time of surgery to see if there's any microscopic spread or cancer cells that may have spread that we don't see by the naked eye.

Now, if we do see that there is cancer that has spread beyond the ovary at the time of surgery, then this surgery is a little bit different, and it's called a cytoreductive surgery, also known as a debulking surgery, where the goal for this surgery is now to remove as much disease as possible. The goal would be to remove all of the visible disease, something called complete gross resection.

Following the surgery, depending on, once again, the type of ovarian cancer, as well as the stage, additional treatments may be warranted, such as chemotherapy. Chemotherapy may also be given prior to the surgery, in special circumstances, if the disease is currently in an unresectable location, or if it’s too big or causing too many symptoms. This is called neoadjuvant chemotherapy when it's given before the surgery. It could also be given after the surgery in a post-operative setting, and in some situations, could be given both neoadjuvantly and postoperatively as well.

Transcript has been edited for clarity and conciseness.

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