Ovarian Cancer, Fallopian Tube Cancer, and Primary Peritoneal Cancers

Approximately 21,000 women in the U.S. will be diagnosed with ovarian cancer this year. Over 15,500 women will die from it.

What you need to know

The most common type of ovarian cancer is epithelial ovarian cancer, and within that category papillary serous carcinoma occurs most commonly. It most often spreads from the ovary to any surface within the abdominal cavity. The most common distant site of spread outside of the peritoneal cavity is the lungs.

Fallopian tube cancer and Primary Peritoneal cancer have similar cell types and behaviors as ovarian cancer. These two diagnoses are made if a similar cancer grows on either the fallopian tube or the peritoneal surface of the abdomen with little, or no, involvement of the ovaries. Fallopian tube cancer is one of the rarest forms of cancer and is usually identified incidentally in its earliest stages due to vague pelvic symptoms resulting in pelvic exploratory surgery. Primary peritoneal cancer is always detected in late stages by virtue of the fact that it starts on multiple surfaces around the peritoneal cavity. Fallopian Tube and Primary Peritoneal Cancers are treated similarly and have relatively similar outcomes when compared stage-for-stage to ovarian cancer.

Screening

Although many laboratories are dedicating their efforts to finding an accurate screening test for ovarian cancer, to date there is no reliable test to offer to women who have no symptoms or signs of cancer.

Symptoms may include

changes in bowel function
changes in bladder function
pelvic pressure
inability to eat as much in one sitting as usual
shortness of breath
fatigue

Unfortunately, these symptoms are rarely felt when the cancer is confined to the ovary. Therefore, ovarian cancer is usually diagnosed in later stages of the disease. Diagnosis

The diagnosis of ovarian cancer can only be made by surgically removing the ovarian mass, then having it evaluated by a pathologist. Surgery is recommended to patients if a suspicious mass is found on the ovary during a routine gynecologic exam or by ultrasound (MRI or CT scan) prompted by complaints of abdominal or pelvic symptoms.

An elevated CA-125 blood test may increase the suspicion for ovarian cancer. However, many benign conditions may result in an elevation of the CA-125 and some ovarian cancer patients have normal CA-125 levels.

Staging Procedures

In order to determine the stage of the disease, or where ovarian, fallopian tube, and peritoneal cancer have spread, a surgical procedure must be performed. The surgical procedure includes an exploration of the peritoneal cavity, aspiration of fluid from the peritoneal cavity, total hysterectomy, removal of both fallopian tubes and ovaries, removal of the omentum, and a lymph node dissection. Additionally, the chest should be evaluated before surgery with a chest x-ray or chest CT scan.

Stages of Disease

Stage I: Confined to the ovaries
Stage II: Spread of ovarian cancer to other sites in the pelvis
Stage III: Spread beyond the pelvis to other parts of the peritoneal cavity or lymph nodes
Stage IV: Distant spread of disease to locations outside of the peritoneal cavity such as the lungs or to areas deep within the liver. These cancers rarely spread to locations such as the brain or bones.

Treatment

Treatment of ovarian, fallopian tube and peritoneal cancers is dependent on the stage and grade of disease. For some patients with disease confined to the ovaries and no spread of disease, no further treatment is required. Standard recommendations for other patients include surgical removal of any visible spread of the disease, followed by chemotherapy. Chemotherapy may be delivered intravenously or directly into the peritoneal cavity. Alternative treatment plans exist for women who may not be able to tolerate an aggressive surgery due to extensive spread of cancer or to the patient's poor health.

Outcomes

Patients with Stage I or Stage II disease who undergo surgery and chemotherapy have great than an 80% chance for long-term survival.

Unfortunately, 75-80% of women are diagnosed with Stage III or Stage IV disease. Only about 20% of patients with advanced disease can expect a long-term survival.

See Frequently Asked Questions about Ovarian Cancer.