If you are newly diagnosed with advanced-stage ovarian cancer, you may have difficulty learning that despite your best efforts with standard treatment, the disease may recur. However, an interesting dialogue is currently taking place among medical experts and patients with ovarian cancer. This conversation relates to a shift in the way the medical profession is beginning to approach planning for the treatment of ovarian cancer, particularly when it is diagnosed at a later stage.
Significantly, since a majority of women (at least 75%) have stage III or IV ovarian cancer at diagnosis, only about 20% to 25% of women will have a “durable remission”—that is, they will have no evidence of disease for 5 years after their diagnosis. Therefore, for a majority of women, ovarian cancer will recur. The good news is that while a cure may not be possible, ovarian cancer can be effectively treated or stabilized over an extended period of time.
When ovarian cancer recurs, the goal of treatment may become focused on stopping or slowing the spread of the cancer even when it cannot be completely eliminated. In some women the disease will go in and out of remission, with chemotherapy being required intermittently, over a long period of time. Thus, ovarian cancer specialists are beginning to approach the illness as more of a chronic disease, meaning that the patient can live for an extended time with a good quality of life. This does not mean that researchers are not working toward finding a cure for ovarian cancer; quite the contrary. What it does mean is that proactively planning the sequence of what therapy to take and when over an extended period of time may help women live longer and better with ovarian cancer.
For some, it may be overwhelming to think about living with ovarian cancer as a chronic disease. Obviously, you and your health care team want nothing more than to rid your body of cancer forever. And, while over 9 million cancer survivors in the United States today dispel the myth that cancer is a death sentence, it may still be difficult to comprehend that you and your family may be living with this disease for an extended period of time.
On the other hand, the idea that the disease can be repeatedly treated over time may give you a sense of hope that it can be managed and controlled to enable you to live your life and to do the things you want to do. Either way, you may feel angry and afraid.
Nearly every woman with ovarian cancer shares your fear. But there is hope. By being well-informed about the disease and its treatment, you may be able to more effectively manage your disease over an extended period of time. In addition, by developing constructive ways to better address your emotional, social, and spiritual needs, you can take back control and live well, not just despite the disease, but also because of it.
Ovarian cancer is the fifth most common cancer in women in the United States. A woman's risk of getting ovarian cancer is approximately 1.4% (1 in 70) during her lifetime. This year, the American Cancer Society estimates that over 24,000 women will be diagnosed with ovarian cancer, a malignancy that arises from the ovaries.
Although ovarian cancer can be a complex and challenging disease, there are several things you can do to regain hope and take active control of the disease, its treatment, and your life in general.
Understanding Ovarian Cancer
The ovaries develop from the same fetal tissue that forms the lining of the abdominal cavity. As a woman develops from birth through puberty, the ovaries grow larger.
The average size of the ovary in a premenopausal woman is 3.5 cm long by 2.0 cm wide by 1.0 cm thick, or about the size of a small walnut. The ovaries change size, shape, and position many times during a woman’s reproductive years. They are pinkish gray in color, almond-shaped, and occupy space on either side of the uterus. It is the ovaries that produce hormones needed for growth and development and the eggs needed for reproduction.
As a woman ages and moves through menopause, the ovaries shrink in size to smaller than an almond, and begin to fall behind the uterus. In a postmenopausal woman, the ovaries can become so small that they cannot usually be examined as easily by pelvic exam.
Ovarian cancer is a malignant tumor that can begin in one or both ovaries. Like all cancers, ovarian cancer occurs when abnormal cells grow in an uncontrolled manner that cannot be controlled by the body’s natural defenses. These abnormal cells, which can invade and destroy normal tissue, can accumulate and form growths or masses called tumors. Cancer cells can spread through direct contact with other organs, the blood stream, or lymph nodes to other parts of the body.
The spread of a tumor from the original location to a new site is called metastasis. Because ovarian cancer tumors start out small and often do not cause discomfort, the disease is difficult to diagnose early before it has a chance to spread. Consequently, many women will be diagnosed with advanced metastatic disease.
Types Of Ovarian Cancer
There are three general categories of ovarian tumors, which are classified according to the type of cell from which they start. The most common type of ovarian cancer is epithelial, which includes about 90% of ovarian tumors and is the leading cause of death from gynecologic cancer in the United States. Epithelial tumors (those that start in the cells covering or lining the ovaries) can be subtyped into serous (most common), mucinous, endometrioid, clear cell, and Brenner tumors.
The remaining categories of ovarian tumors are germ cell tumors (5% of all cases) and sex-cord stromal tumors (5% of all cases).
It is important to emphasize that although all cancers arise from genetic dysfunction, only 5% to 10% are actually inherited. Most cases of ovarian cancer—probably 90% to 95%—occur randomly or without any inheritance pattern. Ovarian cancer that is hereditary, or passed from one generation to the next, may be associated with family members who have had ovarian, fallopian tube, breast, colon, prostate, and endometrial cancers.
Two genes that are associated with hereditary breast and ovarian cancer in families are the BRCA1 and BRCA2 genes. Mutations in either of these genes may lead to the development of breast and ovarian cancer. Families that seem to have several cancers in the family, especially if they occur in young women and men, should discuss this trend with their physicians, who in turn may recommend genetic testing and counseling.
There are specific recommendations for women who have a risk for familial breast and ovarian cancer that may offer some protective benefits and monitoring options that should be discussed with a physician. It is important to stress that the medical community does not yet fully understand the risks of genetic mutations, nor have they perfected genetic testing to answer all the questions that you and your family may have.