Learning About Ovarian Cancer
- Tracy Berry, a 38-year-old Australian mom, was diagnosed with stage 4 ovarian cancer after experiencing back pain, bloating, and fatigue.
- Now she’s spreading awareness for the disease and urging others to listen to their bodies when something feels off.
- People should remain vigilant and aware of any new or unusual symptoms and report to their physicians for appropriate evaluation.
- Ovarian cancer treatment may involve a combination of surgery, chemotherapy, and possibly targeted therapies called PARP inhibitors
- SurvivorNet’s extensive resources on ovarian cancer can be found here: https://www.survivornet.com/journey/ovarian-cancer-initial-treatment/
Berry, of Queensland, Australia, was working as a personal trainer and competing as a bodybuilder when she started noticing a change in how her body was feeling, something she initially dismissed as “normal.”Read More
Berry admitted to the news outlet that she missed “a lot of signs” of the disease before her 2017 diagnosis.
She explained, “I didn’t really think I had any signs or symptoms as I didn’t know anything about ovarian cancer. The pain just kept getting worse to the point where I ended up in a ball on the ground, unable to move.”
It was then she was rushed by an ambulance to a nearby emergency room where she was treated for gallstones. Further testing and an ultrasound ultimately revealed a large growth on her left ovary.
Then, doctors found that a 16cm cyst on her left ovary had burst, prompting her to get surgery to remove the cyst and her ovary.
After visiting an oncologist and undergoing more scans, biopsies, and ultrasounds, it was confirmed that the cancer had spread to her right ovary, her uterus, and her endometrium.
“I needed to have a full hysterectomy, which included the removal of my ovaries, uterus and cervix,” Berry said. “My doctor also removed my appendix, some lymph nodes and the fatty layer over my stomach to minimize the likelihood of the cancer traveling.”
Berry, who feels “very luck to be alive,” was declared cancer free after undergoing six rounds of chemo in November 2017, and just this year, she was given the “five-year clear mark.”
“My condition is, in the words of my oncologist, ‘cured.’ I am fit, healthy and enjoying my life,” she said.
Berry insisted “no one is immune” to the disease she battled, noting “there is so much misinformation about ovarian cancer.”
Now she’s working to raise awareness and plans to take part in Ovarian Cancer Australia’s Workout 4 Women challenge to move a total of 500km throughout the month of November.
“I was at my healthiest when I was diagnosed with ovarian cancer, which goes to show how no one is immune from its impacts,” she concluded.
Learning About Ovarian Cancer
With ovarian cancer, chemotherapy is usually the first stage of treatment, but as far as staging your actual cancer? It’s a little more difficult to tell until your doctor performs a surgery.
For ovarian cancer, gynecologic oncologists recommend a staging procedure after a diagnosis when they have evidence that the cancer may be early or limited, which has to do with the location of the tumor. Based on where the cancer is found, it will be assigned a stage.
We spoke with Dr. Amanda Fader, who further describes the notion of staging your ovarian cancer through surgery, that determines what, if any, cancer has spread.
“If it’s remained in the ovary where it was initially found or developed, then the cancer is Stage 1,” says Dr. Amanda Fader, vice chair of gynecologic surgical operations at Johns Hopkins University in Baltimore, tells SurvivorNet.
“But if the cancer has started to spread to other organs or through the lymph nodes to other parts of the body, then it would be identified as Stage 2, 3, or 4,” Dr. Fader adds.
The Stages of Ovarian Cancer
- Stage 1: The cancer is confined to the ovaries or fallopian tubes
- Stage 2: The tumor involves one or both ovaries with extension to other pelvic tissues (or is a primary peritoneal cancer)
- Stage 3: The cancer has spread outside of the pelvic peritoneum including to the outside of the bowel, liver and spleen and/or it involves the lymph nodes
- Stage 4: There are distant metastases (outside of the pelvis and abdomen) or metastases to the inside of the spleen or liver
When doctors have evidence before the surgery, such as from imaging tests, that the tumor may be limited to the ovary, they will usually recommend a staging procedure. During that operation, doctors remove all or part of the ovary with the tumor and send it—while the patient is still asleep on the operating table—to a pathologist who will examine the tissue and identify the type of tumor so doctors can decide how best to treat it.
If the tumor is determined to be benign, the surgery can end. Otherwise, more extensive surgery is usually performed. Prior to the surgery the patient and her doctor would have discussed the various possible findings, so that depending on the result of the ovarian biopsy, the surgeon knows what the patient’s wishes are and how to proceed. “We would have made these decisions ahead of time through our preoperative counseling,” explains Dr. Fader.
If the tumor is malignant—ovarian cancer—“then we usually do a hysterectomy and remove the opposite ovary, too, in case it’s involved with the cancer. We also remove the omentum—an apron of fat in the abdomen. It has no known function, like the appendix, but can be involved in many ovarian cancer cases. And we’ll do several biopsies around the abdomen and pelvis, including biopsies of the lymph nodes and peritoneum (the tissue lining of the abdomen).”
These biopsies will determine whether the cancer has spread and if so, how far.
Ovarian Cancer Treatment Options
If your doctor diagnoses you with ovarian cancer, you might be referred to a gynecologic oncologist. Surgery and chemotherapy both factor into treatment for most women with ovarian cancer and, according to SurivorNet’s experts, the only variation is the sequence in which women get them.
Several factors go into deciding what kind of treatment is best, depending on the type and stage of ovarian cancer, your age, and whether you are planning to have children in the future. Surgery is usually the first treatment recommended, with chemotherapy afterward to get rid of any cancer that may have been left behind. The other option is to have chemotherapy first, called neoadjuvant chemotherapy, to shrink the tumor so that it’s easier to remove surgically.
If a doctor is confident that he or she can remove the ovarian tumor completely without initial cycles of chemotherapy, they will go ahead with a surgical procedure. Doctors who are not confident they can perform successful surgical tumor removal will go with chemotherapy initially, then proceed with surgery once tumors have shrunk.
Meanwhile, chemotherapy can shrink ovarian cancers. The standard chemotherapy regimen for ovarian cancer is made up of two drugs in combination: a platinum-based chemotherapy drug like carboplatin or cisplatin and a taxane chemotherapy drug such as paclitaxel (Taxol) or docetaxel (Taxotere).
Women with ovarian cancer typically get these treatments through an IV every three to four weeks. The usual course of chemotherapy is made up of three to six treatment cycles, based on the cancer stage, but different drugs have different treatment cycles.
After the initial treatment with surgery and chemotherapy got rid of as much of the cancer as possible, the next goal is to extend the amount of time before the cancer comes back. Doctors call this maintenance therapy, and for ovarian cancer it can include two drugs: bevacizumab (Avastin) and olaparib (Lynparza), which is a PARP inhibitor
PARP inhibitors work by preventing cancer cells from repairing their damaged DNA.
They have shown great promise in keeping the cancer from returning. These drugs can also now be used in the initial treatment of ovarian cancer.
Ovarian Cancer: Difficult to Diagnose
It isn’t unusual for women, like Berry, not to realize they have symptoms of a disease, as ovarian cancer is often referred to as the “cancer that whispers,” according to Dr. Beth Karlan, Director of the Women’s Cancer Program at the Cedars-Sinai Medical Center.
It has symptoms that are very vague and are often similar to the symptoms many women experience every month with their menstrual cycle. However, if you are experiencing any of the following symptoms, and they seem to be “crescendoing,” or getting worse, it is worth it to see a doctor to rule out ovarian cancer:
- Feeling full earlier/decrease in appetite
- Feeling bloated
- Changes in bowel habits
- Pain in the pelvis
- Urinary symptoms, such as an urgent need to go
- Extreme fatigue
- Abdominal swelling
- Pain during sex
It’s hard to connect these symptoms specifically with the ovaries because they could be caused by a whole host of other issues. That’s why Dr. Karlan, as well as many other top gynecologic oncologists in the U.S., highly suggest women be vigilant about getting tested if they feel that something is amiss with their bodies.
Because many of these symptoms are associated with women’s menstrual cycles, this may mean being insistent with doctors who may want to write off symptoms.
Ovarian cancer also tends to be diagnosed in older women; roughly half are diagnosed when they are over the age of 60. Because of this, many doctors will write off symptoms as signs of menopause. Since there is no screening test for ovarian cancer so far, only about 20% of cases are diagnosed in the early stages, according to the American Cancer Society.
Contributing: SurvivorNet Staff