Ovarian cancer continues to cause 5.6% of all cancer deaths in women here in Minnesota. Efforts to reduce these deaths are focused on prevention, better detection of early stage disease, aggressive surgical removal of more widespread tumor, and advances in secondary or adjunctive therapy including intraperitoneal chemotherapy. Prevention remains the ideal way to decrease the impact of this disease. Prolonged use of oral contraceptives is a proven way to reduce risk. Prevention by removal of both the ovaries and fallopian tubes is highly effective and often pursued by particularly high-risk patients.

Early diagnosis depends on patient awareness of recent onset of the nonspecific abdominal symptoms of bloating, abdominal pain, difficult eating, early sense of fullness, and urinary symptoms such as frequent or urgent voiding. These symptoms are common so concern is reserved for those women with newly developed symptoms that are usually daily or persistent for several weeks. Evaluation with standard examinations and ultrasound and CT are usually sufficient to clarify whether a potential problem exists. Blood studies are less value in these situations. Routine screening of asymptomatic women with CA 125 and ultrasound is not accurate and therefore not recommended. Much research is being done on more effective screening studies for this disease since early diagnosis is associated with high cure rates. The next few years will likely offer new opportunities for screening in both high and normal risk women.

The foundation of treatment of ovarian cancer continues to be aggressive removal of as much tumor as possible, ideally leaving no visible disease. This can best be accomplished by either gynecologic oncologists or skilled gynecologic surgeons with assistance of other surgical specialists as necessary. Removal of the maximum amount of tumor and subsequent treatment with either intraperitoneal or intravenous chemotherapy provides the best opportunity for patients dealing with this difficult disease.

Comparison of data on ovarian cancer patients treated at Rice Hospital with the national experience clearly indicates that we see a larger percentage of patients with serous/papillary cystadenocarcinomas (68% vs 32%) Figure 1. This may explain the observation that more patients at Rice Hospital are over 60 when diagnosed (78% vs 63%) Figure 2. It may also partially explain why slightly more patients at Rice Hospital are diagnosed at Stage III/IV (64% vs 59%) Figure 3. The NCDB data show a higher number of patients diagnosed as Stage IV (24% vs 7%) which probably explains why NCDB data show no primary site surgery in 35% of patients while Rice patients managed without primary site surgery was only 7% (Figure 4) of the total. There is no clear explanation for this difference.

"Observed Survival for Ovary" >> view graph

Glenn G. Buchanan, MD, OB/GYN

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