Ovarian and Fallopian Cancer

What Is Ovarian Cancer (Ovarian Tumors)?

Ovarian and Fallopian Cancer

Ovarian cancer (also called ovarian tumors) is a disease in which malignant cells are found in an ovary, the female reproductive organs located in the pelvis. There are a few types of ovarian tumors, named for the tissue in which they are found:

  • Epithelial cell—cells that cover the surface of the ovary. Epithelial ovarian cancer accounts for 85 to 90% of ovarian cancer cases.
  • Fallopian tube cancer—once thought to be relatively uncommon, recent studies have shown that many cases of ovarian cancer actually originate in the fallopian tubes, and are treated in the same way as ovarian cancer. The most common type of fallopian tube cancer is serous carcinoma, which begins in cells in the lining of the fallopian tubes.
  • Germ cell—cells that form the eggs in the ovary.
  • Stromal cell—cells that form the main part of the ovary and produce female hormones.
  • Peritoneal cancer—another cancer closely related to epithelial ovarian cancer. It occurs outside the ovary in the peritoneum, which is the lining of the abdomen. Because it occurs outside the ovary, women who have had their ovaries removed can still develop this type of cancer.  Peritoneal cancer presents with the same symptoms and signs as ovarian cancer and can also cause an increase in the CA-125 tumor marker.

Ovarian and Fallopian Cancers Symptoms

The following are the most common symptoms of ovarian, fallopian tube, and peritoneal cancers.  However, you may experience symptoms differently from other women. Symptoms may include:

  • General discomfort in the lower abdomen, including any/all of the following:
    • Feeling swollen or bloated
    • A loss of appetite or a feeling of fullness—even after a light meal
    • Gas, indigestion, pain and nausea
  • Weight loss
  • Diarrhea or constipation, or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder
  • Vaginal bleeding
  • Build-up of fluid around the lungs, which may cause shortness of breath
The American Cancer Society (ACS) recommends that if any of these symptoms occur almost daily or last a few weeks and are new, you should seek the attention of her physician. In many cases, symptoms do not occur until the cancer is in an advanced stage. The symptoms of ovarian, fallopian tube or peritoneal cancer may resemble other medical conditions or problems. As with any suspected medical condition, it is important that you consult your physician for assessment and diagnosis.

Ovarian and Fallopian Cancers Diagnosis

Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum and lower abdomen for masses or growths. Your doctor may request a Pap test as part of the pelvic examination. Your doctor may also order other tests, including:

Ultrasound

What Is an Ultrasound?

Ultrasonography, which is sometimes called sonography, uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. The sound waves bounce off body parts and send back an image, like sonar on a submarine. A computer then looks at the signals sent back by the sound waves and creates an image of the body using those signals.

Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. Ultrasound procedures are often used to examine many parts of the body such as the abdomen, breasts, female pelvis, prostate, scrotum, thyroid and parathyroid, and the vascular system. During pregnancy, ultrasounds are performed to evaluate the development of the fetus.

CT scan

Computed Tomography Scan (CT Scan)

PET scan

What Is Positron Emission Tomography (PET) Scan?

Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine imaging. A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning.

PET is a powerful diagnostic test that is having a major impact on the diagnosis and treatment of disease. A PET scan (positron emission tomography scan) monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). PET can detect extremely small cancerous tumors, subtle changes of the brain and heart, and give doctors important early information about heart disease and many neurological disorders, like Alzheimer’s.

Most common medical tests, like CT and MRI scans, only show details about the structure of your body. PET scans give doctors images of function throughout the entire body, uncovering abnormalities that might otherwise go undetected. This allows doctors to treat these diseases earlier and more accurately. A PET scan puts time on your side. The earlier the diagnosis, the better the chance for treatment.

For example, a PET scan is the most accurate, non-invasive way to tell whether or not a tumor is benign or malignant, sparing patients expensive, often painful diagnostic surgeries and suggesting treatment options earlier in the course of the disease. Although cancer spreads silently in the body, PET can inspect all organs of the body for cancer in a single examination.

Today, most PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic activity within the body. The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.

About nuclear medicine

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose or treat a variety of diseases, including many types of cancers, heart disease, and certain other abnormalities within the body. Depending on the type of nuclear medicine exam you are undergoing, the radiotracer is either injected into a vein, swallowed or inhaled as a gas and eventually accumulates in the organ or area of your body being examined, where it gives off energy in the form of gamma rays. This energy is detected by a device called a gamma camera, a PET scanner and/or probe.

PET/CT scan

PET/CT Scan

Stanford is the first health care institution in Northern California to offer patients a powerful new diagnostic imaging system known as Positron Emission Tomography/Computerized Tomography (PET/CT) scanning.

This hybrid technology combines the strengths of two well-established imaging modalities in one imaging session to more accurately diagnose and locate cancers while increasing patient comfort.

Today, most PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic activity within the body, like malignant tumor cells. The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.

Every PET/CT scan at Stanford is reviewed and correlated by both a board certified nuclear medicine doctor and a board certified radiologist at a daily joint review session. Separate full reports are generated from each division for each patient.

The PET and CT scans are done at the same time on the same machine. The physician is able to precisely overlay the metabolic data of the PET scan and the detailed anatomic data of the CT scan to make a more detailed image than either test would make by itself. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Some people are sensitive to the radioactive glucose and may have nausea, headache, or vomiting.

What PET scans do

PET, or positron emission tomography, monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). Cancer cells metabolize glucose at a much higher level than normal tissues.

Lower gastrointestinal (GI) series

Barium Enema / Lower Gastrointestinal Series

A barium enema, sometimes called a lower gastrointestinal (GI) series, is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine using a contrast dye containing barium. The barium—a metallic chemical, chalky-liquid—coats the inside of the organs so that it will appear on an X-ray, showing strictures (narrowed areas), obstructions (blockages), and other problems.

Blood test

Blood Test

To measure a substance in the blood called CA-125 (a tumor marker that is found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test since non-cancer problems can cause it to be elevated.

Biopsy

What Is a Biopsy?

A biopsy is a procedure in which tissue samples are removed from the body by a needle or during surgery, for examination under a microscope to determine if cancer or other abnormal cells are present.

By examining and performing tests on the biopsy sample, pathologists and other experts can determine what kind of cancer is present, whether it is likely to be fast or slow growing, and what genetic abnormalities it may have. This information is important in deciding the best type of treatment. Open surgery is sometimes performed to obtain a biopsy, but in most cases, tissue samples can be obtained without open surgery using interventional radiology techniques.

Some biopsies can be performed in a doctor’s office, while others need to be done in a hospital setting. Most biopsies require use of an anesthetic to numb the area and may require sedation.

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