What Is Ovarian Cancer (Ovarian Tumors)?
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
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)
Computed tomography scan (CT or CAT scan) is a non-invasive diagnostic imaging procedure that uses a combination of special X-ray equipment and sophisticated computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor or printed.
CT scans are more detailed than general X-rays, showing detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular X-ray exams. CT scans also minimize exposure to radiation. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
In standard X-rays, a beam of energy is aimed at the body part being studied. A plate behind the body part captures the variations of the energy beam after it passes through skin, bone, muscle, and other tissue. While much information can be obtained from a standard X-ray, a lot of detail about internal organs and other structures is not available.
In computed tomography, the X-ray beam moves in a circle around the body. This allows many different views of the same organ or structure. The X-ray information is sent to a computer that interprets the X-ray data and displays it in a two-dimensional (2D) form on a monitor.
Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.
CT scans of the chest can provide more detailed information about organs and structures inside the chest than standard X-rays of the chest, thus providing more information related to injuries and/or diseases of the chest (thoracic) organs.
Chest CT scans may also be used to visualize placement of needles during biopsies of thoracic organs or tumors, or during aspiration (withdrawal) of fluid from the chest. This is useful in monitoring tumors and other conditions of the chest before and after treatment.
While many images are taken during a CT scan, in some cases the patient receives the same or less radiation exposure than with a single standard X-ray.
CT scans may be done with or without “contrast.” Contrast refers to a substance taken by mouth or injected into an intravenous (IV) line that causes the particular organ or tissue under study to be seen more clearly. Contrast examinations may require you to fast for a certain period of time before the procedure. Your physician will notify you of this prior to the procedure.
Care agreement:
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
Related procedures
Other related procedures that may be used to assess the heart include:
- Resting or exercise electrocardiogram (ECG or EKG)
- Holter monitor
- Signal-averaged ECG
- Cardiac catheterization
- Chest X-ray
- Echocardiogram
- Electrophysiological studies
- Magnetic resonance imaging (MRI) of the heart
- Myocardial perfusion scans
- Radionuclide angiography
- Ultrafast 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.
By detecting increased glucose use with a high degree of sensitivity, PET identifies cancerous cells—even at an early stage when other modalities may miss them. However, PET cannot pinpoint the exact size and location of tumors to a precision necessary for optimal diagnosis and treatment planning.
What CT scans do
CT, or computed tomography, yields a detailed picture of the body’s anatomical structures by taking cross-sectional images or X-ray slices of the body. While CT does an excellent job of depicting structures and anatomy, it may miss small or early stage tumors.
How a combined PET/CT scan improves on separate scans
Currently, doctors can overlay the results of PET and CT scans performed separately to identify and locate tumors. However, because a patient may not be positioned identically for both scans, the two images can be difficult to line up exactly, degrading the accuracy of the diagnostic information.
The combined PET/CT machine allows doctors to rapidly perform both scans in one session without having to move the patient. This means doctors can precisely overlay the metabolic data of the PET scan and the detailed anatomic data of the CT scan to pinpoint the location and stage of tumors.
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.
