Advanced Ovarian Cancer: Diagnosis, Symptoms and Treatment

A diagnosis of Advanced Ovarian Cancer can be overwhelming. This term simply means the cancer has spread beyond the ovaries, typically into the abdomen or other distant sites (like the lungs). Unfortunately, ovarian cancer is often diagnosed at this later stage (Stage 3 or 4) because its initial symptoms are vague and easily mistaken for less serious conditions.

While the diagnosis is serious, advanced does not mean treatment stops. Advances in surgery, chemotherapy, and targeted medicine have significantly improved outcomes. The focus of your care is to control the disease, alleviate symptoms, and maintain the best possible quality of life.

 

What Is Advanced Ovarian Cancer?

Ovarian cancer starts in the ovaries, fallopian tubes, or the peritoneum (the lining of the abdomen). It is categorized into four stages, with Stage 3 and 4 being considered advanced:

• Stage 3: The cancer has spread outside the pelvis, into the abdomen, or to lymph nodes within the abdomen.

• Stage 4: This is the most advanced stage, where the cancer has spread to distant organs, such as the liver or the tissue around the lungs (pleural effusion).

 

Common Symptoms of Advanced Disease

The symptoms of ovarian cancer are often non-specific early on, but they become more persistent and troubling as the disease advances:

• Persistent Bloating: A feeling of swelling or fullness in the abdomen that does not come and go, often due to fluid build-up (ascites).

• Abdominal Pain and Discomfort: Pain or a heavy sensation in the lower abdomen or pelvis.

• Early Satiety: Feeling full very quickly when eating, or experiencing a loss of appetite. This can lead to unexplained weight loss.

• Bowel or Bladder Changes: Changes like persistent constipation (sometimes due to a bowel obstruction), or needing to urinate more frequently or urgently.

• Fatigue: Extreme, persistent tiredness that is not relieved by rest.

Treatment Options for Advanced Ovarian Cancer

The treatment plan is complex and tailored by a multidisciplinary team, typically including a gynecologic oncologist (a surgical specialist) and a medical oncologist (a chemotherapy specialist).

The goal is usually to achieve disease control and the best possible quality of life. Treatment generally combines surgery with medical approaches:

1. Surgery (Debulking)

The main surgical procedure for advanced ovarian cancer is cytoreductive surgery or debulking. The primary goal is to remove as much visible cancer tissue as possible. Studies show that patients have a better prognosis when the surgeon can remove all visible disease.

• Primary Debulking Surgery (PDS): Surgery is performed first, followed by chemotherapy.

• Neoadjuvant Chemotherapy (NACT): Chemotherapy is given before surgery to shrink large tumors, making the subsequent operation more successful.

2. Chemotherapy

Chemotherapy is the standard follow-up treatment to eliminate any remaining cancer cells after surgery. It typically involves a combination of two cytotoxic drugs:

• Platinum-based drugs and a taxane, administered intravenously in cycles.

 

3. Targeted Therapy and Maintenance Treatment

After successful initial chemotherapy, your doctor may recommend maintenance therapy to help prevent the cancer from returning. These newer drugs are a crucial part of modern treatment and are categorized into classes based on how they work:

• Medications that Inhibit DNA Repair: This is a class of oral medications (known as PARP inhibitors) that are highly effective for patients whose tumors have a genetic alteration (such as in the BRCA genes). They work by preventing cancer cells from effectively repairing their own damaged DNA, leading to cell death.

• Medications that Inhibit Blood Supply: These are antibody therapies that work by blocking the formation of new blood vessels that tumors need to grow. This process effectively starves the cancer and slows its progression.

Living Well with Advanced Ovarian Cancer

Managing an advanced cancer diagnosis requires focusing on more than just the medical treatments. You can approach ovarian cancer as a chronic disease and take proactive steps to empower yourself:

• Active Symptom Control: Talk openly with your doctor about pain, nausea, or other discomfort. Effective treatments exist to alleviate these issues, whether through medication, fluid draining, or other supportive care.

• Physical Activity and Prehabilitation: Even during chemotherapy, maintaining gentle activity (like daily walking or yoga) can help manage fatigue and strengthen your body before and after surgery. Staying active is essential for quality of life.

• Psychosocial Support: It is normal to feel anxious, sad, or uncertain. Utilize the support resources available to you, such as social workers, counselors, or patient advocacy groups. Discussing priorities and future planning with your loved ones can also be a vital part of the process.

 

Clinical Studies

There are currently clinical studies investigating potential treatments - find out more about that here.

 

Final Thoughts

Even with a diagnosis of advanced ovarian cancer, you are an active participant in your own care. By working closely with a specialized team, leveraging the latest medical advances, and focusing on support and quality of life, you can take control of your situation and live better.

Sources

Mayo clinic