Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have and helps your doctor determine which treatments are best for you. Ovarian cancer types include:

• Epithelial ovarian cancer. This type is the most common. It includes several subtypes, including serous carcinoma and mucinous carcinoma.
• Stromal tumors. These rare tumors are usually diagnosed at an earlier stage than other ovarian cancers.
• Germ cell tumors. These rare ovarian cancers tend to occur at a younger age.

The exact cause of ovarian cancer isn’t yet known. But some people have a slightly higher risk of developing the condition. Ovarian cancer risk factors include:

• Genetic mutations. Approximately 15% of ovarian cancers are linked to genetic mutations. Most are due to BRCA1 (BReast CAncer gene 1) or BRCA2 (BReast CAncer gene 2) mutations. However, other mutations can also be associated with ovarian cancer, including Lynch syndrome.
• Family history of ovarian cancer: People with a relative diagnosed with ovarian cancer (such as a mother, sister, grandmother or aunt) have higher risk.
• Being overweight or obese. Being overweight or obese increases the risk of ovarian cancer.
• Postmenopausal hormone replacement therapy. Taking hormone replacement therapy to control menopause signs and symptoms may increase the risk of ovarian cancer.
• Endometriosis. Endometriosis is an often painful disorder in which tissue similar to the tissue that lines the inside of your uterus grows outside your uterus.
• Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.
• Never having been pregnant. If you've never been pregnant, you may have an increased risk of ovarian cancer

If you have symptoms that may signal ovarian cancer, your doctor will examine you and ask you questions about your health and family medical history. One or more of the following tests for ovarian cancer may be used to find out if you have the disease and if it has spread. These tests also may be used to find out if treatment is working.

Pelvic examination:

A clinical pelvic exam helps find out if there is a mass on either side of the uterus. . During the exam, the doctor will check for any abnormal growths or enlarged organs.

Tumor markers for ovarian cancer:

The tumor marker for ovarian cancers will depend on the exact type of ovarian cancer that is suspected or diagnosed. Among the common tests used for epithelial ovarian cancer is CA-125. 

These tests can't tell your doctor whether you have cancer, but they may provide clues about your diagnosis and prognosis.

There are many other types of blood tests that may be requested by the gynecologic oncologist based on the exact subtype of ovarian cancer.

Ovarian cancer biopsy

The only way to find out for certain if a growth is ovarian cancer is for the doctor to remove tissue from it and look at it under a microscope. This is called a biopsy. Tissue can be removed by:

• Surgery
• Laparoscopy
• Fine needle aspiration (FNA)

However, if a mass appears confined to the ovary, then surgery to remove it may be the most appropriate next step. The mass is biopsied after it is removed.

Ovarian cancer imaging

The following imaging exams may be used to diagnose ovarian cancer:

• CT  (computed tomography) scans
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans
• Transvaginal ultrasound: A wand-shaped scanner is put into the vagina. It has a small ultrasound device on the end.

Once it's confirmed that you have ovarian cancer, your doctor will use information from your tests and procedures to assign your cancer a stage. The stages of ovarian cancer range from I to IV. The lowest stage indicates that the cancer is confined to the ovaries. By stage 4, the cancer has spread to distant areas of the body.

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Other treatments may be used in certain situations.

Surgery:

Your surgeon may use laparoscopy (a minimally invasive surgery) or laparotomy (open surgery that requires an abdominal incision).

The type of surgery recommended depends on the stage and spread of the cancer. Ovarian cancer surgeries include one or more of the following procedures.

• Salpingo-oophorectomy: removal of one or both fallopian tubes and ovaries. It is done for early-stage cancer that have not spread beyond the ovaries. This procedure may preserve your ability to have children.
• Total Hysterectomy: Surgery to remove both ovaries and the uterus. 
• Pelvic and/or para-aortic lymphadenectomy: removal of lymph nodes in the abdomen and pelvis
• Omentectomy: removal of fatty tissue (omentum) that drapes over the intestines. Ovarian cancer has a high propensity to spread to the omentum.
• Cytoreduction (debulking): If cancer has spread throughout the abdomen, surgery to remove the cancer and affected organs may be recommended. This can be an extensive surgery that may include removal of other organs or parts of other organs, including the small and/or large intestine, bladder, liver, spleen and peritoneal surfaces throughout the abdomen. This type of surgery can be done before or after chemotherapy, depending on your situation.

Chemotherapy:

Your doctor may recommend chemotherapy to kill cancer cells or to interfere with their ability to grow. Chemotherapy drugs can be given intravenously, and some can be taken by mouth. Chemotherapy may be given before and/or after surgery for ovarian cancer. In some situations, chemotherapy may be administered directly into the abdomen via an abdominal port (intraperitoneal chemotherapy), or it can be given intraoperatively during cytoreductive surgery as hyperthermic intraperitoneal chemotherapy (HIPEC).

Targeted therapy:

Targeted drug treatments focus on specific weaknesses present within cancer cells. By attacking these weaknesses, targeted drug treatments can cause cancer cells to die.

If you're considering targeted therapy for ovarian cancer, your doctor may test your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer.

Hormone therapy:

Hormones or hormone-blocking medications may be used to treat some types of ovarian tumors. These medications block the production of estrogen, lower estrogen levels or block estrogen from circulating where tumors can use it to grow.

Immunotherapy

Immunotherapy uses the immune system to fight cancer. The body's disease-fighting immune system may not attack cancer cells because they produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy might be an option for treating ovarian cancer in certain situations.

Palliative care:

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery and chemotherapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Ovarian cancer care at Shefa-El Orman:

Shefa-El Orman doctors draw on their experience caring for those with ovarian cancer to provide personalized and comprehensive treatment that takes into account your needs and goals.

Each year, more than 1,500 people with ovarian cancer seek care at Shefa-El Orman Hospital. Specialists have extensive experience caring for all types and stages of ovarian cancer.

At Shefa-El Orman Hospital, surgeons trained with additional training in surgery and cancer treatment (gynecological oncologists) work as a team with other medical experts such as medical oncologists, pathologists and radiation oncologists.

Shefa-El Orman doctors have access to the most advanced ovarian cancer treatment available. Depending on your situation, you and your care team might consider:

• Advanced surgical techniques, including fertility-sparing surgery, minimally invasive surgery and robotic surgery, when appropriate
• The latest treatments, such as hyperthermic intraperitoneal chemotherapy (HIPEC)
• Innovative systemic therapy options, including targeted therapy, immunotherapy and chemotherapy

Comprehensive palliative care to support you during treatment

______________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical blood test
  • inflammation markers (CRP, ESR)
  • blood coagulation analysis (aPTT, PT, INR)
  • tumor markers (CEA, CA19-9, AFP, CA125)
• gynecological examination:
  • colposcopy
  • transvaginal ultrasound
• ultrasound of abdomen and pelvic organs
• CT/MRI of the abdomen and pelvic organs (if clinically indicated)
• biopsy with histological and immunohistochemical study (if clinically indicated)
• nursing services
• consultation on individual treatment 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

• Price from: On request 
• Type of program: Outpatient
• Expected duration of the program: 5 days

_____________________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • TSH-basal, fT3, fT4
  • tumor markers (CA  125, AFP, LDH)
  • indicators of inflammation
  • indicators blood coagulation
• CT/MRI scanners, pelvic ultrasound and transvaginal ultrasound (if indicated clinically).
• gynecological examination
• colposcopy
• preoperative care
• operations: 
  • Laparoscopic salpingo-oophorectomy

1. Staging laparotomy 
2. hysterectomy, salpingo-oophorectomy, lymphadenectomy,
    appendectomy
3. fertility sparing surgeries 

• biopsy with histological examination of the material
• symptomatic treatment
• cost of essential medicines
• nursing services
• stay in the hospital with full board
• full hospital accommodation
• elaboration further recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 10 days

______________________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT / MRI and ultrasound scans (if indicated clinically)
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • inflammation indicators (CRP, ESR)
  • indicators of blood coagulation
  • tumor markers (CEA, CA19-9, CA125)
• individual plan of the chemotherapy (the cost of medicines is included) the cost defined per cycle.
• symptomatic treatment
• nursing services
• control examinations
• consultations of related specialists
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the day hospital procedure, without mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request 

Type of program: Outpatient

Expected duration of the program: 3 days