What We Treat

Ovarian Cancer

Background

Forming in the ovaries or fallopian tubes, ovarian cancer can take several forms, but the most common type occurs as tumors of the epithelial cells, which form the outer surface of the ovaries. Ovarian tumors may be benign, borderline, or malignant. The most prevalent subtype is high-grade, serous ovarian cancer, which is typically diagnosed in postmenopausal women (average age of 63). Low-grade serous ovarian cancer is a rarer subtype that mainly affects younger women, with an average age of diagnosis of 45. This low-grade subtype has historically been less responsive to chemotherapy and more difficult to treat. However, in recent years gynecologic oncologists, including the team at Mount Sinai, have begun using new therapies that have shown significant promise in helping women live longer. Older age, obesity, and hormone use after menopause increase a woman’s risk for ovarian cancer. In addition, 25% of women who develop ovarian cancer have familial cancer syndromes, including inherited gene mutations. Genetics And Ovarian Cancer Certain mutations in a woman’s genetic makeup can put her at increased risk for ovarian cancer, as well as other types of gynecologic cancers. In particular, if a woman carries the BRCA-1 or BRCA-2 mutation, she is at increased risk of developing ovarian cancer. In fact, women with the BRCA-1 mutation face a 39% to 46% chance of developing ovarian cancer by the age of 70. Fortunately, at Mount Sinai, we utilize genetic testing to identify women with these mutations and others. When a mutation that increases a woman’s risk is detected, our doctors can utilize a range of interventions to better manage her risk, a concept known as “previvorship.” This process covers everything from genetic counseling to prophylactic surgery, proving that our team offers the best care possible at every step of the way.

Symptoms

Ovarian cancer tends to grow rapidly, and the symptoms frequently resemble those of other, less serious, abdominal illnesses. As a result, if ovarian cancer is not diagnosed early, it can spread swiftly. Symptoms can include pelvic discomfort; bloating, swelling, constipation, and feeling full quickly after eating; fatigue, back pain, and frequent urination.

Diagnosis

At Mount Sinai, our doctors use a variety of tests to accurately diagnose ovarian cancer, identify the subtype, and stage the disease. To check for any ovarian or fallopian cancer, gynecologists primarily rely on a pelvic exam, in which your Mount Sinai physician will examine the internal and external reproductive organs. Imaging tests, such as ultrasounds or CT scans, can help your physician visualize your ovaries and analyze their structure. Our team may also use blood tests to check for any markers, such as the CA125 marker. Finally, pathology of any tissue removed during surgery provides definitive evidence of disease and allows for further genetic testing.

Initial Management

Surgery Your Mount Sinai team will utilize surgery as the first or initial treatment for ovarian cancer. Once the cancerous tissue is removed, Mount Sinai’s pathology team will determine the subtype and stage of the cancer by evaluating nearby tissue to determine if the cancer has spread. This can indicate how advanced the cancer may be and help your doctors develop your treatment plan. The more cancerous tissue your surgeon removes during surgery, the less likely the cancer will return or spread, so your physician will likely recommend a complete hysterectomy. However, some patients and their surgeons elect to only remove the affected ovary and its fallopian tube, both ovaries and fallopian tubes, both ovaries and the uterus, or something else altogether. The type of surgery you decide to undergo is entirely based on your unique circumstances and your doctor’s recommendations, and it may include one of the advanced surgical procedures available from the experts at Mount Sinai. Chemotherapy For almost all ovarian cancer patients, chemotherapy is typically a foundational part of treatment. Your Mount Sinai gynecologic oncologist will likely recommend a combination of two drugs via IV to treat the cancer before or after surgery. For women whose cancer has definitively not spread from the abdomen, our surgeons may deliver chemotherapy during surgery to the abdominal cavity. The purpose of this technique is to send the drugs directly to the cancerous cells, rather than infusing them throughout the whole body.

Treatment of Recurrent Disease

The primary treatment method for recurrent ovarian cancer is chemotherapy. If your cancer returns after six to twelve months, then the same combination of drugs used the first time will likely be used to treat the recurrence. Surgery, hormone therapy, targeted therapy, and immunotherapy are also used to treat recurrences, and the specific treatment chosen depends on your unique circumstances and your doctor’s recommendations.