An ovarian cancer diagnosis is frightening and devastating. But you need to prepare for the battle. In recognition of Ovarian Cancer Awareness Month, here are 12 important questions you should ask your doctor about surgery, treatment, hormone-replacement therapy and more. Plus, take our quiz to see if you really know what causes cancer...
After weeks of dismissing nagging symptoms of abdominal bloating, gas, nausea, pressure and swelling, you finally go to your internist or gynecologist.
A pelvic exam and ultrasound reveal a mass and abdominal fluid, and you get the scary news: Signs point to advanced ovarian cancer, the fifth most-common cause of cancer death among women.
“Most ovarian-cancer symptoms aren't present until Stage III,” says Andrew Li, M.D., staff physician at Cedars-Sinai Medical Center in Los Angeles and assistant professor of obstetrics/gynecology at UCLA's David Geffen School of Medicine.
About 80% of cases are discovered in Stage III, when one or both ovaries are involved and the cancer has spread to the abdominal lining and more distant lymph nodes.
A prompt diagnosis and aggressive treatment are crucial and, no doubt, you’ll have many questions. Here are the top 12 to ask your doctor, plus the answers to help you in your battle against ovarian cancer:
1. Should I get a second opinion?
If your gynecologist or internist suspects ovarian cancer, get a referral to a gynecologic oncologist, a specialist who performs surgery to remove as much as of the tumor as possible promptly, confirms the diagnosis and prescribes a treatment.
Over the past two decades, several studies have shown that surgery by a gynecologic oncologist is one of the top factors in increasing ovarian cancer survival rates – by 10%-25% – as well as decreasing rates of recurrence, according to the Minnesota Ovarian Cancer Alliance.
2. What does surgery entail?
Your surgeon’s goal is to remove as much of the tumor as possible – called "optimal, or maximal, debulking" – so that the largest tumor left is no bigger than a centimeter, says Ronald Leuchter, M.D. (Remaining tumors are treated with chemotherapy.)
Typically, the cancer has spread throughout the abdomen in nodules. Some are barely visible or microscopic, so it’s hard to remove all of them, says Amreen Husain, M.D., associate professor of gynecologic oncology at Stanford University. (Remaining tumors are treated with chemotherapy.)
At Stage III, the procedure typically involves removing the ovaries, the omentum (a sheet of fat that hangs down in front of the intestines and other organs), all big nodules on the liver, the bowel, bladder and other organs.
In rare cases, only one ovary is removed, particularly if the patient is young and of childbearing age, with Stage I cancer.
First, more advanced cancer must be ruled out.
The extent of the metastasis (the amount of the cancer that has spread from the original tumor) and the amount left after surgery affects your prognosis: The five-year survival rate is about 30% if the cancer has spread to sites outside the pelvis, according to the University of Maryland Medical Center.
3. How far has the cancer spread?
To get the most complete answer, make sure your doctor performs a thorough staging procedure, in which biopsies are taken of the primary tumor and lymph nodes and from areas in which the cancer has spread.
“Washings,” or “cytology,” also are done during surgery to look for microscopic cancer cells in your abdomen.
The stage of cancer is based partially on whether cancer cells are found in each location.
Accurately diagnosing the stage determines the severity of the disease and guides the doctor in planning treatment. It also helps to estimate your prognosis, or outcome, and identify which, if any, clinical trials – or research – are appropriate for you, according to the American Cancer Society (ACS).
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