Ovarian Cancer Services at Hoag Gynecologic Oncology

Ovarian cancer is the seventh most common cancer among women. It occurs in the ovaries, the two small organs on each side of the uterus that produce eggs and the hormones progesterone and estrogen. Ovarian cancer occurs when cells in the ovaries develop mutations that cause the cells to multiply out of control without eventually dying as healthy cells do. These abnormal cells can accumulate into tumors that can spread to other parts of the body. There are three main types of ovarian cancer:

• Epithelial ovarian cancer: The most common type of ovarian cancer, accounting for about 85 percent of cases, epithelial ovarian cancers form on the surface of the ovary. Subtypes can include mucinous carcinoma and serous carcinoma.

• Germ cell tumors: Germ cell tumors form in the eggs inside the ovaries. Only accounting for about five percent of all ovarian cancers, these tumors are usually diagnosed in adolescent girls and young women.

• Stromal cell cancer: The rarest form of ovarian cancer, stromal cell cancer begins in the ovarian cells that form the connective tissue of the ovary and which produce female hormones

In its early stages, ovarian cancer often produces no symptoms. Symptoms of more advanced ovarian cancer are often misdiagnosed, and can include:

• Frequent need to urinate

• Bloating or swelling of the abdomen

• Unexplained weight loss or fatigue

• Pelvic pain or discomfort

• Constipation

Women who are experiencing these symptoms daily, for several weeks, should get in contact with their gynecologist.

Risk factors for ovarian cancer can include:

• Aging (usually diagnosed in older women)

• Endometriosis

• A family history of ovarian cancer

  • Hoag Family Cancer Institute offers a Hereditary Cancer Program to assess a person’s family history and any associated risk for cancer. Learn more by calling (949) 764-5764.

• Being overweight

• Hormone replacement therapy after menopause

Studies show that taking birth control pills can reduce your risk of developing ovarian cancer, but currently, the only known way for women to definitely avoid developing ovarian cancer is to have their ovaries removed. This is a big decision, however, and should only be performed after carefully considering your risk, future desire to have children and family history in consultation with your doctor. There are also genetic tests which may help determine your risk of developing ovarian cancer in the future.

Hoag offers an breast and ovarian cancer prevention program. Learn about how you can identify your hereditary risks with Hoag.

Research to develop a definitive, non-invasive screening test for ovarian cancer is ongoing. Currently, the main tests used to diagnose ovarian cancer are:

• CA-125 Blood Test: This test measures the levels of CA-125 protein in your blood, which is often elevated in patients with ovarian cancer. This test is unreliable as a diagnosis tool, however, because other common conditions like pelvic inflammatory disease and endometriosis can cause elevated levels of CA-125.

• Transvaginal ultrasound: In this test, an ultrasound wand is inserted into the vagina so the doctor can use sound waves to create images of the ovaries to look for tumors or masses. This test is also not definitive because while it can reveal the presence of a mass in the ovary, it cannot determine whether the mass is cancerous or benign.

• Surgical biopsy: This involves surgically removing a piece of tissue so it can be tested for the presence of cancer. Biopsy is generally the most accurate method of detecting and diagnosing ovarian cancer.

After diagnosis, your fellowship-trained Hoag gynecologic oncologist will work with you to determine a personalized treatment plan.

Hoag treats more women for gynecologic cancers than any other hospital in Orange County. Trust Hoag for your gynecologic cancer treatment.

Our dedicated ovarian cancer nurse navigators will be there for you following your diagnosis to help you find resources, review your options and support you in making informed decisions at every step of your cancer treatment and recovery.

Your personalized treatment plan at Hoag Family Cancer Institute will depend on several factors including the stage and grade of cancer, the pathology (or subtype), your age and general health. Hoag is a Center of Excellence in Minimally Invasive Gynecology (COEMIG) and our gynecologic oncologists are COEMIG accredited.. As a COEMIG site, Hoag offers different types of minimally invasive surgery including laparoscopic and robotic-assisted approaches.

Hoag offers several treatments for ovarian cancer, including:

• Surgery: the most common surgical procedure is the removal of the involved ovary, lymph nodes and the fatty apron in the abdomen, known as the momentum. Depending on the age of the patient, the other ovary and uterus might be removed. In cases of advanced ovarian cancer, other organs may also be removed.

• Laparotomy: The most common procedure for treating ovarian cancer is a laparotomy, during which the surgeon makes an incision in the abdominal wall and attempts to remove as much of the cancer within the abdomen and pelvis as possible. In addition to a complete removal of all visible tumors, other goals of a laparotomy include determining the correct diagnosis and stage of the cancer and gaining information that can help determine whether additional therapy is necessary.

• In some instances of early-stage ovarian cancer or even certain advanced ovarian cancers, minimally invasive surgery can be an option. Hoag is a Center of Excellence in Minimally Invasive Gynecology (COEMIG) and our gynecologic oncologists are also accredited as such. As a COEMIG site, Hoag offers different types of minimally invasive surgery including laparoscopic and robotic-assisted approaches.

• Robotic-assisted surgery. Hoag is the unmatched leader on the West Coast in the field of robotic-assisted, minimally invasive surgery to treat gynecologic cancers. Hoag’s Gynecologic Robotic Surgery Program offers a team of experienced physicians who are specialty-trained in using the da Vinci robot – the most advanced, minimally invasive approach to surgery available today. Benefits to robotic and minimally invasive surgeries include:

  • Less postoperative pain and scarring

  • Decreased blood loss and lower risk of blood transfusion

  • Lower risk of infection

  • Shorter hospital stay

  • Faster return to normal activities.

Explore robotic surgery at Hoag here.

• Surgery to remove the ovaries and other affected tissues, known as Salpingo-oophorectomy.

• Staging procedure: The fatty pad of tissue that covers the intestines, called the omentum, is removed along with adjacent lymph nodes, as well as tiny samples of tissue from the abdomen and pelvis.

• Radiation therapy/radiotherapy: Learn more about Hoag Radiation Oncology.

• Chemotherapy

• Precision Medicine, in which Hoag physicians test the DNA of patients’ tumors, then develop treatments tailored specifically to the mutations that caused the cancer, which allows physicians to treat the cancer very acutely. Hoag is a national leader in the use of precision medicine in several types of cancer, including ovarian cancer. Explore precision medicine at Hoag.

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many gynecologic cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained gynecologic oncologists and surgeons who utilize the latest techniques and technology in the surgical management of many different cancers found in women, including ovarian cancer.

Radical cancer surgery is a surgical procedure in which physicians remove the entire tumor, a margin of normal tissues, and in some cases, nearby lymph nodes. At Hoag, our surgeons have undergone extensive training in radical gynecologic cancer surgery and procedures, including in the areas of:

• Debulking surgery: In cases where the cancer has spread, as much of the cancer is removed as possible. This can often involve extensive surgery including removal of sections of the small or large intestine, as well as tumors from the liver, diaphragm and pelvis.

• Radical hysterectomy

• Excision of vulvar and vaginal cancers

At Hoag, our team applies a multidisciplinary approach to cancer surgery. Our physicians work together on your care, consulting with colleagues in plastic surgery, anesthesia and other specialties to help patients achieve better outcomes, maintain sexual and urinary function and preserve overall quality of life. Hoag surgeons utilize the Enhanced Recovery After Surgery (ERAS) pathway, an approach focused on understanding a patient’s specific biology to improve recovery time and pain management. With ERAS, patients become an active participant in their recovery in four key areas:

• Planning and preparing before surgery

• Reducing the physical stress of surgery

• Post-surgery pain relief planning

• Early feeding and movement after surgery

With ERAS, post-surgical patients require fewer narcotics, suffer from less constipation, are able to return to eating normally sooner and have a recovery period that is, on average, two days faster.

Hoag’s non-surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag Newport Beach was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California, San Francisco. Explore advanced treatment technologies for cervical cancer available at Hoag.

The stages of ovarian cancer treatment, including radiation therapy and surgery, can sometimes impact a person’s ability to conceive and bear a child. If you are considering having children in the future, you can discuss fertility options with your doctor. These may include:

• Egg freezing

• Embryo freezing

• Fertility-preserving surgery

• Gestational surrogacy

Fertility preservation works best if initiated prior to your cancer treatment. These options can be completed within approximately two weeks of diagnosis so as not to compromise initiation of your cancer treatment.

To help patients understand the impact of gynecological cancer treatment on their fertility, Hoag has developed a series of questions you can ask your oncologist or fertility specialist.