Diagnosis

Multiple studies conducted over the past decade have shown that survival is markedly improved when surgery is performed by a gynecological oncologist. One analysis, which looked at multiple studies, found that women whose surgery was performed by a gynecologic oncologist had a median survival time that was 50 percent longer than women whose surgery was done by a general gynecologist or other surgeons inexperienced in optimal debulking procedures. The improved survival of women whose surgeries are performed by gynecologic oncologists is a result of their tendency to perform more aggressive surgical techniques that in turn realize better outcomes.

• Seeking the care of a gynecologic oncologist
A gynecologic oncologist is an obstetrician/gynecologist who specializes in the diagnosis and treatment of women with cancer of the reproductive organs. After completing a four-year residency in obstetrics and gynecology, gynecologic oncologists must complete an additional three-to-four-year fellowship specializing in precancerous and cancerous conditions of the gynecologic tract. These specialists learn unique surgical skills required to properly stage and remove the majority of the tumor, as well as chemotherapy and radiation therapy techniques practiced at the highest skill level. This training uniquely qualifies gynecologic oncologists to care for women with cancer of the reproductive tract. Over the past two decades, research has shown that referral to a gynecologic oncologist remains one of the top factors in increasing ovarian cancer survival rates, as well as decreasing rates of recurrence.

For women suspected of having ovarian cancer, the goal of the surgery is to definitively stage the disease to identify the optimal treatment for the cancer, and remove as much of the tumor as possible. This is also known as "cytoreductive" surgery or debulking. Proper staging and optimal debulking translate into improved overall survival for women with any stage of ovarian cancer. Studies conducted over the past decade indicated that when the surgery is performed by a gynecologic oncologist, the surgical staging is more often complete than when performed by other surgeons. Gynecologic oncologists are more likely to perform the multiple peritoneal and lymph node biopsies necessary to ensure adequate surgical staging. Research indicates that gynecologic oncologists are more likely to optimally debulk ovarian tumors than their non-specialist counterparts. In fact, other surgeons may leave women with a greater likelihood of having residual disease of greater than one centimeter after the operation. Women whose tumors have been reduced to less than one centimeter have been shown to have a better response to chemotherapy and improved survival rate.

According to recent studies, less than half of women with ovarian cancer are treated by gynecologic oncologists. Patients under 40 years of age, over 70 years of age or living in rural areas are less likely to receive care from a specialist. To support their practice, gynecologic oncologists need to be located in and around metropolitan areas. As a result, many rural states have only a few, or in some cases, no practicing gynecologic oncologists.

The Women's Cancer Network has a feature on its Web site (www.wcn.org) where you can search for gynecologic oncologists by ZIP code by selecting "Find a Doctor." You can also call (800) 444-4441. This service will identify your nearest gynecologic oncologist.

• Tests
  
  If you have the signs and symptoms that are suggestive of ovarian cancer your doctor will probably perform the following tests:
  • A complete pelvic exam – In a pelvic exam, the doctor examines your vagina, uterus, rectum and pelvis, including your ovaries, for masses or growths. This exam allows the ovaries to be examined from multiple sides and allows doctors to feel for growths on the ovaries or other abnormalities. Experts recommend that this exam also be done annually.
  • Transvaginal or pelvic ultrasound – This is a test in which sound waves are used to create a picture of the ovaries and can reveal if there are masses on the ovaries.
  • CA-125 blood test – This tests for a substance in the blood that may increase when a cancerous tumor is present. This protein is produced by ovarian cancer cells and is elevated in more than 80 percent of women with advanced ovarian cancer and 50 percent of those with early-stage ovarian cancer. However, a CA-125 may be elevated during ovulation and in the presence of another type of cancer or benign conditions such as endometriosis or fibroids.
  
  None of these tests are definitive when used on their own. They are most effective when used in combination with each other. Your doctor may also use CT scan or PET scan as part of the diagnostic process. The only definitive way to determine if a patient has ovarian cancer is through surgery and biopsy.
• Types of Ovarian Cancer
  
  Several different types of ovarian cancer exist that are classified according to the type of cell from which they start.
  • Epithelial tumors – About 90 percent of ovarian cancers develop in the epithelium, the thin layer of tissue that covers the ovaries. This form of ovarian cancer generally occurs in postmenopausal women.
  • Germ cell carcinoma tumors – This type of ovarian cancer arises from the cells that form the eggs and makes up about five percent of ovarian cancer cases. While germ cell carcinoma can occur in women of any age, it tends to be found most often in women in their early 20s. Six main types of germ cell carcinoma exist but the three most common types are: teratomas, dysgerminomas and endodermal sinus tumors. Many tumors that arise in the germ cells are benign.
  • Stromal carcinoma tumors – Ovarian stromal carcinoma accounts for the remaining five percent of ovarian cancer cases. It develops in the connective tissue cells that hold the ovary together and those that produce the female hormones (estrogen and progesterone). The two most common types are granulosa cell tumors and sertoli-leydig cell tumors. Unlike with epithelial ovarian carcinoma, 70 percent of the cases of stromal carcinoma are diagnosed in Stage I.