Ovarian Cancer (cont.)
More Exams and Tests
Biopsy and staging
Ovarian cancer is diagnosed by taking a sample of the tumor (biopsy). The tumor material is examined by a pathologist, a physician who specializes in diagnosing diseases by looking at the cells under a microscope. There are several ways to collect a biopsy of an ovarian mass.
- Laparoscopy is the usual first step in confirming the presence of a mass and obtaining a tissue sample for biopsy. Laparoscopic surgery
uses small incisions and specially designed instruments to enter the abdomen or pelvis. (This type of operation is widely used to remove the gallbladder.)
- If the mass is small, it may be possible to remove the entire mass during laparoscopy. Usually, the surgeon removes the
- If the mass is larger that 2.75 inches (complex mass) or 3.5 inches (solid mass) on ultrasound, removal will probably be through conventional surgery. This procedure, called exploratory laparotomy, involves making a larger incision in the skin and abdominal muscles to gain access to the pelvic region.
If the biopsy finding is positive for cancer, further staging procedures will be performed.
- Staging is a system of classifying tumors by size,
location, and extent of spread, local and remote.
- Staging is an important part of treatment planning,
because tumors respond best to different treatments at different stages.
- Staging is also a good indicator of prognosis.
- Staging usually requires imaging studies, lab tests, and exploratory laparotomy.
Exploratory laparotomy is a careful and thorough attempt to find the exact extent of cancer spread.
- During the surgery, removal of the ovarian
mass usually includes the entire affected ovary.
- To identify possible invasion by the cancer, samples are taken of other structures in the pelvis and abdomen including the diaphragm (the muscle that separates the organs of the chest from the organs of the abdomen), the peritoneum (the membrane that lines the abdomen), the omentum (a fatty membrane that covers the organs of the abdomen), lymph nodes, bladder, and bowel.
- The goal is to remove as much cancerous tissue as possible (debulking). This may involve removing one or both ovaries (oophorectomy), the
uterus (hysterectomy), fallopian tubes (salpingectomy), and other organs.
- Typically, the surgeon does not know ahead of time exactly which organs and structures will require removal. If a woman plans to undergo exploratory laparoscopy or laparotomy, she should discuss the possible full extent of the operation with her surgeon before consenting to the procedure. Gynecologic oncologists are specialist trained to operate on ovarian cancer. If a high suspicion of a gynecologic cancer exists, a gynecologic oncology consult may provide input into the surgery.
Ovarian cancers are classified in
stages I through IV. Stages I, II, and III are further described by the letters
A, B, or C depending on the location of the tumor, the presence of metastasis,
and other factors. Stage IV cancer is not subdivided.
- Stage I: The cancer is confined to one (IA) or both
(IB) ovaries. The tumor may be on the surface of the ovaries, or ascites may
be present (IC).
- Stage II: Cancer is found outside the ovary (pelvic extension) and has spread to the uterus or fallopian tubes (IIA) or other areas in the pelvis (IIB). The tumor may involve the capsule of the
ovary, or fluid in the abdomen may contain malignant cells (IIC).
- Stage III: Cancer has spread to pelvic organs and possibly to lymph nodes. Microscopic "seeds" of cancer are on abdominal peritoneal surfaces
(IIIA), or small implants of tumor on abdominal peritoneal surfaces (IIIB).
Abdominal implants may be larger or lymph nodes may be involved (IIIC).
- Stage IV: Cancer has spread to the abdominal organs (liver, spleen), or malignant cells are in the fluid surrounding the lungs.
Paul Blackburn, DO, FACOEP, FACEP
Francisco Talavera, PharmD, PhD
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