Early Ovarian Cancer: Saving Fertility?

Study: In Young Women With Early-Stage Epithelial Ovarian Cancer, Keeping the Uterus or Part of One Ovary May Not Hurt Survival Rates

By Miranda Hitti
WebMD Health News

Reviewed By Louise Chang, MD

Aug. 10, 2009 -- For young women with early-stage ovarian cancer, keeping their uterus and at least part of one ovary may not worsen their survival rate, a new study shows.

The study, published online in Cancer, focuses on women younger than 50 with stage I epithelial ovarian cancer, the most common type of ovarian cancer.

The researchers compared survival data on 754 patients who had both ovaries surgically removed and 432 women who kept at least part of one ovary. Over the next five years, both groups of women had similar survival rates, with at least 91% still alive after five years.

Likewise, five-year survival rates were similar among 2,242 patients who had a hysterectomy (surgery to remove the uterus) and 679 women who kept their uterus. At least 91% of the women were still alive after five years, regardless of whether they'd had a hysterectomy.

Ovarian cancer has much better survival rates when the cancer is found early. But usually, ovarian cancer isn't found until its later stages because early-stage ovarian cancer often doesn't have symptoms.

"Around three quarters of women with ovarian cancer have advanced-stage disease at diagnosis," researcher Jason Wright, MD, tells WebMD in an email. "Occasionally, women have symptoms ... and are detected at an early stage," but it's not clear why ovarian cancer was found early in these women, notes Wright, who is the Levine Family Assistant Professor of Women's Health in the gynecologic oncology division at Columbia University Medical Center in New York.

In June 2007, three cancer organizations -- the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society -- issued a joint statement listing four possible symptoms of early ovarian cancer. Those symptoms are:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

Those symptoms don't necessarily indicate ovarian cancer, but women who have those symptoms almost daily for more than a few weeks should see their doctor, and preferably a gynecologist, according to the cancer organizations.

The women in the new study were exceptions in that their cancer was found very early. They weren't assigned to any particular treatment; that was between them and their doctors.

The researchers conclude that, for the sake of fertility and other health considerations, "the benefits of conservative surgical management should be considered in young women with ovarian cancer."

Their study was only about survival rates, not whether the women remained fertile after their ovarian cancer treatment or about chemotherapy or radiation. "We do not have information on subsequent pregnancies," Wright says, explaining that that information wasn't in the database he and his colleagues used.

SOURCES: Wright, J. Cancer, Aug. 10, 2009; advance online edition. Jason Wright, MD, Levine Family Assistant Professor of Women's Health, department of obstetrics and gynecology, Columbia University Medical Center.

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