Ovarian Cancer

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At the Swedish Cancer Institute, women with ovarian cancer, as well as those with cervical and uterine cancer, receive care through a nationally-recognized gynecological cancer program – the fourth-highest volume ovarian cancer center in the United States. This includes the expertise of a renowned team of physicians and other specialists. All ovarian-cancer patients at Swedish benefit from a multidisciplinary approach to care that encompasses leading-edge imaging techniques, the latest in treatment options and a full selection of high-quality support services.

Swedish is also one of the founders of the Marsha Rivkin Center for Ovarian Cancer Research, which is dedicated to saving lives and reducing suffering through improved treatment, early detection and prevention of ovarian cancer.

Our multidisciplinary care teams meet regularly to share information and discuss patient cases, in order to determine an integrated course of care for each person.

Overview

The American Cancer Society estimates that in 2021 21,410 women will be diagnosed with ovarian cancer, and 13,770 women will die of this disease, making this the 5th most common cause of death from cancer in women. About 3 out of 4 women with ovarian cancer present with advanced stage disease which typically causes abdominal and pelvic symptoms given the difficulty of screening and early detection of this disease.

Ovarian cancer comprises many different specific types of cancer, including epithelial ovarian cancer (the most common type, of which “high grade serous cancer” is the most common subtype), germ cell tumors (which typically present in girls or younger women), and a rarer type called sex cord stromal tumors.  Each of these types of cancer are treated differently. 

For over 3 decades, gynecologic oncologists at Swedish Cancer Institute have been actively involved in clinical trials aimed at improving the outcomes in this disease, including trials evaluating use of intraperitoneal chemotherapy, angiogenesis inhibitors, different types of chemotherapy, and trials involving parp inhibitors and immunotherapy.

Swedish Cancer Institute ranks amongst the top centers nationally in ovarian cancer patient volume, and as many studies have shown, outcomes for patients with ovarian cancer are improved in high-volume centers where physicians have vast experience with the disease. Our gynecologic oncologists work in a multi-disciplinary format to develop highly individualized treatment plans with each patient based on her stage of disease and incorporate advanced surgical techniques, chemotherapy, and clinical trials to optimize the outcome of each patient. In addition, we were the first group in the Pacific Northwest to utilize robotic surgery to stage patients with ovarian cancer who had their tumor removed by and OB/GYN previously, or to perform primary surgical staging and removal of tumor in patients with early stage disease in appropriate patients.

Symptoms

Ovarian cancer has been labelled the “silent cancer” based on women frequently presenting with advanced stage disease with minimal or vague symptoms.  However, researchers at Swedish Cancer Institute were integral in studies that evaluated women with ovarian cancer to determine if there were symptoms prior to their presentation, and ultimately showed that there are indeed symptoms that physicians should be aware of early in the disease, called the “ovarian cancer symptom index”.  These symptoms can include pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full when they were present <1 year and occurred >12 days per month.

With advanced stage disease, women tend to present with abdominal or pelvic pain, weight loss, and a distended abdomen which can be filled with fluid called ascites or a lung cavity filled with fluid called pleural fluid.

Diagnosis

Women with early-stage ovarian cancer are frequently diagnosed either during a surgery to remove an ovarian mass or after an ovarian mass is removed and is found to be malignant. Gynecologic oncologists at Swedish Cancer Institute who see women in consultation with ovarian masses who are surgical candidates will frequently recommend an intra-operative technique called “frozen section” which can be performed by a pathologist during surgery to render a diagnosis of ovarian cancer during the operation, at which time an appropriate ovarian cancer staging surgery can be performed.

For women with more advanced stage disease, diagnosis is frequently made by removing fluid from the abdominal or chest cavity and finding ovarian cancer cells within the fluid or performing a “needle biopsy” of a mass in the abdomen or the omentum (a fatty apron in the abdomen and common site of spread of ovarian cancer) by an interventional radiologist. 

Swedish has a longstanding tradition of excellence in pathologic evaluation and diagnosis in women with ovarian cancer.  Our program was the first in the state with a fellowship-trained gynecologic pathologist, and now boasts the largest group of fellowship-trained gynecologic pathologists in the state, who specialize in cellular diagnosis and tissue diagnosis in women with ovarian cancer. Specialized gynecologic pathologists lead to a higher likelihood that the diagnosis will be accurate as compared to a general pathologist and are critical to establishing and finalizing an appropriate treatment plan.

Our highly specialized pathologists are complimented by a skilled group of radiologists who specialize in “cross sectional imaging” (CT scans and MRIs) in patients with cancer, and both are integral to our Swedish Cancer Institute Gynecologic Oncology Tumor Board, where patients are reviewed in a multi-disciplinary format and treatment plans are developed with a large group of ovarian cancer specialists, particularly for challenging cases.

Treatment

Ovarian cancer is generally treated with two approaches. The first, called “neoadjuvant chemotherapy”, typically used for more advanced disease or older or sicker patients, incorporates treatment with chemotherapy prior to surgery. The goal of this approach is to decrease the volume of cancer present with chemotherapy in order to make surgery (called “secondary cytoreductive surgery”) more likely to be successful (i.e., removing all cancer present) and to decrease the rate of complications and the duration of hospital stay in the post-operative setting.  The second approach, called “primary debulking surgery”, utilizes an upfront surgery to remove the cancer, and is typically followed by chemotherapy.  This tends to be used for patients with less advanced disease where the surgeon is relatively confident that all the cancer can be removed with an “upfront” surgery, and is more often used for younger, healthier patients with a lower disease volume.

Our ovarian cancer program focuses on treating patients based on the unique characteristics of their cancer, frequently known as the “molecular fingerprint” of the cancer.  This incorporation of personalized medicine allows us to determine if the patient has specific biomarkers either in all the cells of their body (called “germline mutations”) or in the ovarian cancer cells (called “somatic mutations”), and all patients with ovarian cancer treated at our specialized center are encouraged to meet with a genetic counselor to undergo genetic testing for ovarian cancer predisposition as well as to have their tumor analyzed for specific “actionable mutations”, which are mutations in the cancer that make it vulnerable to specific treatments.

Our highly integrated program aims to develop individualized plans for each patient that consider not only their ovarian cancer type and stage, but also genetic or molecular markers that allow specific and tailored treatment plans. 

Additionally, our surgical oncology team at Swedish Cancer Institute has been a critical component of our surgical care of patients, increasing the chances of leading to an “optimal cytoreduction” (complete removal of all disease at the time of surgery), especially for patients with more advanced disease or upper abdominal disease.

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Research and Clinical Trials

Our ovarian cancer research team is highly involved in advancing our field in both early detection of ovarian cancer and offering newer progressive treatments for the disease. In the most recent worldwide trial of ovarian cancer (The FIRST Study/ENGOT-OV44), Swedish Cancer Institute was the 6th highest enrolling site in the world of 197 sites overall.  Our commitment to affording patients the potential advantages of novel treatment paradigms is evidenced in our large number of clinical trials for ovarian cancer, including studies evaluating ovarian cancer tissue to develop newer therapies, investigating new techniques that may lead to earlier detection of ovarian cancer (uterine lavage), as well as active treatment trials which are evaluating a variety of active biologic agents to hopefully improve outcomes and change the landscape of this disease.

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Beyond physical health, the Swedish Cancer Institute is committed to the emotional well-being of our patients and their families. We offer:

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See Patient Support and Resources and Services for the Body, Mind and Spirit at Swedish.

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