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Ovarian cancer is the ninth most common form of cancer among women. An estimated 21,000 new cases of ovarian cancer occur yearly in the U.S. Ovarian cancer originates in the cells of the ovary. There are several types of ovarian tumors, named for the tissue in which they are found:

Epithelial tumors originate from the cells from the outer surface of the ovary and make up most of the ovarian tumors.

  • Benign epithelial ovarian tumors: These are not cancer and don't spread.
  • Tumors of low malignant potential: These tumors don't grow into the supporting structure of the ovary. If the tumors spread, it happens slowly.
  • Malignant epithelial ovarian tumors: These make up approximately 85-95 percent of ovarian cancers. Epithelial ovarian carcinomas are classified as one of four subtypes, and by grade and stage.
  • Extra-ovary primary peritoneal carcinomas (EOPPC): These tumors can look much like epithelial tumors and are treated like them, but they start outside the ovary and may even occur in women who have had their ovaries removed.

Germ Cell tumors: Fewer than 2 percent of ovarian cancers are germ cell tumors, formed in the egg-producing part of the ovary. Germ cell tumors may be a mix of more than a single subtype.

Ovarian Stromal tumors start from structural tissue cells that hold the ovary together. They produce the estrogen and progesterone hormones. Only 1 percent of cancers of the ovary are ovarian stromal cell tumors.

Carcinosarcomas: These are rare ovarian tumors consisting of a mixture of epithelial and other cells. These account for only about 1 percent of all ovarian cancers.

As an academic center, Sylvester has board-certified genetics professionals working closely with oncology specialists to identify and manage patients and their families with hereditary cancer syndromes.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.

More experienced physicians to care for you. Sylvester treats more than 5,000 patients with cancer each year. Your dedicated team of physicians at Sylvester have a huge depth and breadth of experience treating your unique cancer.

Multidisciplinary care teams provide nationally recognized expertise. Your physician experts talk to each other, face-to-face, on a regular basis and plan the right care for you and your specific cancer. And you can expect that caliber of care in years to come. Sylvester also has the only gynecologic oncology fellowship in South Florida training the next generation of doctors.

Fertility preservation experts. You don’t have to choose between future fertility and cancer treatment. Specialists at the University of Miami Fertility Center in the Department of Obstetrics and Gynecology offer fertility counseling for male and female cancer patients to help you explore your options and make decisions regarding fertility preservation before you undergo treatments such as chemotherapy or radiation therapy.

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Treatments

  • Surgery

    Surgery can diagnose and stage ovarian cancer as well as treat it. Your surgeon removes tissue and examines it for signs of cancer. He or she may remove one or both ovaries and possibly surrounding tissue and lymph nodes, followed by post-operative chemotherapy. There are several approaches to ovarian cancer surgery:

    • Laparotomy: One option is to undergo a traditional open surgery through a relatively large incision in the abdomen, called a laparotomy.
    • Laparoscopy: Most patients at Sylvester qualify for a minimally invasive laparoscopy procedure that's executed through relatively smaller incisions in the abdomen. Sylvester surgeons are skilled at robotic laparoscopic surgery, through which they can explore the abdomen, evaluate the degree of the disease, drain fluid build-up in the area, and retrieve small samples of the abnormal tissue to perform a biopsy or remove a tumor.
    • Cytoreductive Surgery: In addition to removing the uterus and/or fallopian tubes and ovaries, an additional surgical procedure may be used to achieve full visible cancer removal. The procedure, called tumor debulking, or cytoreductive surgery, removes as much of the tumor as possible. It may be performed after chemotherapy or may be followed by chemotherapy or radiation.

  • Chemotherapy

    This is a combination of cancer-fighting drugs that are usually administered intravenously to kill any remaining cancer cells in the body.

  • Targeted therapy

    This approach uses drugs to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy in which the antibodies attach to the substances and kill the cancer cells, block growth, or keep the cells from spreading. Monoclonal antibodies are given intravenously alone or to carry drugs, toxins, or radioactive material directly to cancer cells. These treatments have the potential to be more effective and with fewer side effects than chemotherapy. Several of these targeted therapies have been approved by FDA.

    Targeted therapies also include:

    • o Poly (ADP-Ribose) Polymerase (PARP) Inhibitors: These are enzymes that slow cancer growth by helping prevent cancer cells from repairing themselves after chemotherapy. Drugs that inhibit PARP-1 help fight cancers caused by mutations in BRCA1 and BRCA2. The PARP inhibitor Alaparib is approved for women with BRCA mutations who have experienced a recurrence of ovarian cancer.
    • Antiangiogenesis Agents: These are agents that prevent the tumor from forming new blood vessels to feed it. Several are being studied in clinical trials.

  • Immunotherapy

    Called personalized medicine, immunotherapy uses your own tumor genetics to help your immune system T-Cells recognize the tumor cells as invaders and target them specifically. There are several different approaches to immunotherapy being studied.

    • Retrovirus Therapy: Scientists at Sylvester and Miller School of Medicine are developing an oncolytic retro-viral treatment for ovarian cancer to target specific mutations found on genetic analysis of tumor cells.
    • Checkpoint Blockade Therapy: This cancer treatment takes advantage of immune T-cells present in many tumors but have been shut off by cells through a checkpoint system that prevents immune cells from attacking them. These drugs disable that safety mechanism, which allows your immune T-cells to use their destructive capabilities on the tumors.

  • Palliative Care

    Palliative care focuses on relief from symptoms of serious illness and the side effects of treatment, incorporating you and your family as a unit to improve quality of life for the whole family. If starting early in the treatment process, palliative care can increase your tolerance to treatment and any side effects, improving treatment outcomes. Your specially-trained care team includes doctors, nurse practitioners, a social worker, and a chaplain who work alongside your surgical, radiation, or medical oncologist. You may contact them at (305) 243-4129.

Tests


Symptoms of ovarian cancer may be very vague or due to non-cancerous ovarian cysts or other pelvic conditions. The specialists at Sylvester Comprehensive Cancer Center know that an accurate and complete diagnosis is key to getting you the right treatment at the right time to ensure the best outcomes. Making a diagnosis of ovarian cancer may involve different approaches.

  • Transvaginal or Abdominal Ultrasound Exam

    During this test, your specialist examines the vagina, uterus, fallopian tubes, ovaries, and bladder. A probe, called an ultrasound transducer, is used to bounce high-energy sound waves (ultrasound) off your internal tissues or organs. The doctor will be able to identify tumors on your sonogram.

  • Computed Tomography (CT or CAT) Scan 

    This is a noninvasive diagnostic imaging procedure that uses X-rays and computer technology to produce horizontal, or axial, images of the body. The CT scan may show any enlarged lymph nodes, which could be a sign of spreading cancer or infection.

  • Lower Gastrointestinal (GI) Series

    These X-rays of the colon and rectum are performed by using a contrast dye called barium to highlight any masses in the lower abdomen.

  • Intravenous Pyelogram (IVP)

    X-rays of the kidneys and ureters are taken after the injection of a dye and can also show the extent of any present disease.

  • Blood Test

    The laboratory will measure a baseline reading of substance in the blood called CA-125, a tumor marker often found to be elevated with ovarian cancer. Taking additional readings of CA-125 levels can help monitor the progress of treatment. It’s not reliable as a screening test for ovarian cancer since non-cancer problems can cause it to be elevated.

  • Biopsy

    Tissue samples are removed from the ovary and examined to see if any cancer or abnormal cells are present. A biopsy is a key part of any cancer diagnosis.

  • Genomic Tumor Profiling

    Also called somatic DNA testing, this breakthrough test is the driver for precision medicine. It looks at your tumor’s molecular signature to identify characteristics indicating how aggressive it is and what types of treatment will work best. Through this genomic profiling, your pathologist can identify groups of mutations in your tumor tissue sample and create a tumor profile for your specific cancer. The genomic profile can be used to select a targeted therapy specific to your cancer’s molecular characteristics.

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