Scenario #1: An 18-year-old woman goes to her internist complaining of recurring, mild abdominal pain. The doctor runs a CT-scan and finds a small cyst on one of her ovaries. Her doctor reassures her that s/he does not think it is cancer because "she’s too young," and s/he refers her to a general surgeon for removal of the cyst.

Scenario #2: A 55-year-old postmenopausal woman (who has already had her ovaries, uterus, and cervix removed) has a bloated abdomen and persistent constipation. She goes to a gastroenterologist; s/he diagnoses IBS (irritable bowel syndrome) and gives the woman a prescription for drugs to alleviate the symptoms.

Scenario #3: A 40-year old woman who has already survived breast cancer and teaches aerobics begins to experience shortness of breath, abdominal pressure, and gas. She goes to her OB/GYN. The doctor gives her a check-up and a pelvic exam. S/he finds nothing extraordinary, suggests antacids, and asks the woman to return to the office in a month or two if she’s still having problems. Unfortunately, all of these women had undetected ovarian cancer. They each could have benefited by being referred to a gynecologic oncologist for an evaluation.

They all had classic ovarian cancer symptoms, but ovarian cancer was not on anyone’s radar screen. Nobody was considering the possibility that these women had ovarian cancer. 

To follow up on these women:

#1: The general surgeon removed the cyst and the one ovary. Pathology later revealed that it was malignant. She recovered for a couple of weeks and then was referred to a gynecologic oncologist for a second surgery for the necessary debulking (removal of all visible cancer) and Staging of her cancer. Accurate staging is essential for determining further treatment requirements and options. This woman had two major surgeries in two weeks, when only one would have been necessary if she had been properly referred to a gynecologic oncologist.

#2: The gastroenterologist was not looking for ovarian cancer in a woman without ovaries. But s/he should have considered the possibility. Primary Peritoneal Cancer (a form of ovarian cancer) accounts for 10% - 20% of all ovarian cancers. The ovaries and the peritoneum (the lining of the abdomen) arise from the same stem cell, and the cells are virtually identical. Primary Peritoneal Cancer occurs when the cancer begins in the peritoneum and the ovaries have already been removed or are present but only minimally involved.

#3: A "let’s wait and see" attitude can cost a woman her life. If her problem is not serious, there is probably nothing to be lost by waiting. But, if she has ovarian cancer, waiting can allow the cancer to spread and go to a more advanced Stage, when it is more difficult to treat. 

When a woman goes to her doctor with symptoms that could be ovarian cancer, her doctor should always consider that possibility and refer that patient to a gynecologic oncologist if there is any possibility that she might have ovarian (or other gynecologic) cancer. While a woman’s symptoms could be from something else, ovarian cancer should be on the list of considerations.

A National Institutes of Health (NIH) Consensus Panel opinion states, "Adequate and complete surgical intervention is mandatory primary therapy for ovarian carcinoma, permitting precise staging, accurate diagnosis, and optimal cytoreduction." This report also indicates  that all women with a suspected ovarian cancer should be offered a preoperative consultation with a gynecologic oncologist. (NIH Consensus Conference: Ovarian cancer: screening, treatment, and follow-up. JAMA 6:491-497, 1995)

Surgeons certified in gynecologic oncology typically are able to remove the maximum amount of tumor in 75 percent or more of patients. Surgeons without formal training in specialized tumor removal report rates of 25 percent or less. (Johns Hopkins 2004 study of long-term data provided by the Maryland Health Services Cost Review Commission)

Numerous studies have demonstrated that specialized treatment by a gynecologic oncologist improves treatment outcomes for women diagnosed with ovarian cancer. Women are entitled to make an informed decision regarding their care for a potentially malignant, premalignant, or malignant condition. Unfortunately, many women are not being referred to gynecologic oncologists nor are they being advised that such a profession exists. 

Gynecologic oncologists are the only board-certified subspecialists whose training encompasses all aspects of ovarian cancer treatment. Gynecologic Oncologists initially complete their training as an obstetrician/gynecologist (OB/GYN). They then complete an addition three to four years of intense training in all of the effective forms of diagnosis and management of gynecologic cancers. This includes training in the pathology and biology of gynecologic cancers and surgery, radiation therapy, chemotherapy, and experimental treatments. This training is offered in a limited number of medical centers around the nation.

Board Certification in Gynecologic Oncology requires years of clinical practice and successful completion of written and oral examinations and promotes the delivery of effective, state of the art therapy. This training is unique, in that it allows patients to receive total therapy without fragmenting their care, resulting in an improved chance of survival. Gynecologic oncologists are also prepared to provide important supportive services such as pain management, management of medical or surgical complications from treatment, complications of the cancer, and hospice referral.

Studies done on the management of ovarian cancer showed that gynecologic oncologists were almost five times more likely to completely debulk ovarian tumors and accurately stage the disease than were their non-specialist counterparts.

Reprinted from Ovarian Cancer News, Volume 1, Issue 2 - Fall Edition 2005, a publication of Ovarian Cancer Alliance of Florida - Gulf Coast - 6017 Pine Ridge Rd., #149, Naples, FL 34119 - 239.455.0554