Metastatic ovarian cancer occurs when cancer cells, originating in the ovaries, spread and form new tumors in other parts of the body. This is also known as advanced or Stage IV ovarian cancer. Understanding this diagnosis means recognizing how the disease progresses beyond its initial site.
How and Where Ovarian Cancer Spreads
Ovarian cancer can spread through several pathways. One common method is direct extension, where cancer cells grow from the original tumor into nearby organs within the pelvis and abdomen, such as the fallopian tubes, uterus, bladder, or rectum. Cancer cells can also shed from the ovaries or fallopian tubes into the abdominal cavity. These shed cells then travel through the peritoneal fluid and implant on the lining of the abdomen, called the peritoneum, and on organs like the bowel and spleen.
The lymphatic system also serves as a route for cancer cells. Ovarian cancer cells can enter lymphatic vessels and be carried to regional lymph nodes, particularly those in the pelvis and along the aorta (para-aortic lymph nodes). From these regional nodes, cancer cells may reach more distant lymph nodes, such as those between the lungs (mediastinum) or above the collarbone (supraclavicular areas).
A less common pathway is hematogenous spread, where cancer cells enter the bloodstream and travel to distant organs. Frequent distant sites for these metastases include the liver and lungs, as well as the pleura, the membrane lining the lungs and chest cavity. This can sometimes lead to fluid accumulation around the lungs, known as a malignant pleural effusion. Other possible distant sites include the bones, brain, and spleen.
Symptoms and Diagnosis of Metastasis
Symptoms of metastatic ovarian cancer vary depending on where the cancer has spread. When cancer has spread to the peritoneum, common symptoms include persistent abdominal bloating, discomfort, and swelling, often due to fluid accumulation (ascites). This can also lead to a feeling of fullness after eating small amounts, difficulty eating, and changes in bowel habits like constipation.
If the cancer has spread to the lungs or pleural lining, individuals may experience shortness of breath or chest pain. Spread to the liver can manifest as changes in appetite or weight, abdominal swelling, and sometimes jaundice (yellowing of the skin and eyes). Other general indicators of advanced disease include fatigue, back pain, and unexplained weight loss. Many of these symptoms can also be associated with less serious conditions, making early detection challenging.
Detecting metastatic ovarian cancer relies on diagnostic tools. Imaging tests visualize the extent of the disease. CT scans provide detailed images, helping identify tumor locations and enlarged lymph nodes. PET scans, often combined with CT (PET/CT), use a radioactive tracer to highlight areas of increased metabolic activity, indicating cancer cells throughout the body.
Blood tests are also used for diagnosis, particularly the tumor marker CA-125. While elevated CA-125 levels can suggest ovarian cancer or its recurrence, this marker is not specific and can be raised by other benign conditions. Therefore, CA-125 results are interpreted with imaging findings and other clinical information. A definitive diagnosis of metastasis is typically confirmed through a biopsy, where a tissue sample from a suspected metastatic site is examined under a microscope to identify cancer cells.
Treatment for Metastatic Ovarian Cancer
The management of metastatic ovarian cancer typically involves controlling disease progression and alleviating symptoms. Systemic therapies deliver drugs throughout the body to target cancer cells wherever they have spread. Chemotherapy, often a combination of platinum-based drugs like carboplatin or cisplatin with taxanes such as paclitaxel, is frequently used to destroy rapidly dividing cancer cells. These drugs are administered intravenously, with a typical course involving several cycles depending on the cancer’s response.
Targeted therapies focus on specific molecular pathways that promote cancer growth. PARP inhibitors, including olaparib, rucaparib, and niraparib, block an enzyme called poly ADP-ribose polymerase, which cancer cells rely on to repair damaged DNA. By inhibiting this repair, PARP inhibitors can cause cancer cells, particularly those with BRCA gene mutations or other homologous recombination deficiencies, to die. These inhibitors are often used as maintenance therapy after chemotherapy to delay recurrence or to treat recurrent disease. Other targeted agents, like bevacizumab, are angiogenesis inhibitors that prevent new blood vessel formation, thus starving tumors of nutrients.
Immunotherapy harnesses the body’s own immune system to fight cancer. Drugs like pembrolizumab, a checkpoint inhibitor, work by unblocking immune cells so they can recognize and attack cancer cells more effectively. While still being researched for ovarian cancer, immunotherapy may be used in specific cases, such as those with high levels of microsatellite instability or DNA mismatch repair deficiency.
Surgery, specifically cytoreductive or “debulking” surgery, plays a significant role in managing metastatic ovarian cancer. The objective is to remove as much visible tumor as possible from the abdominal cavity and other affected areas. Achieving minimal or no visible residual disease after surgery correlates with improved outcomes and can enhance the effectiveness of subsequent chemotherapy. This may involve removing the ovaries and fallopian tubes, and portions of other organs if cancer has spread to them.
Palliative care focuses on improving the overall well-being of individuals living with metastatic ovarian cancer. This specialized medical care aims to relieve symptoms and treatment side effects, such as pain, fatigue, nausea, and constipation, from diagnosis and throughout the course of illness. It addresses physical, emotional, and psychological needs.
Clinical trials offer access to new treatments and therapeutic strategies not yet widely available. These research studies investigate new drugs, combinations of therapies, or different approaches to surgery and radiation. Participation in a clinical trial can provide an opportunity to receive advanced care and contribute to advancements in ovarian cancer treatment.
Managing Prognosis and Quality of Life
For individuals with metastatic ovarian cancer, a complete cure is uncommon. However, the disease is often treatable and can be managed as a chronic condition for an extended period. Prognosis, the likely course of a disease, is complex. While statistical averages like the 5-year survival rate for distant ovarian cancer (around 15-31%) offer a general perspective, they do not predict an individual’s specific outcome.
Many factors influence an individual’s outlook, including their cancer’s characteristics, overall health, and treatment response. These statistics are derived from large populations and cannot account for each person’s unique circumstances. Therefore, discussions about prognosis are best held with the healthcare team, who can provide personalized insights.
Focusing on quality of life is important for managing metastatic ovarian cancer. This involves addressing and managing treatment side effects, such as fatigue, nausea, pain, and neuropathy. Effective symptom management enhances daily comfort and overall well-being.
Emotional and psychological support is also important. Facing a diagnosis of metastatic cancer can bring about feelings of anxiety, distress, or isolation. Engaging with support groups, counseling, or other psychosocial interventions can provide coping strategies and a sense of community. Open communication with the healthcare team is also important, allowing individuals to discuss their treatment goals, preferences, and concerns, ensuring care aligns with their values and wishes.