Ovarian cancer is a disease where malignant cells form in the ovaries, the paired organs in the female pelvis responsible for producing eggs and hormones. This cancer is often diagnosed at an advanced stage because early symptoms are vague and easily mistaken for less serious conditions. When the cancer advances, it can spread beyond the pelvis to other parts of the body, a process known as metastasis. Understanding this progression is important for managing the disease and addressing the challenges that arise when the cancer spreads to the stomach area.
Understanding the Spread Mechanism
The predominant way ovarian cancer spreads throughout the abdomen is through peritoneal carcinomatosis. The abdominal cavity is lined by the peritoneum, a thin membrane covering internal organs like the stomach, intestines, and liver. Ovarian cancer cells detach from the primary tumor and are shed into the peritoneal fluid circulating within the abdominal space. These malignant cells implant and grow on the surfaces of abdominal organs, including the serosa, the outermost layer of the stomach wall. Stomach involvement is usually part of a broader, widespread peritoneal disease rather than an isolated metastasis.
This differs from many other cancers that typically spread through the bloodstream (hematogenous spread). The cancer cells often form small tumor deposits across the lining of the abdominal cavity, including the stomach’s surface. Direct seeding within the peritoneal fluid is the primary route for gastric involvement, though spread via the bloodstream is less common.
Identifying Symptoms of Gastric Involvement
When ovarian cancer deposits affect the stomach, they often lead to symptoms specifically related to gastric dysfunction. One frequently reported symptom is early satiety, the sensation of feeling full quickly after starting to eat a meal. This occurs because tumor deposits on the stomach wall interfere with the organ’s normal expansion and movement. Patients may also experience persistent nausea and vomiting, which can be severe if tumor growth causes a partial or complete obstruction in the stomach’s outlet (pylorus).
The inability to properly digest and pass food leads to discomfort and abdominal distention. This gastric involvement contributes to unintended and rapid weight loss due to poor nutrient absorption and inadequate food intake. Other manifestations include an upset stomach or epigastric pain, felt in the upper central part of the abdomen. In rare cases, lesions may cause internal bleeding, leading to anemia or blood in the stool. These specific gastrointestinal symptoms often represent a worsening of the overall peritoneal disease burden.
Confirming the Diagnosis
Confirming a gastric lesion is a metastasis from ovarian cancer requires imaging and tissue analysis. Advanced imaging techniques, such as Computed Tomography (CT) and Positron Emission Tomography (PET) scans, visualize tumor deposits in the abdomen and stomach wall. However, imaging alone cannot definitively determine the tumor’s origin. An upper endoscopy involves passing a thin, flexible tube with a camera down the throat to examine the stomach lining. During this procedure, a biopsy is taken from the suspicious lesion for pathological analysis.
The appearance of gastric metastases can vary, sometimes mimicking a primary stomach tumor, making tissue diagnosis essential. Definitive confirmation relies on immunohistochemistry, a technique using specific antibodies to identify protein markers within the cancer cells. Ovarian cancer cells typically express markers such as WT1, PAX8, and Cytokeratin 7 (CK7), while often being negative for markers common in primary gastrointestinal cancers like Cytokeratin 20 (CK20) and CDX2. This specific staining pattern confirms the ovarian origin of the metastatic lesion, distinguishing it from a new, primary gastric cancer.
Treatment Strategies for Advanced Disease
The management of advanced ovarian cancer with stomach metastasis is complex and requires a multidisciplinary approach, focusing on disease control and quality of life improvement. Systemic therapy, primarily chemotherapy, remains the standard treatment for widespread disease. Platinum-based regimens, often combined with a taxane drug, are the foundation of treatment and are used to shrink the tumors throughout the body. Chemotherapy may be administered before surgery (neoadjuvant) to reduce the tumor burden, or after surgery (adjuvant) to eliminate remaining cancer cells. For patients with recurrent disease, the choice of systemic agent depends on the time elapsed since the last platinum-based treatment, classifying the disease as platinum-sensitive or platinum-resistant. Targeted therapies, such as bevacizumab (an anti-angiogenic agent) or Poly(ADP-ribose) polymerase (PARP) inhibitors, are often incorporated into the treatment plan depending on the cancer’s molecular profile and patient history.
Surgical Intervention
Surgical intervention, known as cytoreductive surgery or debulking, aims to remove as much visible tumor tissue as possible. While maximal cytoreduction is a goal in ovarian cancer, its feasibility is limited when there is extensive involvement of the stomach and other abdominal structures. Removing large tumor masses can reduce the pressure on organs and potentially improve the effectiveness of subsequent chemotherapy.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a specialized procedure that may be considered in select cases. It involves circulating a heated chemotherapy solution directly within the abdominal cavity immediately following cytoreductive surgery. This localized treatment targets microscopic disease deposits that may remain after the surgeon has removed all visible tumors. The decision to perform HIPEC is made based on the extent of the disease and the patient’s overall health status.
Palliative and Supportive Care
Managing the symptoms of gastric obstruction is a primary focus of palliative and supportive care. If the tumor causes a blockage that prevents food from passing, interventions are necessary to restore comfort and nutritional intake. This may involve placing an expandable metal stent through an endoscope to open the narrowed area of the stomach or intestine. In situations where stenting is not possible or effective, a feeding tube (jejunostomy or gastrostomy tube) may be surgically placed to ensure the patient receives adequate nutrition. Palliative care also includes rigorous pain management, anti-nausea medications, and nutritional counseling to support the patient’s quality of life throughout the course of the advanced disease.