Julie Bromberg and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund
Ovarian cancer is especially traumatic for young women, because it is often diagnosed when the disease is advanced. Standard treatment usually includes having both ovaries, fallopian tubes, and the uterus removed. While this “radical” surgery was once considered the safe option, the procedure left younger women with early menopause and unable to become pregnant. Now, many young women have the option of “fertility sparing surgery,” which removes one ovary and one tube.
A 2017 study in the Journal of Obstetrics & Gynecology found that women below age 40 who have early-stage epithelial† ovarian cancer can be safely treated without losing their fertility. Women in the study had an 89% chance of surviving at least 10 years after their surgery, whether they had the standard surgery or the fertility-sparing surgery.
A similar 2017 study in the Journal of Gynecologic Oncology examined premenopausal women under age 50 with a more aggressive type of ovarian cancer called early-stage ovarian clear cell cancer. At 5 years after surgery, 90% of women who did not have their uterus removed were alive compared to 88% of women who did. Similarly, 93% of women who had one ovary removed were alive compared to 85% who had both ovaries removed.
The traditional treatment approach for ovarian cancer was to remove the organs to prevent the cancer from coming back. The uterus was also removed, because it was assumed to be safer to remove a nearby organ where cancer could grow. Younger women who were treated for ovarian cancer underwent early menopause (known as surgical menopause) because of the greatly reduced level of estrogen hormones in their bodies, and lost their ability to have children.
Since the 2017 studies only included pre-menopausal women under age 50 with Stage 1 ovarian cancer, it is impossible to know whether older women would have similar survival rates under similar circumstances. Fertility-preserving treatment is risky for women with stage II or later stage ovarian cancer.
Cancer surgery has evolved over the years, becoming less radical. For example, breast cancer used to be treated by removing the entire breast and the muscles underneath, instead of just the cancer and a small area of healthy tissue around it. Eventually, research proved that women lived just as long with much less radical surgery, and now early-stage breast cancer is often treated by removing just the cancer, rather than one or both breasts. The latest research indicates that breast cancer patients’ survival is slightly better with the less radical surgeries. (Read more on breast conserving surgery here.)
What Happens after Ovarian Cancer Surgery?
After surgery, women need to see their physician frequently for clinical exams during the first 5 years. The Society of Gynecologic Oncologists (doctors specializing in women’s cancers) recommends the following :
- In the first 2 years after surgery, women should have a regular exam, including an exam of the pelvis and lymph nodes every 3 months (or 4 times a year).
- In the third year, women should have exams every 4-6 months (or 2-3 times a year).
- In the fourth and fifth year, women should have exams every 6 months (or twice a year).
- After 5 years, women can resume annual exams.
- A blood test that checks for a tumor marker (CA-125) is optional.
- CT scan should be done only when the doctor is concerned the cancer has recurred.
How can you Detect Ovarian Cancer Early?
For all cancers, early treatment greatly increases the chances of survival. Unfortunately, the early symptoms of ovarian cancer are easily confused with less serious problems, making it difficult for women to know if they need to be tested for ovarian cancer.
If a woman has any of the following symptoms every day for more than 2 weeks, or if the symptoms are more severe or unusual for her, she should talk to her doctor about being tested for ovarian cancer:
- Feeling bloated or swelling in the stomach area
- Pain in the stomach area
- Difficulty eating or feeling full
- Gas, bloating, or constipation
The Bottom Line
Treatments that preserve the uterus and at least part of one ovary, instead of removing the uterus and both ovaries, can be safe for women younger than 50 who have Stage 1 epithelial ovarian cancer. Premenopausal women with early-stage ovarian cancer who want to preserve their fertility should find a doctor who is experienced in that treatment and find out whether it is a safe option for them.
- Melamed A, Rizzo AE, Nitecki R, Gockley AA, Bregar AJ, Schorge JO, delCarmen MG, and Rauh-Hain JA. (2017). All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer. Obstetrics & Gynecology, 130 (1): 71-79. doi: 10.1097/AOG.0000000000002102
- Nasioudis, D., Chapman-Davis, E., Frey, M. K., Witkin, S. S., & Holcomb, K. (2017). Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma? Journal of Gynecologic Oncology, 28(6), e71. http://doi.org/10.3802/jgo.2017.28.e71
- Medscape. Ovarian Cancer Guidelines. (2016, Aug. 22). Available Online: https://emedicine.medscape.com/article/2500016-overview#showall
- National Cancer Institute. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Patient Version. (2017, Oct. 13). Available Online: https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq
† 85%-90% of all ovarian cancers are epithelial