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How is Stage 4 Ovarian Cancer Treated?

Stage 4 ovarian cancer is also known as advanced or late-stage ovarian cancer. In stage 4, ovarian cancer spreads past the reproductive system to other body organs and tissues, which may include the following:

  • Liver

  • Brain

  • Skin

  • Lungs

Studies show that only 30.3% of the population with stage 4 ovarian cancer can survive up to 5 years after the diagnosis.

Stage 4 ovarian cancer typically shows nonspecific or asymptomatic symptoms such as frequent urination, bloating, and pain in the reproductive organs.

Standard treatment plans may include surgery (followed by chemotherapy) to remove as many cancerous cells as possible. People who do not want to undergo surgery can receive palliative care instead.

Stages of Ovarian Cancer

Stage 4 cancer is divided into the following substages:

  • Stage 4A

  • Stage 4B

Ovarian Cancer Stage 4A

Stage 4A ovarian cancer occurs when the cancerous cells spread into the fluid layer surrounding the lungs. This phenomenon is known as malignant pleural effusion. Cancer cells do not metastasize to other locations outside the pelvis or peritoneal cavity. The peritoneum is the thin membrane lining of the abdomen's external cavity, covering the abdominal organs.

Ovarian Cancer Stage 4B

In stage 4B, cancerous cells spread to areas outside of the peritoneal cavity, such as:

  • Lungs

  • Nearby lymph nodes

  • Brain

  • Skin

Symptoms

Earlier stages of ovarian cancer show asymptomatic signs, and later stages show nonspecific symptoms; thus, confusion with other diseases may occur during identification. Research shows that more than 75% of people with ovarian cancer are diagnosed at an advanced stage when cancer has metastasized to other organs.

Following are the symptoms of stage 4 cancer:

  • Swelling in the abdominal region

  • Increased pain in the pelvic area

  • Nausea

  • Difficulty eating food

  • Frequent urination

Less Common Symptoms Associated with Ovarian Cancer

These symptoms do not help recognize ovarian cancer because they are widely found in populations who do not have it.

  • Tiredness

  • Dyspepsia

  • Backbone pain

  • Discomfort with intercourse

  • Constipation

Ovarian Cancer Risk Factors

Factors that increase the risk of ovarian cancers are mentioned below:

Age

The possibility of developing ovarian cancer increases with age. The chances of ovarian cancer are less in women younger than 40. It usually develops in women after menopause or who are 63 years of age or older.

Obesity

Obesity increases the chances of developing many cancers. However, the information available for ovarian cancer and obesity is not clear. Women with a body mass index of 30 or more have a greater tendency to develop earlier stages of ovarian cancer. The survival rate in women with ovarian cancer is very low, especially if they are obese.

Having Children at a Later Age or Never Being Pregnant

The likelihood of developing ovarian cancer is higher in women who have their first pregnancy after 35 years or have never been pregnant.

Initiating Hormone Therapy After Menopause

Women who intake estrogens alone or with progesterone after menopause are at a greater risk of developing ovarian cancer than women who do not use hormones.

Family History of Ovarian Cancer, Colorectal Cancer, or Breast Cancer

Ovarian cancer can also develop due to genetic or family history. The probability for ovarian cancer increases if a family member such as mother, sister, or daughter already has it.

If other types of cancer such as colorectal and breast cancer run in the family, the risk for ovarian cancer increases due to the mutations in specific genes.

Using Fertility Treatment

In vitro fertilization (IVF) is a popular fertility treatment that appears to increase the chance of the formation of ovarian cysts, which are known as "low malignant potential" or "borderline."

Previous History of Breast Cancer

Women with a history of breast cancer are at a much higher chance of developing ovarian cancer. It is due to mutations in the BRCA1 or BRCA2 genes, associated with an increased likelihood of ovarian cancer.

Smoking

Smoking causes an increased risk for the mucinous type of ovarian cancer. However, many studies have not shown the clear effect of smoking.

The survival rate of ovarian cancer

The chances of ovarian cancer estimated by the American Cancer Society in the United States for 2021 are:

  • About 21,410 women will be diagnosed with ovarian cancer.

  • About 13,770 deaths will be caused by ovarian cancer in women.

Ovarian cancer is fifth in cancer deaths among women, accounting for more deaths than other female reproductive system cancer. The chance for a woman to get ovarian cancer throughout her lifetime is around 1 in 78. The possibility for death from ovarian cancer is about 1 in 108. (The statistics mentioned above do not include low malignant potential ovarian tumors.)

The prognosis of the cancer is common in older women. Most of the women diagnosed with ovarian cancer are of the age of 63 or older. The prevalence rate of ovarian cancer is higher in white women than African American women.

Studies show that the rate at which women are diagnosed with ovarian cancer has slowly fallen over the past 20 years.

Ovarian Cancer Detection & Diagnosis

Blood Tests

  • CA-125

    CA-125 is a substance circulating in the blood that increases when a malignant tumor is present. Ovarian cancer cells produce this protein and are present in increased levels in 80 percent of those with advanced ovarian cancer and 50 percent of those at an early stage of ovarian cancer.

  • Inhibin B and Inhibin A

    The Granulosa cell tumors are typically identified and monitored by two blood indicators: Inhibin A and Inhibin B.

Transvaginal Ultrasound

A transvaginal ultrasound test examines female reproductive organs and bladder and helps identify any abnormal masses or bumps on the upper surface of the ovaries and within cysts that develop inside the ovaries.

Pelvic Exam

A pelvic exam is a part of a regular gynecologic wellness exam. In this exam, the doctor places one or two fingers into the vaginal opening and another over the patient's abdomen to observe the ovaries and uterus size, shape, and position.

Recto-vaginal Pelvic Examination (also called a bimanual exam)

Recto-vaginal Pelvic Examination examines the ovaries for lumps. A Pap test is a routine test in a pelvic exam, but it identifies cervical cancer, not ovarian cancer.

How is Advanced-stage Ovarian Cancer Treated?

The following therapies are the main treatments for ovarian cancer:

  • Chemotherapy is a treatment that involves the use of anticancer drugs. The medicines are directly injected into the bloodstream to kill cancerous cells. Chemotherapy is a very effective treatment option. The only drawback is that it also affects the patient’s immune system.

  • Hormone Therapy is a treatment designed to decrease or prevent the production of hormones. A few hormones help in the progression and spread of specific tumors. As the hormone levels decrease, cancer may not metastasize as quickly.

  • Radiation Therapy is a kind of treatment that utilizes X-rays and high-energy particles to damage cancerous cells. It is most often utilized to treat different cancers, including ovarian cancer, that has grown or metastasized past the primary location.

  • Targeted Therapy is a unique treatment intended to overcome the destruction done to healthy cells while killing cancerous cells. Targeted therapy drugs vary from chemotherapy because they attack and destroy cancerous cells.

Personalized Treatment for Stage 4 Ovarian Cancer at Silver Cancer Institute and Center for Chronic Disease

Silver Cancer Institute and Center for Chronic Disease is known best for the therapy plans for ovarian cancer. Dean R. Silver creates a personalized treatment strategy for every stage 4 ovarian cancer patient.

Following are the treatment options available at SCI:

Genomic Personalized Molecular Testing

SCI can now profile through genomic testing to evaluate the tumor drivers. Tumor drivers are pathways that cause the multiplication of cancerous cells. The factors causing mutations include:

  • Genetic mutations

  • Growth factors

  • Hormone factors

This treatment strategy blocks multiple pathways to stop the growth of cancerous cells.

The prognosis and recurrence of ovarian cancer can be predicted by evaluating the circulating cancer cells. Chemosensitivity testing is conducted in patients with ovarian cancer to decide which chemotherapy is effective.

Combination Therapy Works Best

The patient's biomarkers are evaluated in this therapy. This therapy helps to see which cancer pathways are causing ovarian cancer to become more aggressive. The treatment plan includes the following:

Low-dose Chemotherapy and Natural Synergistic Substance

Low-dose chemotherapy is one of the best treatment options as it does not have any toxic side effects compared to high-dose chemotherapy. It does not suppress the patient's immune system as well. Natural targeted therapies are also non-toxic and can prevent chemotherapy resistance and enhance the patient's immune status.

Immunotherapy with Checkpoint Inhibitors

Advanced ovarian cancer is now easily treated at SCI because of the recent approval of immunotherapy with checkpoint inhibitors. The following checkpoint inhibitors are currently being used:

  • Anti-PD–1

  • Anti-PD–L1

  • CT LA–4

Immunotherapy with an Autologous Cancer Vaccine, Dendritic Cell Vaccine, and Supportive Oligonucleotide (SOT):

Personalized vaccines are produced according to each stage 4 ovarian cancer patient. The circulating cancer cells are taken from the patient's blood to make this vaccine and then injected directly into the bloodstream to destroy the cancer cells.

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