Tests, Treatments & Therapies for Ovarian Cancer at the University of Colorado Cancer Center

Staging and Detection Tests

Tests are only as good as the doctors who report and interpret them. That’s why our doctors-who work together as a patient’s care team-are the highest trained specialists in the state.

Once a cancer has been diagnosed, it is very important for doctors to find out where the cancer may have spread (the “stage” of the cancer) to determine the best possible treatment plan for you. To find out, doctors use staging tests, which include:

• Different types of scans
• Different ways to take tissue samples to look for tumor cells microscopically (biopsy tests)

Scans and other tests may also be used:

• In a “surveillance program” looking for any signs of relapse after treatment
• In a “screening program” to detect cancer early in individuals at high-risk
• To monitor responses to treatment

Diagnostic Tests

Pelvic exam – The doctor inserts one or two lubricated, gloved fingers of one hand into the vagina. The other hand is placed over the lower abdomen to feel for masses. After examining the vagina, a rectal exam done to check for spread of cancer. An instrument called a speculum is inserted into the vagina to check for signs of disease.

Pap smear (Pap test – A brush or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to see if they are abnormal.

Biopsy – The removal of cells or tissues so they can be viewed under a microscope by a doctor called a pathologist to check for signs of cancer.

Colposcopy – A procedure to look inside the vagina and cervix for abnormal areas. Allows for a magnified view of the vagina and cervix to inspect for precancerous or cancerous changes and to guide biopsies of the abnormal areas.

Staging Tests

After vaginal cancer has been diagnosed, tests are done to find out the “stage” of the cancer (how far it has spread). Tests include:

Biopsy – A sample of tissue is cut from the cervix and viewed under a microscope by a doctor called a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office.

Cystoscopy – An instrument called a cystoscope is inserted through the urethra into the bladder to check for abnormal areas. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Proctoscopy – A proctoscope is inserted through the rectum to check for abnormal areas. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

CT scan (CAT scan) – A series of detailed pictures are taken of areas inside the body. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called:

• Computed tomography
• Computerized tomography
• Computerized axial tomography

MRI (magnetic resonance imaging) – A magnet, radio waves, and a computer are used to make a series of detailed pictures of areas inside the body. Also called nuclear magnetic resonance imaging (NMRI).

PET scan (positron emission tomography scan) – This complements a CT scan and is some times done at the same time. A small amount of safe radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

Radiotherapy and Chemotherapy

Radiation therapy (“Radiotherapy”) involves using X-rays and other types of medical radiation aimed at specific parts of the body to:

• Kill cancer cells
• Prevent cancer cells from developing or recurring
• Improve many of the symptoms caused by cancer

Radiation therapy can be:

• Used before surgery to make the operation easier (this is called “neoadjuvant” treatment)
• Used after surgery to reduce the chances of the cancer coming back (this is called “adjuvant treatment”)
• Almost as effective as surgery in people who are not fit enough for an operation
• Better than surgery when used together with chemotherapy for certain cancers (this is called “chemo-radiotherapy”)

Chemotherapy and other drug-based treatments:

Anti-cancer drug treatments: Chemotherapy-and new “targeted therapies”-involve using drugs that kill, slow down or damage cancer cells. Many new drugs are being developed.

Anti-cancer drug treatments may involve:

• Single drugs or combinations of drugs
• Intravenous injections or tablets/capsules
• Taking the drugs in repeating patterns, called “cycles”, that usually last three to four weeks
• Taking some drugs every day or only on a few days within the cycles
• Taking other medicines to reduce or eliminate side effects associated with chemotherapy
• Taking targeted therapies, often with very little side effects, on their own or in combination with standard chemotherapy

Chemotherapy and targeted therapies can:

• Be given before surgery to make the operation easier
• Be given in combination with radiotherapy to make both treatments more effective
• Be given after surgery to reduce the chances of cancer coming back
• Successfully control advanced cancer and many cancer-related symptoms

Surgery

Sometimes a tumor can be removed through an operation or a procedure. A specially trained surgeon, called a gynecologic oncologist, will perform the operation. Here are some of the possible procedures for vaginal cancer.

Laser surgery – Uses a narrow beam of light to kill cancer cells.

Wide local excision – Takes out the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body (grafted) to repair the vagina after the cancer has been taken out.

Surgery – An operation in which the vagina is removed. Could be combined with the following procedures, depending how far the cancer has spread:

• Radical surgery – Includes removal of the uterus if it is still present, part of the vagina and the tissues next to it.
• Lymph node dissection – Removal of lymph nodes in the pelvis.

Exenteration – This would be done if radiation had been given for another type of cancer. Removal of the lower colon, rectum or bladder (depending on where the cancer has spread) along with the cervix, uterus and vagina.