Ovarian Cancer

Ovarian cancer often develops silently and is frequently diagnosed at an advanced stage. However, treatment options have significantly improved in recent years.

Types of Ovarian Cancer

• Epithelial ovarian cancer (≈90%)
• The most common type. Arising from the surface of the ovary, fallopian tube, or related tissue (including endometriosis). Includes subtypes such as serous, mucinous, endometrioid, and clear cell. Risk increases with age, especially after the age of 50.
• Germ cell tumors (≈5%)
• Develop from egg-producing cells. Occur more often in younger women, usually under the age of 30.
• Stromal tumors (≈5%)
• Arise from hormone-producing tissue of the ovary. Often grow more slowly and may occur at any age.

Who Is at Risk?

The lifetime risk of developing ovarian cancer is 1 in 70 women. Risk rises with age (most commonly after 50 years old), family history, or inherited mutations like BRCA1/BRCA2, though in most cases the exact cause is unknown.

Detection and Diagnosis

The symptoms of ovarian cancer are often vague and most commonly appear only when the disease had already spread. These include abdominal bloating, pelvic discomfort, loss of appetite, early satiety, or changes in bowel habits.

There are no effective screening tests for early detection of ovarian cancer. Once symptoms have developed patients usually undergo diagnostic evaluation which may include:

• Imaging tests: Ultrasound (US), CT scan
• Blood tests (e.g., tumor markers such as CA-125)

Diagnosis may be confirmed by tumor removal during surgery, or by imaging (US or CT)- guided biopsy.

Treatment

Ovarian cancer treatment usually includes a combined approach of both surgery and chemotherapy.

Surgery

Surgery is the main treatment for ovarian cancer and plays a key role in both diagnosis, stage determination and treatment. At Hadassah Medical Center, our surgeons have extensive experience in complex ovarian cancer surgery, aiming for the best outcomes while maintaining patient safety.

When the tumor is apparently early stage (confined to the ovaries), a staging procedure is performed to determine microscopic involvement of other organs. This includes removal of the ovaries, fallopian tubes and the uterus, as well as tissue sampling including the omentum (fatty tissue covering the abdominal organs) and abdominal lymph nodes.

Most cases, however, are diagnosed at an advanced stage, where the tumor had already spread to the pelvis, abdomen or other organs. The goal of surgery in these cases is to resect all visible tumor lesions in a procedure called debulking

surgery. This procedure may include resection of other organs (e.g. part of the bowel, spleen, liver, diaphragm) in addition to removal of the uterus, ovaries and fallopian tubes and omentum.

Chemotherapy

Chemotherapy uses medications to destroy cancer cells and control disease. The most common treatment includes a combination of two drugs:

• Carboplatin: a platinum-based drug that damages cancer cell DNA. Some of the side effects are temporary low blood counts (risk of infection, anaemia and bleeding), fatigue, nausea (usually well controlled with medication).
• Paclitaxel (Taxol): works by preventing cancer cells from dividing. Some of the side effects are temporary low blood counts, Hair loss, Peripheral neuropathy (numbness or tingling in hands and feet), muscle and joint aches.

The treatment typically includes 6 cycles of these medications, given intravenously every 3 weeks. In some cases, a divided dose for a weekly schedule may be recommended to improve tolerance and reduce side effects.

At Hadassah Medical Center, we will guide and support you throughout the treatment in order to minimize side effects and help you safely complete the therapy. We use measures such as scalp cooling (helmet) to reduce hair loss and cooling gloves and stockings to help prevent neuropathy.

Targeted biologic therapies

Maintenance therapy may be given to prolong remission.

PARP inhibitors: an oral capsule medication given usually in cases with BRCA mutations or HRD tumors

• Bevacizumab (Avastin): an intravenous medication given every 3 weeks in select cases.

Dedicated Chemotherapy Unit

Treatment is provided in our specialized Gynecologic Oncology Chemotherapy Unit at Davidson Building, 7th floor.

This unit is separate from general oncology services and is dedicated exclusively to women with gynecologic cancers, with a highly experienced, dedicated team providing personalized care in a supportive environment.

Venous Access Options

If standard IV access is difficult or for long-term treatment, a more comfortable solution may be recommended. Ask us about PICC line (Peripherally Inserted Central Catheter) or Port-a-Cath (Port)

Your team will help decide which option is best and most comfortable for you and will help get the device.

Genetics

Genetic testing is recommended for all ovarian cancer patients, as it impacts treatment, follow-up and family counselling.

About 20-30% of ovarian cancers are linked to changes (mutations) in the BRCA1 and BRCA2 genes, which can be inherited (germline) or occur only in the tumor itself (somatic). In addition, tumors might show homologous recombination deficiency (HRD), a broader group that also predicts response to specific treatments.

In Israel, testing for BRCA (germline and tumor testing) and HRD is included in the national health basket and is an essential part of care. These results guide the use of targeted maintenance treatments, particularly PARP inhibitors, which can significantly prolong remission after initial therapy. When germline BRCA mutations are found, patients are referred for genetic counselling, which may be important for family members as well.

Prognosis

Prognosis depends largely on stage and response to treatment. While advanced disease is more challenging, many patients achieve meaningful, long-term disease control with modern therapies.

We are here to guide and support you throughout diagnosis, treatment, and recovery. Please make an appointment via email at: [email protected]