Low-grade serous cancer of the ovary is a more recently recognized type. This type of ovarian cancer makes up about 7 – 10 % of all ovarian cancers. Low-grade serous ovarian (LGSOC) may develop on its own or may develop from a low malignant ovarian cancer (see above). Low-grade cancer has a different appearance than high grade ovarian cancer on pathology evaluation, and different gene mutations associated. It has a different response to chemotherapy. This type of ovarian cancer is a frequent finding when the patient was previously treated for a low malignant potential ovarian cancer. (see above)
This type of cancer will most often present with pelvic pressure or pain, and sometimes with urinary frequency or constipation and abdominal bloating. Occasionally persistently increasing waist size is caused by fluid retained in the abdomen. Fluid in the abdomen is called ascites. This fluid collection is a response to the cancer on the surfaces inside the abdomen. Further evaluation with an exam may reveal a pelvic mass.
Additional studies are usually done to explain patient's symptoms or an abnormal exam. Ultrasound or CT scan would reveal an ovarian cyst/tumor or mass caused by an ovarian cancer. When the ovarian tumor is not a simple cyst and is involved with complex features, then malignancy such as the low-grade serous cancer is a more likely cause for the patient's abnormal ultrasound.
The exact diagnosis of low grade serous ovarian cancer is not made until surgery. Surgery is initially recommended because a concerning ovarian cyst or tumor has been found. Suspicion of cancer is often based on exam and ultrasound findings. Prior to surgery it is difficult to confirm cancer when no spread is seen on x-rays or ultrasounds. Findings at the time of surgery are made more accurate with pathology review during the surgery. This is called a frozen section pathology study. Final pathology will be even more accurate than a frozen section report because large tumors cannot be thoroughly sampled at frozen section pathology. It is common to have mixtures of low malignant potential tumor and low-grade serous ovarian cancer in the same specimen, and thorough sampling is required to find all of these areas. There may also be benign ovarian tumors with small areas of cancer contained within the larger tumor. Proper pathology evaluation during surgery improves the chances that the surgeon will complete the proper procedure for the final diagnosis that may not be available until after surgery is over.
Surgical removal of the tumor, and surgical staging to identify spread of disease are the most important treatments available for low-grade serous cancer of the ovary. Up to 25% of low-grade serous cancers do not have spread, and some of those with spread are involved with individual areas of spread too small to see on CT scan. About 75% of low-grade serous cancers do have advanced disease and will require extensive surgery to remove all disease found at the time of surgery.
If the findings at surgery confirm visible spread of cancer, then surgery to remove all the spread is crucial. If there is no visible spread then a staging procedure may be done to hunt for microscopic spread. A specialist in treating ovarian cancers would commonly carry out lymph node biopsies and surface biopsies inside the abdomen in order to complete a staging procedure. Dr. Martin is very experienced in completing those procedures. If an ovarian tumor is removed by a non-cancer specialist then very commonly a second surgery would be needed to complete the ideal surgery.
Chemotherapy may be used for advanced disease, and individual patients have different response. The more aggressive the behavior of the cancer the more it responds to chemotherapy. Low-grade serous cancer of the ovary can respond to chemotherapy, but is expected to have a lower response rate to chemotherapy compared to high-grade ovarian cancer, and therefore meticulous surgical resection of all visible disease is crucial. If all the disease can be resected or only minimal residual and microscopic amount remains after surgery, then hormone therapy may be more valuable than chemotherapy. If chemotherapy is needed, Dr. Martin can administer chemotherapy for these tumors in the office.
Recent management changes now include hormone manipulation of the tumor. Many patients with low-grade serous cancer have successfully controlled their tumor with hormone agents including medications they can take by pill. Thankfully those medications often have very few side effects and can provide very prolonged control of disease.
The specialist managing a malignant ovarian tumor has many decisions to make regarding extent of surgery to recommend and whether chemotherapy would be needed. A gynecologic oncologist is uniquely trained for that management and has the surgical skills to carry out various surgeries needed and familiar with the statistics regarding different tumors and their behavior. Younger patients may also have desire to preserve fertility. Dr. Martin is a board certified gynecologic oncologist, and his familiarity with the clinical behavior of different types of tumors and usual response to various therapies for each type of tumor will allow him to provide the best possible care for a very complicated and potentially dangerous disease.