I was diagnosed with stage IIc ovarian cancer this year. My left ovary and tube were removed. Lymph node removal showed no spread. The right side and the uterus were not diseased. Is it possible for me to ever become pregnant? Are there risks? Is stage IIc considered early stage?

Angie

There is controversy in leaving behind the uterus and opposite ovary in anything above stage I ovarian cancer; whether this is done -- and the risks of doing so -- greatly depends on the exact type of ovarian cancer.

Stage I disease is that which is confined to the ovaries. Stage II disease extends to other pelvic tissues. Stage III means there is tumor beyond the pelvis, or lymph nodes are positive. Stage IV involves distant metastasis, such as to the lung. Stages I-III are further subdivided into a, b or c. For example, stage IIa means the cancer has spread to the uterus or tubes, while in stage IIc, there are cancer cells in the peritoneal fluid as well as on the uterus, tubes, bladder or other pelvic structures.

Early-stage borderline ovarian cancers can be treated with removal of one affected ovary and careful biopsies to ensure that there is no spread. The five-year survival rate with these cancers is nearly 100 percent, even if just the one ovary is removed. Subsequent pregnancy does not increase the risk of recurrence. In fact, pregnancy, breastfeeding and use of oral contraceptives all decrease the risk of developing borderline ovarian cancers in the first place.

The other type of ovarian cancer in which it is appropriate to preserve fertility by removing only the diseased ovary is a germ cell tumor. Germ cell tumors often occur in younger women, and the usual therapy for early-stage disease is to remove only the affected ovary and tube. Postoperative chemotherapy or radiation therapy are usually given; the exact type of additional therapy depends on the type and stage of the tumor. While radiation therapy may lead to failure of the saved ovary, chemotherapy usually has no impact on future fertility.

Even in cases of ovarian cancer in which both ovaries must be removed, if the uterus is able to be spared, pregnancy may occur through the use of donor eggs and in vitro fertilization.

All women who have fertility-sparing surgery after being diagnosed with ovarian cancer must be followed very closely. So called "second-look" surgery may be performed by open techniques (which involve opening the body) or via laparoscopy (a surgical technique using miniature instruments inserted through tiny incisions) several months after the original diagnosis in order to ensure that there has been no spread. Tumor markers, such as CA-125 (for epithelial ovarian cancers), AFP (for endodermal sinus tumor), or hCG (for choriocarcinoma) are followed through blood tests as appropriate. Chest X-rays or CT scans may be performed periodically as well.

Most often, both treatment and follow-up for ovarian cancer are done under the direction of a gynecologic oncologist. Your oncologist, who knows your exact tumor type, will be able to answer your questions with much greater accuracy.