September 15, 2016

Know the facts about ovarian cancer


Listening to the body, being aware of individual risks are especially important when it comes to ovarian cancer.

As a woman, you’re most likely aware of ovarian cancer, but you’re unlikely to think that much about it. It’s easy not to; we’ve been taught that it’s the “silent killer,” rarely diagnosed until it’s too late for effective treatment. The most we can do is hope we don’t get it, right? How common is it, anyway?

More common than you might think. An estimated one out of every 70 women will be diagnosed with ovarian cancer in her lifetime. That’s about the same rate as autism, yet there seems to be so much mystery surrounding what is considered by medical experts to be the deadliest gynecological cancer for women.

There is hope in this area; a new study in the Annals of Oncology came out this month showing death rates for ovarian cancer are decreasing in the U.S. and Europe, in part due to oral contraceptive pill use. But more work needs to be done.

For September, Ovarian Cancer Awareness Month, we chatted with Dineo Khabele, M.D., Associate Professor in Obstetrics and Gynecology, Associate Professor in Cancer Biology and Director of Gynecological Oncology Translational Research at Vanderbilt. Khabele talked about the myths vs. the facts of ovarian cancer, important advances in treatments and how much further researchers have to go to find a cure.

Ovarian cancer is often called silent. Why do people think there are no symptoms?

Ovarian cancer was previously thought of as a silent disease because it is typically diagnosed in the late stages of disease when most symptoms appear. On the other hand, if detected early, most ovarian cancers can be cured but early disease is usually asymptomatic.

What are the symptoms?

We now know that ovarian cancer is not silent. Many women complain of symptoms such as persistent abdominal bloating and swelling, loss of appetite and feeling full easily, changes in bowel and bladder habits and irregular vaginal bleeding. The symptoms are common and could be due to other causes. However, if the symptoms persist over weeks, we recommend a gynecologic evaluation.

What are the most effective ways to diagnose it?

Current methods of diagnosing ovarian cancer early are not very effective. It is typically diagnosed by a patient’s symptoms, and sometimes diagnosed by examination of a large abdominal mass, but often diagnosed on imaging with a transvaginal ultrasound or CT scan after the patient develops symptoms. The diagnosis is confirmed by biopsy or surgical resection.

To date, we do not have an effective method of screening for ovarian cancer.

Some sources suggest the CA-125 blood test. Others say it’s ineffective. What’s your opinion?

The CA-125 blood test is not a good screening test in isolation because sometimes it is elevated in women who do not have ovarian cancer, and sometimes it is not elevated in women who do have it.

Clearly we need more research. There was a very big trial in the U.K. that was recently published. They used CA-125 blood tests and transvaginal ultrasounds to screen the study population. Unfortunately, the ultimate result was that they did not significantly increase the chances of detecting ovarian cancer early and, in fact, missed some cancers. We still use CA-125 and transvaginal ultrasound tests to help diagnose ovarian cancer, but these are not screening tests for the general population.

Ongoing research is needed for new strategies and approaches to early detection.

Are there certain risk factors or demographics more prone to ovarian cancer?

Ovarian cancer occurs most often after menopause. Some reproductive factors, such as breast-feeding and birth control pills, reduce ovarian cancer risk. In contrast, infertility is associated with an increased risk. One of the risk factors is a strong family history of ovarian and breast cancer. Inherited mutations in genes such as BRCA1 and BRCA2 predispose women to developing ovarian cancer.

There is something called hereditary breast and ovarian cancer syndrome, although there are some with a family history of just breast cancer or just ovarian cancer who are at higher risk. We’ve known for a very long time that women who were at higher risk for developing ovarian cancer include those who have the mutations in BRCA1 and BRCA2. Insurance does cover testing, but it’s important to seek specialty care for this.

Any provider can order these labs. What we offer at Vanderbilt, however, is multi-disciplinary teams that include highly trained genetics counselors who perform critical counseling to the patient that accompanies the testing. This important because genetic tests have implications for an entire family.

Why is the mortality rate so high?

Ovarian cancer is the leading cause of gynecological cancer death in the United States. The high mortality rate is due to the fact that it is typically diagnosed only once it has become widespread within the peritoneal cavity. If diagnosed early, at stage 1, most ovarian cancers can be cured.

Most symptoms that are usually associated with ovarian cancer are when the disease is already at a stage 3 or 4. Nevertheless, we want people to be aware of what those symptoms are and to seek help as early as possible.

People are really not aware of these cancers. They’re very aware of breast cancer, but not as aware of other deadly cancers out there. For ovarian cancer, the family history link only accounts for about 10 percent of women who develop it.

You’ve been working on genetic alterations for targeted therapies. What kind of progress have you experienced?

My laboratory is working on changing some of the underlying molecular features of ovarian cancer cells using combinations of novel drugs to improve response to treatment without causing significant side effects. Some of our recent work is being developed into a clinical trial we plan to open at Vanderbilt soon.

What are some of the most effective treatment therapies available now, either new or otherwise?

The most effective treatment for advanced ovarian cancer is a combination of aggressive surgical resection and the administration of chemotherapy directly into the abdomen, along with chemotherapy given through the veins. If successful, these treatments have been shown to prolong women’s lives for years. Not all women are eligible for aggressive surgery, and often ovarian tumors develop resistance to chemotherapy. Therefore, there is an urgent need for additional effective treatments.

Does Vanderbilt have any clinical trials for ovarian cancer patients?

Vanderbilt is a National Comprehensive Cancer Center site, one of only a few in the country, and has a large portfolio of clinical trials for people diagnosed with all types of cancer, including ovarian. We also have several clinical trials open specifically for women diagnosed with recurrent ovarian cancer.

Is there anything you can do to reduce your risk or prevent ovarian cancer?

Approximately 1 in 70 women will develop ovarian cancer over her lifetime. For some women the risk is increased because of a strong family history of ovarian and breast cancer.

According to the Foundation for Women’s Cancer, it is important for a woman to learn about her individual risk, which includes understanding and awareness of her family history. Personal history of infertility and not bearing children are risk factors. Pregnancy and use of oral contraceptive pills decrease the risk.

It is important for a woman to listen to her body for symptoms, such as bloating, abdominal swelling and pain, difficulties eating or feeling full quickly. If the symptoms last for more than a few weeks it is important to seek evaluation by gynecologist.

Unfortunately, there is no effective screening test. More research is urgently needed. If a woman develops symptoms that persist and her gynecologist or other provider considers that ovarian cancer is a possibility, it is important to seek care from a gynecologic oncologist, a specialist in this area.

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