Suppose the mammography had never been invented—how much would we know today about breast cancer? Without it, how many more women might have died from breast cancer? Unlike mammography, no routine test, such as a Pap smear, can yet detect ovarian cancer. Each year, approximately 22,000 women in the United States are diagnosed with ovarian cancer, and 14,000 die from the disease. The majority of patients have advanced cancer, and 80% to 85% have a recurrence within 2 years. Ovarian cancer is the most deadly gynecologic cancer, with approximately 45% of patients surviving only 5 years. The death rate from ovarian cancer has changed very little in the past 40 years. By the time ovarian cancer is detected, it is already in stage III in nearly 51% of patients, meaning it has spread throughout the abdominal cavity. If cancer is detected earlier, a survivor has a higher 5-year survival rate.
WHO IS AT RISK?
Several factors can increase the risk for this disease, and approximately 1 in 75 women actually get this cancer. AGE. Ovarian cancer can occur in any age, including young women and girls, but it is most common in women aged 50 to 60. GENETICS. About 15% of ovarian cancers are caused by an inherited mutation (alteration) in the BRCA1 or BRCA2 gene. Therefore, women with this family history of BRCA, and some with no history, are now being tested for this genetic alteration. These genes also increase a woman’s risk for breast cancer. If you have a genetic risk, you may need to have regular pelvic imaging and blood tests to check for this cancer. Genetic mutations that cause Lynch syndrome (which relates to colon cancer) also increase the risk for ovarian cancer. Other risks include long-term use of estrogen-replacement therapy; early start (before age 12) or late ending (after age 52) of menstruation; never being pregnant; smoking; and polycystic ovary syndrome.
The symptoms of ovarian cancer are vague and are not specific to cancer, so they are not easy to link to cancer. They include:
- Stomach or pelvic pain
- Feeling full quickly while eating
- Urinary urgency
- Bleeding abnormally
In addition, some patients may experience pain during intercourse, extreme fatigue, indigestion, constipation, back pain, and changes in their menstrual cycle. If these symptoms occur almost daily for 2 to 3 weeks, see your doctor.
The first step in diagnosis involves a blood test called a CA 125 (cancer antigen 125), which measures the amount of the CA 125 protein in your blood. However, some ovarian cancer cells don’t express this protein, so advanced disease can be diagnosed with low levels of CA 125. The second step is a pelvic exam and a transvaginal ultrasound, which may or may not definitively diagnose ovarian cancer. If the ultrasound is suspicious, a CT scan will often be ordered to confirm the diagnosis. However, a definitive diagnosis can only be done with surgery, which shows the extent or the stage of the cancer. If ovarian cancer is diagnosed, the decision must be made, based on the test results and the woman’s overall health status, whether to have immediate surgery or to start chemotherapy first, followed by surgery after the tumor size is reduced.
STAGES OF OVARIAN CANCER
The stage of the disease indicates how far the cancer has spread, which determines the course of treatment. Other factors that affect the grade of the tumor are classified as “a” (the least aggressive), “b” (less aggressive), and “c” (more aggressive). The 4 stages of ovarian cancer are: Stage I. The tumor is confined to 1 or both ovaries and has not spread outside the peritoneal cavity; no ascites (excessive fluid causing bloating) is present; and the tumor has not ruptured. The 5-year survival rate is about 92%. Stage II. The tumor extends beyond the ovaries and has spread to other organs in the pelvis, such as the uterus or the fallopian tubes. In this stage, the 5-year survival rate is about 73%. Stage III. The tumor has spread beyond the pelvis into other areas around the abdomen; the chance for 5-year survival drops to about 28%. Stage IV. The tumor has spread to the liver, lungs, or other organs; the chance for 5-year survival drops to about 22%. In addition, ovarian cancer includes several types. Epithelial tumors, especially serous, are the most common type; they arise from epithelial tissue and generally occur in postmenopausal women. The other ovarian tumor types affect fewer women.
After surgery, all those with stage III or IV disease are given 6 rounds of platinum-based chemotherapy, usually with one of these drug combinations:
- Platinol (cisplatin)
- Paraplatin (carboplatin) plus Taxol (paclitaxel)
- Taxotere (docetaxel) plus carboplatin.
In addition, patients are also given drugs to prevent nausea and vomiting that are associated with chemotherapy. If the cancer returns in less than 6 months after starting a platinum-based therapy, this suggests that the cancer is “platinum resistant,” meaning that another drug should be used, such as Abraxane (nab-paclitaxel), Alimta (pemetrexed), Camptosar (irinotecan), Gemzar (gemcitabine), and a few others. Your doctor will determine which is the best treatment option based on your personal condition. Because early diagnosis is so important to the survival of a patient with ovarian cancer, women must listen to their bodies and seek medical advice if symptoms occur.
NEW TREATMENTS FOR ADVANCED OVARIAN CANCER
The treatment of patients with advanced ovarian cancer is making some progress, with the first approval of a new type of drug for advanced disease in the past year, and with more therapies in development. Lynparza. In December 2014, the FDA approved Lynparza (olaparib), the first of a new drug type called PARP inhibitors, for patients with advanced ovarian cancer and a BRCA gene mutation. Olaparib is to be used in women who have already received several treatments for this type of ovarian cancer. In addition, together with Lynparza, the FDA approved a genetic test, called BRACAnalysis CDx, which can identify women with ovarian cancer who have the BRCA gene alteration. If the results of the test are positive, it means that the patient can be prescribed Lynparza, which is intended specifically for patients with this gene alteration. Cantrixil. This is a new chemotherapy drug in late-stage development for patients with advanced ovarian cancer. In clinical studies it has shown that it can reduce the tumor in women with late-stage ovarian cancer. Cantrixil is expected to be available for use in Australia in late 2015 or early 2016. Newer treatments with molecular profiles to identify the best drug for the tumor, targeted drugs, and using drugs after chemo are on the horizon, but are not yet routinely used.