Advances in Ovarian Cancer Diagnosis and Treatment

Ovarian Cancer has a reputation of going undetected until the disease is advanced. At this point it commonly causes death due to the late stage diagnosis; that’s why it is often referred to as the “silent killer.” If left untreated, ovarian cancer rapidly grows and spreads into the abdominal and pelvic areas. Better public and health care provider education has raised awareness of this disease while improved diagnostic and surgical techniques as well as significant advancement in chemotherapy has led to significantly increased longevity and improved quality of life. It is widely recognized that earlier diagnosis saves lives.

Ovarian Cancer Signs & Symptoms:
• Bloating
• Pelvic discomfort
• Abdominal pain
• Trouble eating
• Feeling full quickly
• Urinary urgency or frequency
• Constipation
• Nausea
• Painful intercourse
• Heart Burn
• Fatigue
• Irregular menstrual cycles/ post menopausal
bleeding

Are you at Risk?
Because of the non-specific nature of these signs and symptoms, any persistence of one or more of the symptoms mentioned above should prompt immediate medical attention.

A family or personal history of breast(especially prior to menopause) or ovarian cancer, as well as certain hereditary genetic mutations, can leave you at a significant higher risk of developing ovarian cancer as well as some other forms of cancer. About 15% of ovarian cancer is associated with a mutation called BRCA. Lynch Syndrome is also a genetically inherited syndrome that causes various cancers, including bowel, endometrial, uterine, and ovarian, as well as other cancerous conditions like colon, stomach cancers.

Family members carrying these as well as less common defect are encouraged to seek appropriate counseling and potentially early interventions that would significantly decrease risk of disease development. However, it is important to note that the far majority of ovarian cancer diagnosis are still not related to family history.

Common Risk Factors:
• Genetics (BRCA1 and BRCA2/ Lynch Syndrome)
• Family History
• Personal history of cancer
• Increasing age (average age approximately 62 years)
• Endometriosis(rare)
• Prolonged hormone replacement therapy
• Infertility
• Being overweight/obesity

“It’s important for patients to understand the primary signs and symptoms of ovarian cancer. Only one out five women are diagnosed with early-stage ovarian cancer because the symptoms are often overlooked. At our center, we have board certified gynecologic oncologists that specialize in the treatment of ovarian cancer.” Dr. Grendys explained, “Studies have proven that women who are treated by a gynecologic oncologist have significantly higher longevity and survival rates.

“Over the past four to five years, the way that ovarian cancer is evaluated for surgery or chemotherapy has significantly changed. There is increased use of the laparoscope (keyhole, minimally invasive surgery) for initial diagnosis. Once identified, there is much more decisive and precise understanding of whether a patient would respond best from initial aggressive surgery, chemotherapy or most commonly a combination of modalities.

“Traditional, primary, radical surgery can occasionally be replaced by a less invasive approach. In appropriate cases, this structured laparoscopic approach can yield significantly improved outcomes with dramatic reductions in patient risk. In specific cases, initial use of pre-surgery chemotherapy to reduce the overall tumor size can lead to a lessened need for radical surgery, thereby improving ultimate outcomes. This groundbreaking approach has dramatically changed the initial treatment approach without compromising patient outcomes.

“For advanced stage 3 and 4, there is also a sophisticated technique called HIPEC (Hyperthermic intraperitoneal chemotherapy). This recently approved delivery in which chemotherapy medications are heated and placed directly into the abdominal cavity. This technique can increase cancer cell destruction and reduce risk of recurrence. It has been demonstrated to improve overall survival.

“Along with our advanced training in reproductive cancers and our expertise, we run a full genetic program within the cancer center. When appropriate our patients are screened for specific genetic mutations that may account for particular forms of the disease. If identified, both patients and direct relatives may benefit from both increased surveillances, and/or risk reducing surgery. A presence of a BRCA mutation in a patient with ovarian cancer can also allow for the use of newly developed chemotherapy agents (PARP inhibitors) in both a preventive (maintenance) as well as treatment scenario. These new chemotherapy agents, that block an enzyme that is used to repair the cancer cell’s DNA, can lead to arrest of growth and subsequent death of cancer cells. Taken in a pill form at home, these agents allow for greater patient freedom from onerous office visits.”

Dr. Edward Grendys is a board-certified gynecologic oncologist. He’s also the director of the research program at 21st Century Oncology and brings new treatment methods to patients in the clinical trial stage. With a significant academic background, he remains active in the national research community and serves as principle investigator on multiple clinical trials. He has received numerous awards commemorating his dedication to women’s cancer.

The importance of being treated by a gynecologic oncologist cannot be stressed enough. According to numerous medical studies, there are significant survival advantages for women who are managed, operated on, and treated by a gynecologic oncologist. Why?

• A gynecologic oncologist is a subspecialist who specializes in treating women with reproductive tract cancers specifically ovarian, uterine, cervix, vulva/vagina.

• Gynecologic oncologists are initially trained as obstetrician/gynecologists and then undergo three to possibly more than five years of specialized fellowship education in all of the effective forms of treatment for gynecologic cancers (surgery, radiation, chemotherapy, and experimental treatments) as well as the biology and pathology of gynecologic cancers.

• Gynecologic oncologists are five times more likely to completely surgically remove ovarian tumors during surgery thereby increasing chance of cure.

• Eighty percent of ovarian cancer patients receive inadequate surgical debulking–the removal of tumor tissue during surgery–and staging when done by non-gynecologic oncology surgeons.

• Survival rate and outcomes for women with ovarian cancer vastly improve with treatment directed by gynecologic oncologists.

• For those women with ovarian cancer who live in rural areas that may not have a gynecologic oncologist at a local hospital, her chemotherapy care can be remotely supervised by a gynecologic oncologist who has relationships with local medical oncologists in surrounding areas.1

More on Hereditary Risks
According to the National Cancer Institute (NCI), A woman’s lifetime risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful mutation in BRCA1 or BRCA2.

About 1.3% of women in the general population(non-genetic) will develop ovarian cancer sometime during their lives. By contrast, it is estimated that about 40-60% of women who inherit a harmful BRCA mutation will develop ovarian cancer by the age of 80.

21st Century Oncology is a leader of cancer care services. Their network includes nearly 1,000 expert physicians who work together to deliver advanced cancer care. Their holistic approach to cancer care can lead to a tailored plan of care best suited to the individual patient needs.

Dr. Edward Grendys
Gynecologic Oncologist

Florida Gynecologic Oncology, 21st Century Oncology

www.21co.com . (239) 334-6626

References

1. OCRA “About Gynecological Oncologists,” Ovarian Cancer Research Alliance,2019, Washington, DC, https://ocrahope.org/patients/about-ovarian-cancer/
   symptoms-and-detection/about-gynecologic-oncologists/
2. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer
   Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017.
3. Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 2017; 317(23):2402-2416.