Treatment of Ovarian Cancer
with Paul Celano, MD
Ovarian cancer affects 25,000 women in the United States every year, resulting in approximately 15-16,000 deaths per year. Preventive testing and new approaches to treatment over the last five to ten years have helped increase the average lifespan of a woman diagnosed with ovarian cancer from less than a year to three or four years.
Paul Celano, MD, division head of oncology at GBMC, says, “Progress continues to be made in the detection and treatment of ovarian cancer. This is encouraging because ovarian cancer has been very difficult to treat due to a number of factors, not the least of which has been lack of effective early detection.”
Traditional screening methods for not-at-risk patients in the general population, such as pap smears, physical examinations, ultra-sound tests, and blood tests, like the CA-125, have not been very effective in detecting cancerous cells in the ovaries. The pap smear is not an effective test for ovarian cancer since the area examined, the cervix, lies well below the ovary region. Recently, detection has focused on identifying high-risk patients and then screening them with traditional methods to see if it’s possible to detect ovarian cancer at an earlier stage.
Women at high risk for ovarian cancer include those who have first-degree relatives, such as mothers, daughters, or sisters, who have had breast or ovarian cancer, particularly if the cancer developed at an early age. For instance, if your mother developed ovarian cancer at the age of 80, this is not as much of a risk factor for cancer as if she had developed it at the age of 40. Dr. Celano points out that if a family has been shown to have the BRCA1 or BRCA2 genes (based on a DNA analysis), which are the genes associated with breast and ovarian cancer, these family members are at a very high risk and should be screened for both breast and ovarian cancer.
Dr. Celano says, “The unfortunate aspect of ovarian cancer is that symptoms tend to surface during the disease’s later stages.” These symptoms often include abdominal bloating, loss of appetite, cramping, constipation, and occasionally a mass or swelling from fluid in the abdomen. Complicating diagnosis, ovarian cancer symptoms are often mistaken for symptoms of other ailments such as irritable bowel syndrome (IBS).
Many high-risk patients are tested with the screening method known as CA-125, which acts as both a blood test and an abdominal ultrasound test. During this test, high-frequency sound waves are used to produce images of the ovaries. When used as a blood test, CA-125 enables researchers to monitor microscopic cancer cells, after a patient has had surgery, to determine if the cancer cells are growing back. Researchers are also using the CA-125 test as a sophisticated way to detect cancer in its earlier stages by performing a test of a protein in the blood to see if it correlates, matches, or fits with proteins in cancer cells. Dr. Celano adds that while the CA-125 test is FDA-approved and is the best test currently available for monitoring high-risk patients, it is not as effective with the general population because it is not sensitive enough to detect cancer in its very earliest stages.
After a patient has been diagnosed with ovarian cancer, treatment usually starts with a “de-bulking” surgery, where the surgeon reduces the amount of cancer as much as possible to make it more treatable by follow-up chemotherapy. In certain situations where the cancer is initially unreachable by surgery, chemotherapy is performed first and then followed by surgery.
Even though a patient may often undergo a full hysterectomy. including removal of the ovaries, there is still a possibility that the cancer will occur again. While surgeons try to remove as much of the cancerous tissue as possible, Dr. Celano warns that removal of all surrounding tissue can present serious problems. He emphasizes that it is important that the surgery be performed by an extremely experienced gynecological oncologist. The proper ‘de-bulking’ procedure needs to be performed without overdoing it; otherwise there may be complications of surgery that will make it more difficult to deal with the actual cancer.
Dr. Celano adds that a common challenge for the surgeon occurs when ovarian cancer leaks out into the abdominal cavity and spreads around in the abdominal area. Surgery will often reveal that there is not just one lump but several cancerous lesions spread throughout the area, making removal of all cancerous tissue extremely difficult.
Chemotherapy, a common treatment for ovarian cancer, is generally given to patients intravenously. In some cases, chemotherapy will be delivered directly to the abdominal cavity, but this application will often cause irritation to the abdomen with patients suffering greater side effects than if it is given intravenously. Side effects generally include vomiting, nausea, changes in the blood count, and neuropathy or numbness in the fingers or toes.
Dr. Celano points out that there is ongoing clinical research to find other forms of treatment that are less toxic than current treatments. For example, targeted therapy, one subject of ongoing research, involves directing drugs at specific targets on cancer cells. The goal is to see if there is a better way to treat the cancer without causing major side effects. These drugs prevent blood vessel growth, resulting in slowing or eliminating cancer cell growth. With these drugs, cancer is not poisoned directly, which can result in toxic side effects (such as with chemotherapy). Instead, cancer cells are poisoned indirectly, resulting in fewer side effects and hopefully improving the quality of life for cancer patients.
Another area being actively pursued through research is called “epidermal growth factor receptors.” These are proteins that are sitting on top of cancer cells and helping them grow. Drugs that reverse the effects of these receptors are being tested and may offer new effective treatments at some point.
Dr. Celano adds that medical research is always looking for better and less toxic forms of treatment. He says, “We hope to someday have less toxic drugs that patients can tolerate for long periods of time that will keep cancer from growing back.”
Meanwhile, Dr. Celano emphasizes, “Treatment for all forms of cancer, including ovarian caner, continues to improve. Patients can help themselves the most by having regular check-ups and seeking medical attention when any symptoms appear.”
