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A Stealthy Disease

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Ovarian cancer education is the first step in detecting this deadly disease.

 

HealthCheckSept2016Let’s start with the good news: Ovarian cancer accounts for only about 3 percent of cancers among women. But here’s where it gets challenging. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. After remission, recurrence is common, and, often, more difficult to treat.

What is ovarian cancer?
The ovaries, on either side of the uterus, produce oocytes (eggs) and female hormones (estrogen, progesterone). Ovarian cancer results when one of the three main kinds of cells in the ovaries grow out of control.

Epithelial tumors are the most common type of ovarian cancer (90 percent) and arise from the cells on the surface of the ovary.

Germ cell tumors start from cells that produce eggs.

Stromal tumors begin in the connective- and hormone-producing tissues of the ovary.

Related and similarly treated cancers include primary peritoneal carcinoma and fallopian tube cancer.

Why does ovarian cancer cause such a high rate of death?
In short, ovarian cancer has vague symptoms and no reliable screening methods. Most women diagnosed already have advanced stage disease.

It’s a stealthy and mysterious disease, says Dr. Amelia Jernigan, a Gynecologic Oncologist at University Medical Center New Orleans’ Cancer Center. “The theory is largely that most ovarian cancers start in the fallopian tubes and spread very early to the ovary or to the lining of the abdomen,” she says. “The ability to spread before it is even large enough for your surgeon to see with their eyes makes it very tricky to contain or treat.”

Not only that, she says, ovarian cancer can develop resistance to treatments. And just to really confound the situation, the many types of ovarian cancer require oncologists to respond differently to delineate appropriate treatment options and identify clinical trials when they are available.

“Given the complex and evolving treatment options, it is critical that a woman with ovarian cancer see a gynecologic oncologist soon after diagnosis,” Dr. Jernigan says. “Women who are treated by a gynecologic oncologist have better outcomes, including better long-term survival rates.”

What are the symptoms of ovarian cancer?
Ovarian cancer may cause several signs and symptoms. Women should watch for these problems to be persistent and a change from the norm:

Bloating or abdominal distention
Pelvic or abdominal pain
Nausea and/or vomiting
Indigestion or heartburn
Trouble eating or feeling full quickly
Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)
Change in bowel habits
Other symptoms like fatigue, back pain, pain during sex, menstrual changes and weight loss can also be present but are just as likely to be caused by other conditions.

What is the best way to detect early ovarian cancer?
The most important things women can do is to educate themselves and spread awareness.

Dr. Jernigan says that persistent concerning symptoms should never be ignored. “Don’t be afraid to advocate for yourself,” she says. “When you’re asking your doctor about it, mention ovarian cancer and ask if your symptoms could be related. Also be aware of your family history of cancers and make sure your doctor has all of the details, especially for breast, gynecologic and colon cancers.”

Some other risk factors might include infertility, endometriosis and early menstruation. For women with family history, it is important to discuss genetic testing with your physician.

What is the best way to prevent ovarian cancer?
Dr. Jernigan says maintaining a healthy weight is a start. Women who use birth control pills, carry pregnancy to term, breastfeed, or have their tubes tied reduce their risk. Removal of the reproductive organs often causes many side effects and is usually only advised for high-risk patients.

Is there hope on the horizon?
Innovations are advancing many fields of cancer treatment. Dr. Jernigan is a huge proponent of clinical trials and says there’s a lot of buzz around “targeted therapies” for ovarian cancer, especially:
PARP-inhibitors, which block DNA repair, taking advantage of the fact that many ovarian cancers already have broken DNA repair machinery. They are now FDA approved in certain situations and are included in many clinical trials.

Immune checkpoint inhibitors, which essentially turn off the switch that tells our immune cells to leave the tumor alone. This allows our own body to mount an immune response that holds the tumor at bay or shrinks it.

Parasitic protein in a recent Dartmouth College study were shown to cause the immune system in mice to attack established ovarian tumors.

Other innovations include hormonal therapy in place of chemotherapy, and blood tests to match tumor DNA and to identify a recurrent tumor’s presence well before scans can verify it.

“Quality outcome initiatives, new technologies and enhanced recovery pathways improve surgical techniques and outcomes for ovarian cancer,” Dr. Jernigan says. “This is allowing us to safely push the envelope in regard to what we can accomplish surgically to manage this disease.”

 

Dr. Amelia Jernigan is a Gynecologic Oncologist who joined the University Medical Center New Orleans’ Cancer Center in September and will serve as Assistant Professor of Clinical Obstetrics and Gynecology for LSU Health New Orleans in the Gynecology Oncology Department. Dr. Jernigan completed her residency at Johns Hopkins University and her fellowship in Gynecologic Oncology at the Cleveland Clinic.