Ovarian Cancer Update

In an era of remarkable diagnostic and treatment advances for many diseases, physicians and researchers continue to look for breakthroughs that will help diminish the threat of ovarian cancer. While far less common than breast or cervical cancer, ovarian cancer remains a difficult disease to detect early, when treatments have the most likelihood of saving lives.

“There just aren’t any good and relatively inexpensive ways to screen women for ovarian cancer,” says Dr. David Mutch, chief of gynecologic oncology with Washington University Physicians. Unlike mammograms for breast cancer or pap tests for cervical cancer, no accurate and reasonably affordable test has been identified for mass population screening of ovarian cancer.

Recent studies on transvaginal ultrasound testing resulted in a large number of false positive results, leading to many unnecessary surgeries, and indicated no significant improvement in survival rates. Likewise, blood testing for the tumor marker CA-125 has yielded disappointing results. “There are some technological advances on the horizon for improved early detection,” Mutch says. “But that research is still in the very early stages.”

Despite this sobering news, Mutch strikes a more positive note regarding ovarian cancer prognosis. “When I was a post-doctoral fellow from 1984 to 1987, the median survival for an ovarian cancer patient was 24 months. Now, certain subsets of patients have a median survival of more than 10 years,” he says. “Of course, those extra eight years do tend to be expensive, but even women who relapse may be able to live a long time with the disease.”

When it comes to treating the disease, new drugs, such as Avastin, have been actively investigated as additions to the standard chemotherapeutic regimen,” says Dr. Ming-Shian Kao, a SLUCare gynecologic oncologist. “Early results are promising, but we need to wait for completion of these studies before adopting these agents for clinical use.” In the absence of early detection and in light of the still uncertain prognosis for many patients, Kao notes that oral contraceptives have been shown to decrease ovarian cancer risk. In fact, a January 2008 article published in the British medical journal, The Lancet, reported that the longer a woman took birth control pills, the lower her risk of ovarian cancer.

Family history also affects risk, and some women opt for genetic testing. “Approximately 15 percent of patients with ovarian cancer are known to have a genetic mutation,” Kao says. “(The relation to) two genes, BRCA 1 and BRCA 2, is well established and can be tested clinically. Other genetic factors are being studied, but none has been established for clinical use as yet.” Women who have the mutation may consider prophylactic removal of the ovaries as a protective strategy.

Perhaps the best approach for now is educating physicians and patients about the early symptoms of ovarian cancer, says Dr. Nick Chobanian, a gynecologic oncologist with Mercy Gynecologic Oncology at the David C. Pratt Cancer Center. “The difficulty is that the symptoms can mimic other things, or people ignore them because they’re so non-specific. It’s often six to nine months before a patient seeks care, and then six months more before she is referred to a specialist. By that point, the disease is usually already advanced.”

Chobanian ticks off several symptoms, including bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and urinary symptoms such as urgent or frequent feelings of needing to go. In many cases, these symptoms are not indicative of serious illness, but “if they continue and don’t get better, seek care promptly and make sure your doctor considers ovarian cancer,” he advises.