Ovarian cancer diagnosis and treatment: What’s new

Because its symptoms are often vague, ovarian cancer can be hard to diagnose. And a
definitive diagnosis requires a biopsy, which is best done at the time
of surgery. But MD Anderson’s Ovarian Cancer Moon Shot™ is focused on finding
new ways to detect the disease earlier, when it’s easier to treat.

We spoke with Anil Sood, M.D., co-leader of the Ovarian Cancer
Moon Shot, to learn about the latest advances in ovarian cancer
diagnosis and treatment. Here’s what he shared.

Who’s at risk for ovarian cancer?                                                 

Trends suggest that women around age 59, who’ve never been pregnant
and who have an inflammatory disorder like endometriosis are more
likely to develop ovarian cancer. It was once thought that using
talc-based products, like baby powder, increased the risk, but studies
haven’t shown a direct cause-and-effect relationship.

Also, women with a mutation in the BRCA1 or BRCA2 genes are at
higher risk. For these women, ovarian cancer is hereditary, so it’s
important to undergo genetic testing if your mom, grandmother or aunts
have been diagnosed with ovarian or breast cancer before age 40. Women
of Ashkenazi Jewish ancestry (Jewish people who originated from
Central or Eastern Europe) are more likely to have a BRCA gene
mutation, too.

Is there anything that lowers a woman’s risk for ovarian cancer?

We’re studying ovarian cancer prevention more, but we’ve seen that
having a pregnancy, taking the birth control pill and undergoing a
tubal ligation (commonly referred to as having your tubes tied) all
lower the risk. Patients should talk with their doctor if they’re
concerned about their risk.

What are common symptoms of ovarian cancer?

Among the most common ovarian cancer symptoms is bloating — so,
clothes not fitting right. But patients can also experience pelvic
pain or pressure, as well as nausea. These symptoms are also common in
other conditions that aren’t cancer, but the key distinction is that
ovarian cancer symptoms continue to persist for a month or longer.

If you’re feeling continued discomfort in the pelvic area, seek out
a gynecologic oncologist. Discussing your symptoms with an expert will
ensure you get the most appropriate tests to figure out what’s going
on. Those tests can include a pelvic exam, an ultrasound and blood tests.

How is ovarian cancer diagnosed?

Ovarian cancer is diagnosed with a tissue sample that’s taken at the
same time the tumor is removed surgically, either laparoscopically or
with an incision. The type of surgery depends on the size of the mass
and if it has spread.

Not all tumors are cancerous though. In some cases, when the patient
is in her reproductive years and has a mass that doesn’t show the
signs of cancer — so, no solid areas or blood flow — we may simply
monitor it. It’s not uncommon for ovarian cysts to be benign and go
away naturally. When the cysts begin to grow and/or develop connecting
or solid areas, that’s when we become more concerned.

Is there a test that can diagnose ovarian cancer early?

There isn’t an ovarian cancer screening test now, but MD Anderson is trying to change that. There
has been encouraging data with protein-based tests, such as CA-125, but results weren’t strong enough to roll
this out to the larger patient community. So we’re exploring other
approaches, such as auto-antibodies, exosomes and nucleic acids within
the blood, and even new ways of doing imaging to find small
abnormalities sooner.

What promising new ovarian cancer treatments are on the
horizon at MD Anderson?

Among the more exciting areas we’re studying through clinical trials are drugs that target the blood
supply to the cancer and pathways that are frequently altered in
ovarian cancer. We’re also building on the success of PARP inhibitors
by combining them with other drugs. We’re going after
nanoparticle-based strategies as well. Unfortunately, we haven’t found
that immunotherapy treatments work as well for ovarian cancer, but
that doesn’t mean we give up. We’re working to improve the
effectiveness of these therapies.

How has the Ovarian Cancer Moon Shot advanced treatment?

One of the Ovarian Cancer Moon Shot’s successes has been in
personalizing surgery to ensure patients receive the best treatment
for their specific case. Historically, every patient would undergo
surgery with a large incision, but we now examine a patient
laparoscopically first. Then, based on the findings of the size and
spread of the cancer, we’ll proceed with the full surgery if we think
we can remove all of the disease in one procedure. If the cancer is
more advanced, we start with chemotherapy before doing the full surgery in the
hopes that the tumors have shrunk. With our new approach, we’re able
to remove all visible disease in patients who receive the full surgery
upfront about 88% of the time. In patients who receive chemotherapy,
we’re able to remove all visible disease in around 75% of the time.

What’s your advice for newly diagnosed ovarian cancer patients?

It’s important to see an experienced gynecologist oncologist, rather
than your regular gynecologist. Getting the right treatment up front
increases your chances of success in managing ovarian cancer. And, if
you need chemotherapy, it’s important the right drugs be given for the
subtype of ovarian cancer you have. Lastly, since ovarian cancer is
often genetic, I always recommend undergoing genetic counseling and testing after a
diagnosis. This can provide powerful knowledge that can help protect
you from other cancers and protect your family members as well.

Request an appointment at MD Anderson online or by
calling 1-877-632-6789