Ovarian cancer is the most common cause of gynecologic cancer death in the United States. The average woman with no known genetic mutations has a 1-in-70 chance of developing ovarian cancer in her lifetime. However, that risk can jump to as high as 40% with some familial genetic mutations such as BRCA.
Unfortunately, one of the most common things I hear from my patients with cancer is, “I thought after I had my last baby, went through menopause or had a hysterectomy, I didn’t need to see a gynecologist anymore.” This is concerning because the pelvic exam and review of daily symptoms is the single best detection we have for ovarian masses and malignancy of the gynecologic tract in general.
Ovarian cancers are most commonly found in later stages because some of the early symptoms are often brushed off as normal variations in gastrointestinal function, such as bloating, reflux, abdominal or pelvic pain, and changes in appetite. Furthermore, until ovarian cancer spreads or impinges on the function of other organs, many women are asymptomatic and unaware anything is amiss.
Once ovarian cancer is diagnosed, the patient is assessed for complete surgical resectability. Early-stage cancer can often be treated surgically first, with or without the need for chemotherapy afterward, based on the final stage and grade. Higher-stage cancers, stage 3 and 4, can be assessed with imaging, such as a CT scan, or a diagnostic laparoscopy to evaluate whether all visible disease can be removed at the time of upfront surgery.
We know from several studies that if we cannot remove all visible disease during surgery, patient outcomes are poorer with shorter overall survival. Therefore, if the cancer is not deemed to be resectable upfront, we then recommend neoadjuvant chemotherapy first, to shrink the disease to a more surgically manageable extent, followed by surgery — called interval debulking — and then more chemotherapy. These patients have been shown to have comparable overall survival rates compared to their upfront surgery counterparts.
Furthermore, carefully selected patients receiving neoadjuvant chemotherapy can be considered for HIPEC, or hyperthermic (heated) intraperitoneal chemotherapy, at the time of their interval debulking surgery. In well-selected, completely resected patients undergoing interval debulking, HIPEC has been shown to add up to 12 months of overall survival benefit.
Finally, we are entering an exciting time in the field of gynecologic cancer treatments, specifically in ovarian cancer. For the last 20 or 30 years, our treatments relied on the same chemotherapies. But recently, however, we have seen hopeful advances in the science of treatment with immunotherapies and other targeted therapies that add real survival benefit for our patients. We are now better able to treat cancer, achieve remission and maintain a disease-free interval than ever before.
There are more promising treatments on the horizon, including cancer vaccines in clinical trials for many different cancer types. Hopefully, these changes will bring meaningful improvements in the historical survival statistics that we share with our patients. As in all things, time will tell.
Learn more about ovarian cancer treatment at Northside Hospital.
