By Sandra Ray, Staff Writer
The American Cancer Society reports that ovarian
cancer is the eighth most common cancer among women today. About 3%
of all cancers in women are some type of ovarian cancer.
Unfortunately, ovarian cancer ranks among fifth in cancer deaths,
primarily due to the fact that it is hard to detect until it has
advanced beyond the ovaries into other areas of the body. Estimates
are that 1 in every 57 women will develop ovarian cancer in the
United States.
In the female reproductive system, the ovaries
house the eggs needed for reproduction. There are two ovaries, one
on each side of the uterus where fertilized eggs are implanted
during pregnancy. Another reason for the ovaries importance: they
are the main source of female hormones estrogen and progesterone.
There are three different types of tissues in
the ovaries, each able to produce a different type of ovarian
cancer. By far, the most prevalent type of cancer is found in the
epithelial tissue of the ovaries. Epithelial tissue lines the
outside of the ovaries and is found in about 85 – 90% of all ovarian
cancer cases. It can grow undetected and spread rather quickly to
the abdomen and into other parts of the body.Germ cells actually
produce the eggs that are formed inside the ovaries. Germ cell
tumors accounts for about 5% of ovarian cancer cases today. Stromal
cells produce the estrogen and progesterone and account for the
remaining 5 – 10% of cancer-causing tumors.
Survival rates for ovarian cancer vary widely
largely depending on the stage of the cancer at the time of
diagnosis. Stage 1 and 2 cancers have much better survival rates
than do stage 3 and 4. The American Cancer Society notes that about
76% of women survive one year after diagnosis and the survival rate
drops to 45% at five years. If doctors can diagnose and treat the
cancer while it is still in the ovaries, the overall survival rate
climbs to 94%, yet fewer than 20% of ovarian cancers are diagnosed
at this early stage.
Risk Factors and
Testing:
Despite the facts and figures, it is hard to
detect ovarian cancer since most of the time it starts without
detectable symptoms. Women who have a family history of breast
cancer or ovarian cancer should discuss it with their physician so
that early testing can be done before ovarian cancer has a chance to
grow undetected. Generally the cancer strikes women over the age of
50, with women 65 and older most at risk. It has been found in
younger women, however. Women who are overweight or who have used
fertility drugs also have an increased risk of developing the
cancer. Hormone replacement therapy (HRT) has also been shown to
increase the risk for developing ovarian cancer.
Testing for the cancer isn’t that easy either.
While regular pap tests can help screen for certain types of cancer,
it isn’t a reliable indicator of ovarian cancer. Usually by the time
a doctor can detect ovarian cancer with a pap smear, the cancer is
already in advanced stages. Regular health exams, however, can help
physicians determine if there are changes in the size of the ovaries
or uterus. Tumors in the ovaries that are still in the early stages
may not be detected early, though.
Women with several risk factors or a personal
history of breast cancer could be screened with a vaginal ultrasound
and possibly blood tests that screen for “tumor markers.” Tumor
markers can include testing for increased amounts of CA-125 or a
protein in the blood that is generally higher in women who have
ovarian cancer. There are still many clinical trials to develop
further lines of research along blood tests so that quicker methods
of detection can be brought to light.
Treatment:
Surgery is usually one of the first lines of
defense when fighting ovarian cancer. Surgical options depend
heavily on how far the cancer has spread and the type of ovarian
cancer that is present. Some of these options can include removal of
one or both ovaries, a total hysterectomy – which includes removal
of the uterus as well as the ovaries – or cutting away the tumors in
the tissues, leaving as much of the reproductive system intact as
possible.
One thing to remember is that once a surgeon
starts to remove tissue, he needs to have approval to remove as much
as he feels necessary in order to prevent the cancer cells from
spreading. Cancer that is not removed can quickly spread as a result
of the surgery. Discuss how much surgery needs to be performed,
especially if the woman is still old enough and wants to continue
bearing children after treating the cancer. Bear in mind that once
the procedure starts the surgeon may need to do more tissue removal
than first anticipated and discuss the possibility that the surgery
will be more extensive than first anticipated.
Depending on the stage of the cancer and the
success of the surgery, chemotherapy and radiation treatment may or
may not be necessary. Chemotherapy uses high-powered medications to
destroy cancer-causing cells in the body. Unfortunately,
chemotherapy does not discriminate between cancer cells and
non-cancer cells, so normal cells are often killed during treatment
as well. There are a number of side effects of chemotherapy that
include nausea, vomiting, anemia (low red blood cell count), hair
loss, and decreased white blood cell and platelet counts.
Medications are available to combat these side effects, with the
exception of hair loss. Generally hair will begin to grow back after
chemotherapy is completed.
Chemotherapy is used in the event that doctors
were not able to determine if all cancer was removed during surgery.
The higher the staging of the cancer, the more likely it is that
chemotherapy will be needed. Some tumors, for example, may not be
removed completely by surgery and chemotherapy, in conjunction with
radiation therapy, can shrink the tumors.
Most, but not all chemotherapy treatments are
given intravenously, either through an IV that is inserted at each
treatment or through an IV port that stays in the vein and accessed
each time a treatment is needed. The port can be removed when
chemotherapy is completed. Some chemotherapy treatments are given
orally, while others may be given directly into the abdominal cavity
or into a muscle (intramuscular). The type of chemotherapy used
depends on the type of ovarian cancer being treated. In addition,
the number of doses and the frequency also depend on the stage;
these factors also take into consideration how quickly a patient can
recover from a dose of chemotherapy treatment. Some patients can
endure chemotherapy once every three weeks, while others may need
slightly longer to recover. Normal cells need the chance to “bounce
back” while not allowing cancer cells the same opportunity to
recover. The doctor will discuss each of these factors when
prescribing a treatment plan for chemotherapy.
Radiation therapy is generally only helpful in
treatment if the cancer is still confined to a relatively small
area, like the ovaries. Once the cancer begins to spread to other
organs, radiation therapy loses its effectiveness since it cannot be
sufficiently targeted to help kill the cancer cells.
Role of Clinical Trials
in Follow-up Care:
Because of the relatively small window for
effective detection and treatment of ovarian cancer, doctors
regularly recommend that women enroll in a clinical trial for
follow-up care. Women can help advance the science of treating
ovarian cancer at any stage of the disease. Even when the disease
advances into the third and fourth stages where traditional
treatment methods fail, it is still possible to learn from women in
these categories so that further clinical advancements can be made.
Dr. Don Dizon, FACP, Assistance Professor, OB/GYN
& Medicine at Brown Medical School notes, “Many of the advances in
the treatment of ovarian cancer would not be possible if not for the
women who participate in clinical trials. Whether they joined the
trials before cancer was detected and taught physicians what to
search for or after their cancer was in the treatment stages,
doctors could still learn a great deal from them.”
Dizon leads several clinical trials, each in
different areas since there are many fruitful avenues for medical
exploration in ovarian cancer. Some of these areas include
immunotherapy or ways to use the immune system to combat and treat
ovarian cancer; quality of life studies for women who are completing
treatment; and novel therapeutics for early detection of ovarian
cancer. Dizon says, “When ovarian cancer reaches the abdomen,
something about the environment there allows it to spread quickly to
other parts of the body. Research studies are looking at the
effectiveness of applying chemotherapy directly to the abdomen as a
method of treatment.” These are only some of the reasons that Dizon
recommends that even healthy women get involved in clinical trials.
As far as prevention and early treatment, Dizon
notes that there are several trials out there aimed at blood
profiling that will hopefully give doctors useful tools for finding
ovarian cancer at even earlier stages. Dizon also notes with irony
that one of the best methods for preventing ovarian cancer could put
women at increased risk for developing breast cancer later. “Without
removing the ovaries – one of the only ways known to almost fully
prevent ovarian cancer – birth control pills remain one of the best
ways to reduce a woman’s risk of developing ovarian cancer. Still,
women must weigh the increased risk of breast cancer if they choose
this mechanism of prevention.”
Ovarian cancer can and does recur. For this
reason, five year survival rates are lower than researchers like
when managing a deadly disease. The cancer may not all be removed
during the first treatment and could have spread undetected to other
areas of the body. Another reason many doctors advocate
participation in clinical trials is the possibility of recurrence.
Women and caregivers need to be prepared for this possibility when
first beginning to look at treatment options and follow-up care.
Caregiver Role:
Caregivers play an important role in the
treatment of ovarian cancer. While it may be difficult to discuss,
it is important to maintain open lines of communication with family,
friends, and others who may be supportive during this time. In
addition, caregivers can help relay information to physicians that
may seem insignificant to the patient, yet could give important
details about what is happening at home as a result of treatment.
Caregivers can help fill the following roles in
the treatment “team:”
-
Someone to drive the patient to and from
doctor appointments or treatment (chemotherapy and/or radiation)
-
An extra helping hand in the kitchen to prepare and/or freeze meals
for the family
-
A listening ear when the patient needs time to “vent” about
the struggles of the cancer and its treatment
-
Filling in at school functions for children when the
patient is not feeling well enough to attend
These are only a few of the many activities with
which caregivers can help during the treatment of ovarian cancer.
Perhaps the most important role is one of advocate both at home and
in the physician’s office. Advocacy can be a tiring activity and one
that patients may not have the strength to perform while they are
being treated.
While the outlook for women who
develop ovarian cancer is not always discouraging, it is an area
that deserves increased attention in the research field today. Since
the cancer can grow silently for far too long before it is detected,
women need to be vigilant about comprehensive annual exams and
reporting even small changes in their health to their family
physician. Caregivers can play a role in this process as well by
helping place symptoms in perspective and giving new importance to
even the smallest of changes in a woman’s health. Learning more
about ovarian cancer and being unafraid to objectively balance the
information can aid doctors when trying to determine if the symptoms
represent normal functions of the body or if it could be a more
serious sign.
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