Stopping Ovarian Cancer
Tracy Walker/i2iart.com Four years ago, Angie DeWilfond of moline, Illinois, was diagnosed with advanced ovarian cancer. "I was distraught," says the 41-year-old. "I couldnt bear the thought of not being around to raise my kids." She underwent surgery and chemo twice; both times, the cancer came back. Then in November 2010 she enrolled in a clinical trial of a new class of drugs called PARP inhibitors. Amazingly, blood tests now show that her tumor markers have dropped to the normal range.
"If the drug continues to work, I could survive on it for a very long time," DeWilfond marvels.
And thats a major deal. No one wants cancer, but the ovarian kind in particular can seem like the worst-case scenario. In fact, its the most fatal gynecologic cancer. Thats because its symptoms are subtle, so it usually isnt caught until it has spread to the surrounding tissue, making it more difficult to treat. Just 20% of women with ovarian cancer are cured—meaning the illness never comes back—after undergoing surgery and chemo.
But lately theres been reassuring news: Death rates from the disease have been decreasing (1.7% per year since 2002, according to new data). And thanks to the latest breakthroughs, even women with more advanced cancer are living longer than ever.
"Short of finding a cure, thats our goal: to turn ovarian cancer into a manageable illness. Were on our way," says Linda Duska, MD, associate professor of gynecologic oncology at the University of Virginia. Heres why:
Fewer women are getting the disease
The rate of new cases of ovarian cancer has declined by 1% each year since 1992 (about 22,000 women will be diagnosed this year)—possibly because so many women today are on the Pill, says Deborah Armstrong, MD, associate professor of oncology and OB-GYN at Johns Hopkins Kimmel Cancer Center in Baltimore.
Another reason to praise the Pill: This form of birth control lowers your risk of ovarian cancer by reducing the number of times you ovulate.
—Health magazine, September 2011
The Pill prevents ovulation; the fewer times a woman ovulates over a lifetime, the lower her risk of ovarian cancer.
Surgeons are operating smarter
In the past, if you were diagnosed with ovarian cancer, youd typically have just your ovaries, fallopian tubes, and uterus removed, even if the cancer had spread—doctors feared that the risks of cutting into additional organs outweighed the benefits. But surgeons today are getting more aggressive, seeking to remove all evidence of cancer from the get-go, says Barbara Goff, MD, director of gynecologic oncology at the University of Washington. "Removing every last bit can make a difference in survival rates," says Dr. Goff, "and maybe even cure rates."
- Next Page: Should you be screened for ovarian cancer? [ pagebreak ]
- Chemo is getting better
- Between 70 and 90% of ovarian cancer patients have a recurrence. "Ten years ago, we would typically re-treat them with the drug wed already used," says Carol Aghajanian, MD, a medical oncologist and head of the ovarian cancer chemotherapy research program at the Memorial Sloan-Kettering Cancer Center. "Most women succumbed to the illness within 18 to 22 months. Now there are lots of treatment options, and though they dont cure the illness, the disease is better controlled, sometimes for 10 years or more."
Weve also uncovered better ways to deliver treatments. Now doctors inject the chemo drugs into the abdominal cavity—not just the bloodstream—so a much higher concentration gets to the tumor. This can lengthen survival time by up to 16 months, and every month counts with such a deadly disease.
Meds are more targeted
Avastin, for instance, is a so-called angiogenesis inhibitor, which blocks the formation of blood vessels that feed tumors. In research released in June, Dr. Aghajanian and her colleagues found that adding it to a chemo regimen lengthened survival time in women with a recurrence of the disease to a year—four months longer than with chemo alone. PARP inhibitors—like the drug DeWilfond takes—interfere with cancer cells ability to repair their own DNA. Researchers reported in May that one such drug kept ovarian cancer at bay nearly twice as long as a placebo.
For now, all women can benefit from being proactive: Watch for symptoms, and get your regular pelvic exam, during which your doctor checks for signs of growth. Says Dr. Duska: "If we can catch the cancer at an early stage, we have a better chance of curing it."
Should you be screened for ovarian cancer?
Probably not. Although catching it early is the best way to beat it—the later the stage at diagnosis, the higher the chance of recurrence—doctors say it doesnt make sense for most healthy women to be routinely screened. The reason: Our current tools (physical exams paired with transvaginal ultrasound and a blood test to check for the presence of CA125, a tumor marker) result in a high rate of false positives, which can lead to emotional distress and possibly unnecessary surgery.
But there are exceptions to the no-screening rule: If you have a strong family or personal history of breast cancer or ovarian cancer, talk to your doctor about getting tested. She might also advise you to consult a genetic counselor about getting checked for the BRCA1 or BRCA2 genetic mutations or a genetic condition called Lynch syndrome, which put you at significantly increased risk of ovarian cancer.
Meanwhile, scientists are hard at work trying to develop a more reliable test for ovarian cancer. Some researchers are examining the idea of scanning the fallopian tubes for signs of cancer, based on the emerging theory that ovarian cancer may actually originate there. Other researchers are focusing on developing more accurate blood tests. "Wed love to have a way to identify this disease at an earlier stage," says Dr. Aghajanian. "Im hopeful it will happen at some point."
No matter what your risk factors, see your doctor if any of the following symptoms have cropped up and persisted for more than two or three weeks:
• pelvic, back, or abdominal pain
• urinary urgency or frequency
• feeling full more quickly than usual