Eliminating the 'Silent Killer' in Gynecologic Cancers

DESPITE THE MANY ADVANCES in cancer care in recent decades, one aspect that hasn’t seen much improvement is the detection of ovarian cancer in its earliest stages. Finding the disease sooner could have a big impact on survival compared with what is experienced with later diagnoses.

However, nonspecific symptoms usually impede prompt evaluation. For instance, bloating, feeling full quickly and pelvic pain — all early signs of ovarian cancer — are also associated with maladies that are less life-threatening. These symptoms may go unreported or even lead to misdiagnosis.

Researchers are investigating new and more sophisticated tests to help screen for the disease, because many of the existing tests are not that sensitive or specific. For instance, cancer antigen 125 (CA 125), a protein in the blood that is often found at high levels in women with ovarian cancer, has been found to not be useful because common conditions other than cancer can also cause high levels of CA 125 and not every woman with ovarian cancer has a high CA 125 level. However, researchers are now studying CA 125 in a different way using careful calculations of the change over time, or the velocity, which may be more accurate and effective for early detection. Although most ovarian cancers are found in advanced stages, there still have been improvements in treatment. Avastin (bevacizumab), which is a targeted therapy, continues to shrink or slow the growth of advanced epithelial ovarian cancers. More recently, excitement has built around PARP inhibitors. These types of agents have proven to be effective in managing patients with epithelial ovarian cancer who have known mutations (germline or somatic) in the BRCA gene. PARP inhibitors are also proving valuable for some patients who don’t have BRCA gene mutations but may have other biological features that affect DNA repair (a key function of the BRCA gene).

In this special issue of CURE, we feature an article on some of these new advances in ovarian cancer treatment, including neoadjuvant therapy — chemotherapy that is used to shrink a tumor before surgery. Neoadjuvant therapy may not only be a better way to treat patients but also provides a potential research platform to study new drugs and perform tissue-based correlative trials yielding results more quickly and efficiently than standard trials. You will read the stories of two women with advanced ovarian cancer who received neoadjuvant therapy. One also opted for a newer technique referred to as heated chemotherapy, and she wishes more women were aware of this post-surgery therapy that she considers lifesaving.

Nowadays, all patients with ovarian cancer receive genetic testing, which is crucial. Research has found that mutations in BRCA1 and BRCA2 account for around 15 percent of ovarian cancers overall. It’s important that patients be made aware of the available genetic testing by their health care team and offered it, regardless of family history. Often referred to as the silent killer, ovarian cancer doesn’t have to be that. We have high hopes that, with better detection in early stages, evolving treatments and disease awareness, steady improvements will translate into saved lives.

DEBU TRIPATHY, M.D. Editor-in-Chief Professor of Medicine Chair, Department of Breast Medical Oncology The University of Texas MD Anderson Cancer Center