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On behalf of the National Ovarian Cancer Coalition, CURE spoke with Dr. Debra Richardson, from Stevenson Cancer Center, about the basics of ovarian cancer and its treatments, clinical trials and psychosocial effects.
Kristie L. Kahl: To start, how common is ovarian cancer?
Dr. Debra Richardson: So ovarian cancer is not actually a very common cancer. This year, the American Cancer Society estimates approximately 22,000 women will be diagnosed with ovarian cancer. And to kind of put that in perspective, it's about 10 times less common than breast cancer. That being said, it unfortunately is one of the top 10 causes of cancer deaths in women in the United States; in fact, it's the fifth leading cause of cancer death in the United States.
Kristie L. Kahl: What are some of the symptoms that are associated with the disease?
Dr. Debra Richardson: So there are several symptoms, but they can masquerade as other things. So, it's important that women are educated on this and also men that have women in their lives. So basically, all Americans, I think, should kind of know about the signs and symptoms of ovarian cancer.
What we usually say is, it should be a change in your baseline symptoms and have in most days of the week or month. And so if you find yourself feeling full easily, not able to eat a normal amount, if you're having bloating, if you're having urinary urgency, having to get to the bathroom quickly or frequency having to urinate more often, or abdominal or pelvic pain, those are things that you should discuss with your doctor and have evaluated.
Kristie L. Kahl: What does a woman need to know if she's at an increased risk for ovarian cancer?
Dr. Debra Richardson: So women might be at an increased risk of ovarian cancer if they have a family member who's had ovarian cancer or if they have a known germline genetic mutation that increases the risk of ovarian cancer, and that can include, for example, BRCA1 or BRCA2.
Unfortunately, at this time, there is no effective screening for ovarian cancer. So it's really important that women are in tune with their bodies and discuss with their physicians if they're having symptoms.
Kristie L. Kahl: How is ovarian cancer detected?
Dr. Debra Richardson: So typically, ovarian cancer is detected because a woman has a symptom or a sign of ovarian cancer and then brings that to the attention of her physician. That may be a primary care physician, that may be a GI physician, that may be an OB-GYN. And so it's really important as the physician to take a good history and physical exam on the patient. And then typically a workup if ovarian cancer was suspected might include a transvaginal ultrasound to further evaluate the fallopian tubes and ovaries, a blood test which is a tumor marker called a CA-125. We may do CT scans of the chest, abdomen and pelvis to further evaluate if ovarian cancer is suspected or has it spread. So those would be the most common tests to start with.
Kristie L. Kahl: Because there is no early diagnostic test, why is it important for women to know about the signs and symptoms?
Dr. Debra Richardson: Well, the truth is that there are women that are diagnosed in stage 1 ovary cancer, and we cure the majority of women who are diagnosed with stage 1. It's about 85%, a five-year survival, which is far better than when it's advanced stage, which is unfortunately more commonly diagnosed. So, we often diagnose with stage 3 or 4. But if we are able to diagnose a woman when she is stage 1 or 2, we can definitely improve the cure rate.
Kristie L. Kahl: Similarly, why is genetic testing so important when it comes to ovarian cancer?
Dr. Debra Richardson: So ovarian cancer is actually one of the cancers more associated with germline mutations. And so what a germline mutation means is that you inherited it from one of your parents, and it's in all of your cells in your body, and it increases your risk of cancer. And so for ovarian cancer, about 20% of all ovarian cancers are considered genetic, and therefore it's important both for the patient and her family.
We have new drugs called PARP inhibitors. They're pills and they are very effective in women who have known mutations for that increased risk of ovarian cancer; for example, the BRCA1 and BRCA2 mutations. There are other genes as well, that they can be very helpful with.
And so for one thing, it may give the patient herself more options in the treatment of her ovarian cancer, including maintenance therapy. But then also very important for what we call cascade testing. So really important if a woman has ovarian cancer, that she knows whether or not she carries one of those mutations, because if she does, then all of her family members have a 50% chance of also having that mutation and if we can diagnose somebody with that mutation prior to them developing cancer, we can help reduce the risk of them developing cancer. So for example, there are different guidelines for breast cancer screening for women who are known to carry a BRCA1/2 mutation. We can also do risk-reducing surgery. So removing the tubes and ovaries in order to reduce the risk of cancer in women who are known to be genetic carriers. And in fact, if a woman has a known BRCA mutation and wants to have a pregnancy, she can even go to an REI, a reproductive endocrinology and infertility specialist, and undergo pre-genetic preimplantation genetic diagnosis for her embryos, for example, to prevent passing that on to her children. So it's really important that we identify this early.
Kristie L. Kahl: What is your biggest piece of advice for a woman who is newly diagnosed with ovarian cancer?
Dr. Debra Richardson: So I would say number one, make sure that you see a (gynecologic) oncologist, because we are the experts in managing ovarian cancer. And the second thing I would say would be to investigate if you're eligible for clinical trial.