Not so long ago, a diagnosis of ovarian cancer was a virtual death sentence for all but a few lucky women. With the advent of platinum-based chemotherapy, five-year survival rates are now approaching 50 percent. According to the American Cancer Society, more than 90 percent of those diagnosed early are surviving.
However, ovarian cancer is still a diagnosis more troubling than most cancers, because all too often it comes too late. Although it accounts for only about 3 percent of cancers among women, it causes more deaths than any other cancer of the female reproductive system.
“Unfortunately, one area where we still have far to go is diagnosing ovarian cancer while it is still early-stage. One of the largest screening trials to date, examining over 70,000 women, found no benefit to intense screening in the general population,” gynecological oncologist Monjri Shah, MD of Alabama Oncology said.
In women with a family history of premenopausal breast and/or ovarian cancer, screening may be beneficial. Those women should speak with their gynecologists regarding screening, genetic testing, and risk-reducing surgery.
“Every patient is different, so it is very important to individualize treatment. Medications that may work for one patient may be less helpful in someone else. Everyone's journey is different, and I try to be very mindful of that,” Shah said.
“Over the past few years, there have been several new additions to the drugs and treatments we use for patients with ovarian cancer. The first is a new way to give a drug we've used for almost two decades. Paclitaxel is a cornerstone of ovarian cancer chemotherapy. The standard regimen uses Paclitaxel and Carboplatin every three weeks. We now have data to suggest that Paclitaxel given in a smaller dose every week may have fewer side effects, and be more effective, in certain patients.
“Two new medications we have begun to use are Bevacizumab and PARP inhibitors. Bevacizumab has been shown to extend the time without disease by about four months, and PARP inhibitors may be useful in patients with certain genetic predispositions. Both of these drugs are being actively studied,” Shah said.
Unfortunately many women who have a complete response to initial chemotherapy will eventually have a recurrence.
“What we have seen, which is encouraging, is a prolongation of ‘post-progression survival,’ meaning that even though women recur, we are able to offer them treatments that extend quality life. We also have an increasing variety of ways to manage therapy side effects,” Shah said.
In the battle against ovarian cancer, advances in recent years have done much to turn the tide toward a more optimistic future. However, many challenges are still to be conquered before the war is won.
Research is needed to improve the understanding of how the disease develops, who is at risk, and especially to find ways to detect ovarian cancer early and find targets for effective, long-term intervention.
Edward Partridge, MD of the UAB Comprehensive Cancer Center said, “There is still no effective screening for ovarian cancer. Monitoring CA125 mutations hasn’t helped to reduce mortality. In some patients, there seems to be a relationship to mutations in the BRCA 1 and BRCA 2 genes, but there is so much we don’t know. Ovarian cancer needs its own targeted treatment, but we haven’t yet identified pathways where we can intervene effectively. We’ve made progress, but we still have a long way to go.”
While waiting for those answers, clinicians on the front lines like Dr. Shah work to help one patient at a time and they often find inspiration from those in their care.
Shah was drawn to medicine after seeing her family come to terms with her grandfather’s gastric cancer. Early in her ob/gyn residency, she was inspired to become a gynecological oncologist by a young patient who had an aggressive form of cancer.
“Her grace, strength and humor in the face of her illness made me want to care for other women like her,” Shah said. “My patients motivate me. I feel privileged to be part of their journey, and my goal is to do my utmost to provide the highest level of compassionate care.”