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Progress in ovarian cancer research

Detecting ovarian cancer early is the key to surviving this disease

ovarian risks

Ovarian cancer is an aggressive disease that has a profound impact on the women who battle it and the families who support them

Approximately 1 in 70 women, or 1.4%, will be diagnosed with ovarian cancer in their lifetime. In most cases in the United States, a woman’s ovarian cancer is not diagnosed until it is in the later stages of the disease.  At that point, few women are able to live longer than five years. In contrast, women whose ovarian cancer is diagnosed at earlier stages have up to a 90% chance of long term survival. As a result, ovarian cancer research continues to focus on ways to detect ovarian cancer when it is still in the earliest stages to give women the best chance to survive.

Ovarian cancer and early detection

There are many challenges to detecting ovarian cancer early. Each year in the United States approximately 1 in 2,500 women who have completed menopause are diagnosed with ovarian cancer, but finding them is like looking for a needle in the haystack. At this point, the only way to know with certainty that a woman has ovarian cancer is to perform surgery and remove the ovaries. Once removed, they can be checked for cancer. But the ovaries perform many valuable functions in the body and removing them is invasive and introduces health risks. So, the goal is to identify only the women at the highest risk of having ovarian cancer before making a decision to remove the ovaries.

Some women have a genetic mutation that causes them to have a much higher risk of developing ovarian cancer than the average woman. Rather than a 1.4% risk of developing ovarian cancer, women who carry a BRCA1 or BRCA2 mutation have a 10%-45% risk of ovarian cancer in their lifetime. Since the risk is so much higher, and our methods for detecting ovarian cancer have not been effective at catching ovarian cancer early, it is recommended that women with BRCA mutations have their ovaries removed after age 35 or when they are done having children. It would be a huge breakthrough for these women if there was an effective way to detect ovarian cancer early without removing the ovaries.

Ovarian cancer research is focused on improving detection

One effort to identify women with ovarian cancer has been to find a chemical in the blood that would tell doctors ovarian cancer is likely to be present. There is a blood test called cancer antigen 125 (CA-125) that can do that in some cases. However, when CA-125 is elevated, it may also be because a woman has another condition like endometriosis or uterine fibroids, and NOT ovarian cancer. That is why CA-125 blood tests are not recommended for most women.

Another tool that is used to identify high risk women is a transvaginal ultrasound, or TVUS. For this procedure, an ultrasound probe is passed through the vagina into the uterus and uses sound waves to create a visual image of the ovaries. Like CA-125, if the TVUS shows something abnormal, it could be ovarian cancer, or it could be a different kind of abnormality that does not warrant removing the ovaries.

A team of doctors and researchers at the MD Anderson Cancer Center in Houston, Texas recently did a study to see if combining CA-125 testing and TVUS, while using a special computer program, would help them identify only the women with ovarian cancer out of a group of over 4,000 women who had completed menopause. The results were promising – they identified early stage cancer and demonstrated high positive predictive value. While this technology is not yet available at most hospitals, it shows that we are making strides in our ability to detect ovarian cancer early and increase the survival of women diagnosed with the disease.

Further reading:

Lu, K.H., et al., A 2-stage ovarian cancer screening strategy using the Risk of Ovarian Cancer Algorithm (ROCA) identifies early-stage incident cancers and demonstrates high positive predictive value. Cancer, 2013.

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The University of Michigan Cancer Genetics Clinic provides counseling for people with a personal or family history of cancers that may have genetic links. If a link is confirmed, our specialized physician and genetic counselors will develop a plan for additional screening or lifestyle changes to help reduce cancer risk.

 

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