Tackling the ‘Silent’ Cancer
A round of promising developments in the diagnosis and treatment of ovarian cancer may soon help dispel its description as “the silent disease.”
The cancer--not the most common among women’s cancers but certainly one of the most deadly--has been viewed with particular dread because it has often escaped early diagnosis and because treatment for advanced cases has been only partially successful.
But with advances in medical research, as well as a growing movement among consumer activists demanding more attention to the disease, the outlook for successfully treating ovarian cancer has brightened.
“Ovarian cancer is not the automatic death sentence it once was. But late diagnosis is still a problem,” said Pat Goldman, president of the Ovarian Cancer National Alliance, a consumer advocacy organization formed in 1997 in Washington, D.C.
Even that may be surmountable in the near future. An Irvine company, Atairgin Technologies, is entering a final phase of research on a blood test to detect ovarian cancer in its early stages. The test could become available next year.
Moreover, in October, the National Cancer Institute announced that grants totaling $29 million will be awarded over five years to researchers working on short-term projects designed to yield quick benefits.
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The cancer institute’s research is expected to add to current advancements in ovarian cancer treatment. In June, the Food and Drug Administration approved a new drug, Doxil, for use in patients with advanced disease. Doxil, the latest among a handful of ovarian cancer drugs that have become available within the last five years, helps extend patients’ lives.
And more than three dozen potential treatments for ovarian cancer are in various stages of clinical research, according to the Pharmaceutical Research and Manufacturers of America, a trade group. A test to reveal the disease early, however, is the most sought-after prize in ovarian cancer research.
“The identification of markers for ovarian cancer is critical,” said Dr. Gordon Mills, a researcher at MD Anderson Cancer Center in Houston and a co-founder of Atairgin.
Ovarian cancer strikes about 25,400 women each year in the United States. A stunning 15,000 of those women die annually, largely because the disease is diagnosed at an advanced stage. If diagnosed when the cancer is contained to the ovaries, there is a 90% chance of survival for at least five years. However, when the disease has spread--which is the case for about 70% of all patients--the prognosis dims considerably. In the past, only about one-third of those women survived five years or more, although drugs like Doxil have begun to favorably alter those statistics.
The risk for developing ovarian cancer increases with age; half of all tumors are found in women age 65 or older. But some women are at higher risk for the disease at any age, including those with a family history of it, women who carry the BRCA1 or BRCA2 gene mutations and women who have been diagnosed with breast cancer. Women with mutated BRCA1 and BRCA2 genes have an increased chance of developing breast or ovarian cancer.
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The strong link between breast and ovarian cancer is a new discovery that is vitally important for women under 50 who have had breast cancer. In these younger women with breast cancer, the risk for ovarian cancer is at least double compared with women in general. Younger Asian and Hispanic breast cancer patients are particularly at risk, with a respective threefold and fourfold increased risk beyond what is normal, according to Dr. Wendy Brewster, a UC Irvine doctor who has studied the association.
For women at particular risk, a highly accurate method to detect ovarian cancer early would greatly ease their fears.
“It’s a very scary thing to know that you are at high risk and there is really no good way for testing for the disease,” said Martha Volner, assistant director of the Ovarian Cancer National Alliance. “A real screening tool, akin to the Pap smear [used to detect cervical cancer], is our ultimate goal. Something that is reliable, inexpensive and can be used on a population-wide basis.”
Currently, women at high risk can undergo pelvic ultrasound imaging of the ovaries to look for tumors. These women should also see a doctor for a yearly physical exam of the ovaries, Mills said. In addition, a blood test called the CA 125 is sometimes used to look for signs of the disease, although this test produces a high rate of false positives and misses about 20% of actual cancer cases.
Atairgin’s candidate for early detection is a blood test that detects a tumor marker called lysophospholipids, or LPA. A preliminary study of the test, published in 1998 in the Journal of the American Medical Assn., showed that LPA levels were significantly elevated in women with all stages of ovarian cancer.
“LPA has an advantage over CA 125 in being able to pick up earlier disease. But LPA will require another clinical trial,” said Mills, who estimates that the trial could be completed by the end of this year.
Other markers to identify early ovarian cancer are also being examined, including the HER-2/neu marker that has already been identified as a risk factor in breast cancer mortality. Mills said he is also examining what he calls an “ovarian Pap test” in which a small sample of ovarian tissue is removed and tested for cell abnormalities and genes that raise cancer risk.
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For now, women at high risk can also take oral contraceptives, which greatly reduce the chance of ovarian cancer among even high-risk women. And all women should be aware that the “silent” disease is not as silent as first believed, Volner said.
“There is a myth out there that ovarian cancer has no symptoms,” she said. “That is the case for some women, but for many others there are a whole lot of symptoms.”
Symptoms include persistent pressure or bloating of the abdomen, persistent or progressive changes in bowel and bladder patterns, lower back pain, persistent digestive problems, ongoing excessive fatigue, abnormal bleeding and pain during intercourse.
Survivors of ovarian cancer too often say that they complained of symptoms to doctors only to be told they had gastrointestinal problems, the flu or were experiencing menopause.
“If you are feeling these symptoms,” Volner said, “it is not normal.”
