Ovarian Cancer Treatment Update

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Ovarian cancer is the fifth most common malignancy in postmenopausal women in the U.S. and the fourth most common cause of cancer-related death. Like so many cancers, it's highly treatable when caught early; however, few symptoms make it difficult to detect until it becomes advanced.

Over time, the standard of care for ovarian cancer treatment has changed. In the late 1970s, women generally received a single chemotherapy drug (cisplatin), which had a low response rate. The next generation of treatment combined chemotherapy drugs, improving the response rate somewhat. The results of clinical trials help oncologists determine the best combinations of drugs and the best time in treatment to administer them.

In the 1990s, patients with advanced ovarian cancer received chemotherapy intravenously. This circulates powerful chemicals throughout the body and damages healthy cells right along with cancer cells. Oncologists have also learned to administer chemotherapy intraperitoneally. By directing chemotherapy into the abdomen and pelvis via catheters, they can deliver a large concentration of chemotherapy closer to the precise location of the tumor. This procedure is controversial among physicians due to the side effects and difficulty of administering it.

Today, the standard of care is usually surgery along with a combination of chemotherapy drugs. During surgery, surgeons may remove the ovaries, fallopian tubes, uterus, nearby lymph nodes, and the thin padding of tissue that covers this area. Surgical removal of the female reproductive organs may produce menopausal symptoms due to the loss of female hormones, so women may need to take hormone replacement therapy.

Scientists continue to develop and evaluate new chemotherapy drugs and combinations of drugs. They're also exploring alternative treatment options, such as targeted agents and enzyme therapy (used alone or with chemotherapy). Treating ovarian cancer involves a complex decision making process as physicians must determine the best sequence of treatment for this difficult form of cancer.

While the survival rate from relapsed ovarian cancer is improving, the overall long-term survival of ovarian cancer patients is still poor and patients are at high risk of recurrence. Furthermore, the accompanying side effects from treatment take a toll on women's' quality of life.

Some physicians are screening women at high risk for ovarian cancer. They test the blood level of the protein CA-125 (cancer antigen-125), which is elevated in patients with ovarian cancer. The rate of screening is increasing, along with risk-reducing surgical procedures (removing organs before signs of cancer). However, to date, the data does not show a survival benefit from early treatment based on elevated CA-125.

(See our blog, Four Seeds, written by ovarian cancer survivor Jennifer Wilson Cooper.)

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