Advances in Treatment for Pregnant Women at Higher Risk for Ovarian and Breast Cancer
- A procedure designed for pregnant women who carry the BRCA1 and BRCA2 gene, which elevates the risk of ovarian and breast cancer, shows promise to safely give birth and reduce cancer risk in one procedure instead of two.
- The procedure is called risk-reducing bilateral salpingo-oophorectomy (RRSO). Four women – so far- have undergone the procedure that’s considered the only proven way to reduce ovarian cancer mortality, according to research published in Obstetrics and Gynecology.
- During the routine ovarian cancer surgery process, after the doctor has determined how far the cancer has spread, a hysterectomy (removal of the uterus), a bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries), and an omentectomy (removal of the omentum) are performed. This procedure impacts fertility. However, fertility preservation options exist.
- While about 1.3 percent of women in the general population will develop ovarian cancer sometime during their lives, it is estimated that about 44 percent of women who inherit a harmful BRCA1 mutation and about 17 percent of women who inherit a harmful BRCA2 mutation will develop ovarian cancer,” Dr. Rebecca Arend, Associate Scientist at the University of Alabama, Birmingham explains to SurvivorNet.
- Women with ovarian cancer are encouraged to get genetic testing, as it can help with treatment decisions.
Ppregnant women at high risk of getting breast and ovarian cancer can see their cancer risks significantly reduced with a cesarean section procedure that allows new moms to give birth while also removing their ovaries and fallopian tubes simultaneously.
The procedure is of particular consideration for women who carry the BRCA1 and BRCA2 genes, which enhances the risk of breast and ovarian cancers. The procedure is called risk-reducing bilateral salpingo-oophorectomy (RRSO). Four women – so far- have undergone the procedure that’s considered the only proven way to reduce ovarian cancer mortality, according to research published in Obstetrics and Gynecology.
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The women who underwent the procedure were older than “35 or 40” and carried the BRCA1 or BRCA2 gene.
WATCH: Managing BRCA Risk.
According to the report, “No patient required a transfusion, had internal organ damage, returned to the operating room, or was readmitted. One of two women with intact breast tissue successfully breastfed, and the other chose to bottle feed.”
All of the women involved were reportedly satisfied with the procedure.
The main goal of the procedure is to avoid pregnant women at higher risk of breast and ovarian cancer to undergo two separate procedures, which helps reduce “patient morbidity and healthcare costs.”
Dr. Rosenthal noted since more women are having children later in life, this procedure offers added benefits.
“The older you are, the more appropriate it is to have your ovaries removed because your risk of ovarian cancer, if you’ve got one of these genes, increases with age…There’s also an increasing rate of cesarean section. So, we anticipate that, over time, more women will be eligible for this kind of procedure,” Dr. Rosenthal said.
RELATED: What to do if you are at higher risk of getting cancer.
Helping Patients Better Understand BRCA Gene Mutations
Helping Patients Better Understand BRCA Gene Mutations
Understanding Gene Mutations
The most common breast cancer gene mutation and the one doctors have known about the longest, is the BRCA gene mutation. The BRCA1 (Breast Cancer 1) or BRCA2 (Breast Cancer 2) genes help cells repair DNA damage. Having a change, or mutation, in one of these genes increases a woman’s risk of getting breast cancer. These gene mutations are commonly passed down in families; if a parent carries a BRCA gene mutation, there’s a 50-50 chance you could be carrying it as well.
Between 5% and 10% of breast cancer cases are thought to be hereditary. And about 10% of patients who undergo genetic testing will test positive for the BRCA1 or BRCA2 gene, Dr. Julie Rani Nangia, an assistant professor at Baylor College of Medicine, tells SurvivorNet.
RELATED: Genetic testing for breast cancer.
“The genetic BRCA1 and (BRCA)2 mutations, if a woman has one of these mutations … it puts her at basically the highest quantifiable risk for getting breast cancer,” Dr. Elisa Port, a surgical oncologist at Mount Sinai, told SurvivorNet.
“We typically say between the 60 and 80 percent range. Having a BRCA1 and BRCA2 mutation also means that that person is at higher risk of getting breast cancer at an earlier age and also maybe at risk for other cancers like ovarian cancer, pancreatic cancer for men, prostate cancer, and male breast cancer may be a concern.”
RELATED: Why all women with ovarian cancer should get genetic testing.
“While about 1.3 percent of women in the general population will develop ovarian cancer sometime during their lives, it is estimated that about 44 percent of women who inherit a harmful BRCA1 mutation, and about 17 percent of women who inherit a harmful BRCA2 mutation, will develop ovarian cancer,” Dr. Rebecca Arend, Associate Scientist at the University of Alabama, Birmingham explains to SurvivorNet.
Genetic Testing to Help You Assess Your Cancer Risk
Studies show that between 10 and 15 percent of high-grade epithelial ovarian cancers–the most common type of ovarian cancer–have an inherited component. That’s one reason the Society of Gynecologic Oncology recommends that ovarian cancer patients and, in some cases, their immediate family members undergo genetic testing.
WATCH: Genetic testing for Ovarian Cancer.
Germline testing, genetic testing for inherited mutations, can uncover whether a patient has inherited a BRCA1 or BRCA2 gene mutation. Finding inherited genetic risk can also provide critical information for family members who can go for genetic counseling to see if prophylactic surgery or frequent screening is recommended. Knowing about germline testing can also help couples make decisions about family building.
“If family members test positive for the BRCA mutation, they can have a risk-reducing surgery to prevent the cancer from developing in the first place,” Dr. Ramez Eskander, gynecologic oncologist at the University of California, San Diego tells SurvivorNet. “So, not only does genetic testing in the germline matter for the patient, but it has really important implications for family members who may be tested and identified to carry the mutation before they’re ever diagnosed with a cancer.”
“The importance of genetic testing in patients with ovarian cancer cannot be overstated,” says Dr. Eskander. “Genetic testing may not only inform and guide treatment decisions, but it’s also important for identifying opportunities for future treatment strategies.”
Ovarian Cancer, “The Cancer that Whispers”
According to the medical oncologists SurvivorNet consulted, the symptoms of ovarian cancer can include:
- A feeling of bloating or fullness
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
Any of these can be similar to symptoms many women experience monthly with their menstrual cycle, which makes distinguishing this cancer so tricky. However, if you notice any unusual symptoms, you should contact your doctor for further tests.
If you find yourself diagnosed with ovarian cancer, you may feel quite a bit of anxiousness and even fear. However, many treatments exist to help you along your journey. Typically, surgery and/or chemotherapy are the first lines of treatment. Several factors go into deciding what kind of treatment is best, depending on the type and stage of ovarian cancer, your age, and whether you are planning to have children in the future.
WATCH: Initial ovarian cancer treatment.
If a doctor is confident that they can remove the ovarian tumor completely without initial cycles of chemotherapy, they will go ahead with a surgical procedure. Doctors who are not sure they can perform successful surgical tumor removal will go with chemotherapy initially and then proceed with surgery once the tumors have shrunk.
WATCH: Ovarian cancer recurrence.
It’s important to note that although most women treated for ovarian cancer enter remission, there is a “70 to 80 percent” chance of recurrence, meaning the cancer will come back. Luckily, treatments exist to help manage recurrence.
There is growing data to support the idea that PARP Inhibitors, the class of drug that inhibits cancer cells from repairing their DNA, can benefit a wide swath of women. PARP inhibitors are especially beneficial for women who have genetic testing to discover that they have a mutation called BRCA.
What Goes Into Ovarian Cancer Surgery
Surgery for ovarian cancer is major surgery, and women should expect the usual side effects of exhaustion and post-surgical pain following the procedure. The hospital stay will typically last five to seven days, and most women can resume their regular routines within four to six weeks– sometimes while undergoing post-surgery chemotherapy.
The doctor will determine how far the cancer has spread– through a process referred to as “staging” — and then perform a hysterectomy (removal of the uterus), a bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries), and an omentectomy (removal of the omentum).
Since both the ovaries and the uterus are being removed, this means that the patient will no longer be able to bear children, and if the patient has yet to experience menopause, she will enter it. Some younger women of childbearing age undergoing surgery for ovarian cancer choose first to have their eggs retrieved and frozen so they can have the chance of having biological children down the road using a surrogate mother.
Other than removing a woman’s reproductive capabilities, losing these organs does not interfere with the body’s essential functions.
The next step is “debulking,” the portion of the surgery where most of the cancerous cells are removed. Debulking is especially important if the cancer has started to spread throughout the body and needs widespread attention. Imaging done before surgery will allow the doctors to have an idea of just how far the cancer has spread.
“Based upon the CT scan, then I will have a pretty good idea as to whether or not we are going to have to perform a removal of cancer along the diaphragm,” says Dr. Jewell. “If that is the case, then sometimes you would require a chest tube, which will be removed before your discharge from the hospital,” she added.
There is a possibility during the debulking process that the patient may need to have bowel surgery, where a piece of the intestines will be taken out. This can sometimes lead to the patient receiving an ostomy bag, a prosthetic device that diverts waste from the colon into a bag on the side of the abdomen.
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