Losing a parent to cancer is so hard. On Mother’s Day, Kevin Hart paid tribute to his mom, Nancy, who died of ovarian cancer in 2007. He also joined his wife, Eniko, and children — wearing pink and white– to reveal the gender of their upcoming baby – a girl. “Happy Mother's Day to this beautiful woman & wife of
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mine…. we are thrilled about the arrival of our baby girl….Family of 6 WOOOOOOOOW!!!! God is unbelievable….We are blessed to have you in our lives,” Hart wrote on Instagram. All I can say is thank you honey.”Advances in Ovarian Cancer Treatment
With no screening test for ovarian cancer, it’s among the more difficult cancers to diagnose early. Symptoms include abdominal bloating or swelling, quickly feeling full while eating, weight loss, pelvic discomfort or pain, constipation, or a frequent need to urinate — but they’re so non-specific that the disease often goes undetected.
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But treatment advances, including genetic testing, minimally invasive surgical techniques, and PARP inhibitor drug therapies have improved the outlook for patients diagnosed today, compared to 2007, when Nancy Hart was fighting the disease over a decade ago.
Genetic Testing at Diagnosis
Experts urge women diagnosed with ovarian cancer, to seek genetic testing at the time of diagnosis, not recurrence. A recent study found that too few women are being tested for mutations of the BRCA gene, like BRCA1 or BRCA2. The presence of these mutations guides treatment decisions and identifies whether patients — and family members — at a heightened risk for breast cancer or ovarian cancer.
All women diagnosed with ovarian cancer should undergo genetic testing, says Dr. Ursula Matulonis, Chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.
Ovarian cancer usually develops in women who are post-menopause. But younger women may also get the disease, especially if they carry the BRCA-1 or BRCA-2 genes.
A woman who inherits the BRCA1 gene has a 44% lifetime risk (by age 80) for developing ovarian or fallopian tube cancer, and 70-80% risk of developing breast cancer. With the BRCA2 gene, the risk for ovarian and fallopian tube cancer is 17% higher, while the breast cancer risk is around 70%
Advanced Surgical Techniques
Minimally invasive surgical techniques, including robotic surgery using the "da Vinci Robot," can benefit about half of women diagnosed with ovarian cancer. These new approaches allow surgeons to be more precise in pinpointing and removing ovarian cancer, which may have spread to surrounding organs. The smaller incisions also help decrease post-operative pain and speed recovery time for patients.
Dr. Allan James (“A.J.”) White a gynecologic oncologist at the START Center for Cancer Care in San Antonio, Texas, has seen robotic surgery dramatically change ovarian cancer treatment.
Robotic surgery uses cameras and special robotic surgery tools to make it possible for surgeons to operate through a series of small incisions. For ovarian cancer, doctors make about five incisions, each less than a centimeter in size, around the belly button rather than a large open incision down the abdomen midline.
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The robotic surgery presents high costs for the medical system, but Dr. White says "it's so good for the patients that, around the country and really around the world, most of us have been shifting to using the robotic technique when it's appropriate." For patients, the higher cost of robotic surgery may be offset by decreased hospital time, as it’s often possible to go home on the day of surgery — or shortly thereafter.
Minimally invasive surgery is most appropriate when the disease is focused in the pelvis. “Robotic surgery is not an option for every woman with ovarian cancer," says Dr. Lori Weinberg, gynecologic oncologist with Minnesota Oncology.
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"Most patients with ovarian cancer have disease that is spread out in multiple places, where the robotic platform just cannot achieve what we can do through an open incision,” she explains. “We really have to tailor our approach to treatment based on what we're seeing from the imaging, and also on a patient's physical exam.”
PARP Inhibitor Drugs
PARP inhibitors can be a beneficial treatment option for many women with ovarian cancer. These oral drugs work by preventing ovarian cancer cells from repairing DNA damage, which prevents them from continuing to divide and spread.
Amanda Westwood, a physician assistant at UT Southwestern Medical Center in Dallas, Texas. Westwood describes these different potential options:
Recent research confirms that most women with ovarian cancer can benefit from PARP inhibitors, Amanda Westwood, a physician assistant at UT Southwestern Medical Center in Dallas, Texas, although the timing of that benefit can vary depending on her cancer’s genetic profile, among other factors.
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“The PARPs have a huge importance in treating ovarian cancer, whether it be upfront maintenance for our BRCA patients or a recurrence setting if they’ve had a partial or complete response, and even down the line they can be used as treatment alone,” says Amanda Westwood, a physician assistant at UT Southwestern Medical Center in Dallas, Texas.
Westwood describes these different potential options:
- Upfront maintenance: This means receiving PARP inhibitors directly after the first course of chemotherapy. This option is ideal for women with BRCA gene mutations
- Recurrence setting: This option means PARP inhibitors are given after a woman has already had a complete or partial response to treatment in the past.
- Monotherapy: Down the line, PARP inhibitors can sometimes be an option to use as treatment on their own, the technical term for which is “monotherapy”
After beginning treatment with PARP inhibitors, most women will go in for frequent tests to monitor their tolerance and make sure that the side effects are managed. While some women may experience nausea, the most common side-effect is fatigue. The drugs may also impact blood counts; another reason for close monitoring with lab work.
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Over time, these tests may become less frequent. While some women may experience nausea, the most common side-effect is fatigue. “But most of the time, patients tolerate PARP inhibitors fairly well,” Westwood says.
PARP inhibitors can have a positive impact on progression-free survival, a term doctors use for living with ovarian cancer for a period of time without seeing it spread or progress.
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