An Unfortunate Accident Leads to Unexpected Diagnosis
- A 22-year-old Derby rider was thrown off her horse, prompting a medical evaluation. During testing, doctors discovered a nine-inch tumor in her abdomen and eventual ovarian cancer diagnosis.
- Ovarian cancer is often harder to catch in its early stages because of its subtle symptoms, such as bloating, weight gain, and abdominal pain that can mimic regular menstrual cycle fluctuations.
- Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal.
- After ovarian cancer patients complete initial treatment, maintenance therapy may be recommended to try and delay possible recurrence.
- Genetic testing helps doctors determine the most effective maintenance therapy.
A young jockey rider and her family are thankful for a fortunate accident that helped lead them to a critical cancer diagnosis. Libby Dodes, 22, was thrown off her horse, Coco, and it wasn’t until she received an evaluation that her doctors discovered that she had a nine-inch tumor in her abdomen.
“[Coco] saved her life,” Dodes’ family told BBC News about the incident.
After her diagnosis, Libby began her treatment, which is expected to last two years and will include chemotherapy, surgery, and radiation therapy.
“We have a long, hard road ahead of us; however, Libby is a fighter, and those who know her know she loves to prove people wrong, and this is what she intends to do,” Libby’s mom Vanessa Dodes, 48, said.
The family remains optimistic and grateful that her unfortunate fall was a blessing in disguise.
“It caused Libby to fall and get the hospital attention she needed. If it hadn’t been for the fall, I’m not sure where we’d be today,” Vanessa said.
The family has established a GoFundMe to help with medical costs.
Helping Patients Understand Treatment Options for Ovarian Cancer
Ovarian cancer has been called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages. The symptoms that do appear at first are hard to identify as cancer.
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.
Many ovarian cancers begin in the fallopian tubes. A few cancerous cells first grow on the fallopian tubes. Then, as the fallopian tubes brush over the ovary, these cells stick to the ovaries and eventually form a tumor.
“The symptoms include things like feeling full earlier than you usually would when your appetite is strong and feeling bloated. Some changes in your bowel habits. Some pain in the pelvis. These are symptoms women may have every month. These are not very specific. But we’ve found this constellation of symptoms from multiple studies,” Dr. Karlan added.
The symptoms of ovarian cancer may include the following, according to SurvivorNet experts.
- A feeling of bloating or fullness
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
How Ovarian Cancer Is Treated
The standard of care for ovarian cancer patients is chemotherapy, which helps many patients reach remission.
Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal. With recurrence a strong possibility for this disease, especially in the later stages of ovarian cancer, certain drug treatments to deal with it are giving many women hope.
RELATED: Dealing with recurrence.
WATCH: Treating ovarian cancer.
Ovarian cancer is sub-categorized into two groups.
Platinum-Sensitive Ovarian Cancer: Your cancer does not return for more than six months after treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
Platinum-Resistant Ovarian Cancer: Your cancer returns within six months of treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
“The mechanism that causes platinum resistance will cause someone to be resistant to other chemotherapies, as well. That’s why we’re looking for what we call targeted therapies – precision medicine,” Dr. Noelle Cloven from Texas Oncology-Fort Worth Cancer Center explained.
RELATED: Recurrent Ovarian Cancer Treatment Is Your Disease “Platinum-Sensitive”?
Targeted therapies or precision medicine specifically target the proteins controlling cancer cells’ growth, division, and spread.
Maintenance Therapy for Ovarian Cancer
Maintenance therapy is continued treatment after the patient finishes their initial treatment. After an ovarian cancer patient completes a round of treatments — such as surgery and chemotherapy — her doctor may recommend some form of maintenance therapy to try and delay possible recurrence. Maintenance therapy can involve taking an oral pill called a PARP inhibitor every day after chemotherapy and can keep cancer in remission longer.
Genetic testing helps doctors determine the best maintenance therapy.
“The biggest question is: How do you choose between bevacizumab (brand name, Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Alpa Nick, a gynecological oncologist with Tennessee Oncology in Nashville, tells SurvivorNet.
The drugs have very different ways of combatting cancer cells. PARP inhibitors prevent cancer cells from repairing their DNA, while Avastin blocks the formation of new blood vessels, starving tumors of nutrients.
The Food and Drug Administration approved bevacizumab (Avastin) to be used in conjunction with olaparib (brand name LYNPARZA) in HRD (Homologous Recombination Deficiency) positive women who show a response to platinum-based chemotherapy. During clinical trials, the drug combination increased progression-free survival from an average of 17 months to 37 months.
“A patient really has to make a decision upfront, or near the beginning of their treatment, that they want bevacizumab maintenance treatment because they’ll have it with their primary chemotherapy,” Dr. Nick explains.
The drug is administered intravenously and can be given in combination with other chemotherapy drugs. Avastin affects the growth of blood vessels, starving tumors of the blood they need as nourishment.
The American Society of Clinical Oncology (ASCO) guidelines recommend PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
Surgery offers another important decision point. “When patients have their surgery, we can test their tumor to decide if their tumor has a homologous recombination deficiency,” known as HRD. If it does, that also suggests they would benefit from PARP inhibitor maintenance therapy,” says Dr. Nick.
Elahere (molecular name mirvetuximab) is an FDA-approved targeted therapy providing much-needed hope for patients with platinum-resistant ovarian cancer. This drug treatment is for women who test positive for a molecular factor called folate-receptor alpha (FRα). While many ovarian cancers test positive for the folate receptor, to be eligible for Elahere, you must have very high levels (>75%) of the folate receptor-alpha (FRα).
It is an antibody-drug conjugate. This kind of new anti-cancer drugs, known as “biological missiles,” is leading a new era of targeted cancer therapy.
Dr Lyons explains, “What that means is that the antibody part of the drug conjugates binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell. And then the drug that is conjugated with is the part that kills the tumor cells by affecting the tumor cell’s ability to divide.”
Questions for Your Doctor
If you have been diagnosed with ovarian cancer and need guidance to further educate yourself on the disease and treatment, consider these questions for your doctor.
- What type of ovarian cancer do I have?
- What stage is my cancer in?
- Do you recommend I get genetic testing for any gene mutations, such as the BRCA gene mutation?
- What initial treatment options do you recommend?
- What are the possible side effects of the recommended treatment, and how can they be coped with?
- Will insurance help cover my recommended treatment?
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