Ovarian cancer is hard to detect, but new and better treatments are improving survival
By Jessica Saenz
Ovarian cancer is rare and hard to detect due to its vague symptoms. Although ovarian cancer responds well to treatment in its early stages, it is usually discovered in later stages when it's more difficult to treat. Because of this, the long-term survival rate for ovarian cancer can be low and the chance of recurrence is high.
As cancer experts learn more about ovarian cancer and early detection, new and improved treatments are increasing survival.
Here's what you should know about the latest ovarian cancer treatments.
Ovarian cancer treatments
Surgery and chemotherapy
Surgery is often the first line of therapy for ovarian cancer. Surgery might involve removing one or both of the affected ovaries in addition to the fallopian tubes, uterus, nearby lymph nodes and fatty tissue if cancer has spread to those areas.
Surgery alone can sometimes eliminate ovarian cancer, but it is most often used in combination with chemotherapy to decrease the chance of ovarian cancer recurring. If chemotherapy comes before surgery, this is known as neoadjuvant or adjuvant therapy (after surgery). The order and combination of treatments depend on the stage of ovarian cancer and whether it has spread to other parts of your body.
"The major decision is whether you do surgery or chemo first, and that decision is based on risk factors and how likely somebody is to do well with a surgery-first approach," says John Weroha, M.D., Ph.D., a Mayo Clinic medical oncologist.
"Another way to give chemotherapy is intraperitoneally, meaning the chemotherapy is delivered directly into the abdomen through a catheter," says Dr. Weroha.
Another treatment called hyperthermic intraperitoneal chemotherapy, or HIPEC, is given during surgery and is sometimes recommended when ovarian cancer is advanced or considered inoperable initially. Warm hyperthermic intraperitoneal chemotherapy pumps into your abdomen where the cancer is located, sparing healthy tissue and leading to fewer side effects associated with chemotherapy.
Cancer cells have unique characteristics that allow them to grow, divide and spread. Targeted therapy for ovarian cancer uses these characteristics to identify weaknesses and more precisely attack cancer cells.
"Over the last decade, there has been a huge shift in the way that we treat ovarian cancer. I think the biggest impact has come from a family of drugs called PARP inhibitors," says Dr. Weroha. "This family of drugs has completely revolutionized the way we treat ovarian cancer from the initial diagnosis through recurrence and the entire spectrum of ovarian cancer treatment."
PARP is a protein that helps repair damaged DNA in cancer cells as they divide. PARP inhibitors block the protein from functioning, killing the cancer cells. Currently, PARP inhibitors are most effective in ovarian cancers associated with BRCA1 and BRCA2 inherited mutations, which can increase the chance of several different types of cancer.
Depending on the specific characteristics of your ovarian cancer cells, other targeted drug therapies or immunotherapy also might be an option.
Ovarian cancer treatment, fertility
Different types of cancer treatment carry different risks for fertility, but treatments for cancers of the brain and pelvis carry the highest risk of infertility. Treatments like surgical removal of your ovaries, uterus or fallopian tubes; chemotherapy; radiation; and certain cancer drugs can limit or impair your ability to conceive naturally.
Depending on the location and stage of your cancer, fertility preservation treatments might be an option for you. These treatments aim to preserve your ability to conceive through advanced and precise surgical techniques, including minimally invasive surgery, robotic surgery or ovarian transposition, which surgically moves the ovaries away from the field of radiation to reduce damage.
In cases when surgical removal of reproductive organs is needed and your ovarian cancer treatment timing allows, preserving your eggs or embryos can sometimes be an option.
If you are diagnosed with ovarian cancer and you hope to have children, it's important to talk to your health care professional about fertility preservation before you begin treatment.
Clinical trials, ovarian cancer treatment development
Understanding genetic risk for ovarian cancer to improve early detection
Advanced-stage ovarian cancer has a higher rate of recurrence, and Dr. Butler says early detection is important to improve survival. "If we're able to detect it at stage 1 or 2, the recurrence rates are far lower often with the combination of surgery and chemotherapy," she says.
Although tests and procedures can diagnose suspected ovarian cancer, there is no standard screening test. Therefore, it's important to know the symptoms and your genetic risk factors.
Genetic mutations, including BRCA1 and BRCA2, and an inherited condition called Lynch syndrome, are some of the known genetic factors that increase the risk of ovarian cancer.
Awareness of these genetic factors can lead to better monitoring of ovarian cancer development, but not everyone is aware of their cancer genetic mutations and family medical history. Genetic testing and counseling can help you understand your results and make informed decisions with your health care professional.
Cancer researchers are still trying to understand how genetic testing can guide your health care professional's ovarian cancer screening recommendations and improve early detection for everyone.
Enhancing ovarian cancer treatment options
Clinical trials are investigating the different treatment options for ovarian cancer and ways to improve them.
"Current clinical trials are really focused on how to make PARP inhibitors work even better," says Dr. Weroha.
This is a key area of exploration for Mayo Clinic ovarian cancer researchers. This exploration includes combining PARP inhibitors with chemotherapy to target cancer cells more precisely. However, researchers have also been investigating other types of drugs to specifically kill ovarian cancers.
"We're seeing a lot of clinical trials that are using what are called antibody drug conjugates," says Dr. Weroha. "These are drugs where there is an antibody that recognizes a very specific part of the cancer cell, but it brings with it a chemotherapy that's attached to this antibody. This approach allows the chemotherapy to go directly to the cancer and minimize the toxicity of normal tissues."
Exploring immunotherapy for ovarian cancer
Like other types of cancer, ovarian cancer cells can hide from the immune system. This allows tumors to grow unchecked. Cancer experts are exploring therapies that can teach the immune system to identify ovarian cells and attack them. One of these therapies uses vaccination technology.
"We are conducting a cutting-edge investigation for an ovarian cancer vaccine and are in phase 2 development with very promising outcomes," says Kristina Butler, M.D., a Mayo Clinic gynecologic oncologist. "This vaccine is being studied in patients who have survived ovarian cancer with hopes that it will reduce recurrence and perhaps in the future prevent development."
To avoid overlooking ovarian cancer in its early stages, Dr. Butler emphasizes the importance of being attuned to your body and monitoring new or worsening symptoms.
"I think the best screening is being attentive to your body," she says. "When something doesn't seem right, seek evaluation. Symptoms of ovarian cancer include bloating, abdominal pain, urgency of urination and early fullness after a meal. When these symptoms are new and occur about two weeks out of the month, seeking assessment is key."
When ovarian cancer is detected, Dr. Weroha encourages patients to explore all of their treatment options, including clinical trials, which he says should not be a last resort.
"We try to bring clinical trials to our patients — not because we want to test whether or not this brand-new drug works, but because we already believe the drug works, and we want to give it to our patients because they can't get it any other way."
Watch this "Mayo Clinic Q&A" podcast video to hear Dr. Weroha discuss ovarian cancer treatment and innovation:
Learn more about ovarian cancer and find an ovarian cancer clinical trial at Mayo Clinic.
Also read this article: "Dear Mayo Clinic: Ovarian cancer symptoms and treatment options."
And watch this video with Dr. Butler: "Ovarian Cancer: Mayo Clinic Radio"
The discovery strengthens evidence that the microbiome is an important indicator for early detection of ovarian cancer.
Dr. Travis Grotz explains how hyperthermic intraperitoneal chemotherapy works and how it can help patients with certain late-stage cancers.
Genetic testing can help guide cancer treatment and help your care team understand if you are at risk for developing other conditions.