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Ovarian Cancer: What You Need to Know

Melanie Cole (Host): An ovarian cancer diagnosis can be life-changing. At Cancer Treatment Centers of America® (CTCA), we’re here to help you and your loved ones make a more informed treatment decision. My guest today is Dr. Maurie Markman. He’s President of Medicine and Science at Cancer Treatment Centers of America. Welcome to the show, Dr. Markman. Tell us a little bit about ovarian cancer—sort of a broad overview of what it is and just a little bit about its diagnosis.

Dr. Maurie Markman (Guest): Well, ovarian cancer is, fortunately, not a common cancer. In fact, approximately 20,000 women in the United States each year, so certainly far less common, fortunately, than other cancers and because, in a moment I’ll explain why, certainly less common than breast cancer or lung cancer in women. The issue with ovarian cancer is that we do not have any effective way to diagnose the disease early or in an early stage, which means the vast majority of patients, in fact, when they present, present with what we call “advanced disease,” where abdominal surgery to remove as much disease as possible, followed by chemotherapy, is the standard option. And the symptoms of the disease are generally quite non-specific. Statements are, and women would say, obviously, a little bit—because it’s in the abdomen—bloating, abdominal discomfort, fatigue, and then it might become more painful in the pelvic area, eventually leading the woman to see her physician. It could be her primary care doctor, an internist, a gynecologist, which then something would be found; something would be felt, generally leading to abdominal imaging or radiographic imaging and then surgery. And the disease would have started in the ovary. Sometimes, it actually starts in the lining of the abdominal cavity—actually, the same cells that line the abdominal cavity, called the peritoneum. So, it’s peritoneal cancer, the same cancer as ovarian cancer, and the treatment is the same.

Melanie: If these symptoms are so non-specific, what’s a woman to do? How do we know? What would send us to our doctor, and then, how does your doctor find out that this is what you have?

Dr. Markman: Well, I think it’s, obviously, a very important question. As a male, it’s a little more difficult for me to answer the question, perhaps, than a female, but I’ve been involved in this area now for over 30 years, so I’ve certainly dealt with, now, thousands of patients in this setting. Really, the general answer is if an individual—in this case, we’re obviously talking about a woman—is the best person who knows her body. She knows what she feels. She knows she’s had something to eat that didn’t settle right, if she has abdominal discomfort. She knows her own body. She knows what happens—for example, whether she was pre-menopausal or menopausal. She knows her monthly cycles in the pre-menopausal setting and the menopausal setting. She knows how she’s felt, and then that would go away. The point is, if it’s something different, and if it’s a different pain. It’s a different discomfort. It’s a different swelling she feels, bloating she feels. Very importantly, it’s that it persists. So, there are lots of things that can happen to us that can be quite painful at the time. Someone gets severely constipated, for example. That can be very uncomfortable, but it goes away. It’s relieved. So, it’s the persistence of the discomfort and something different, I would say, as a general statement, that would lead a woman to go to see her physician. The physician, again, who is a gynecologist or maybe it wasn’t a gynecologist. Maybe it was a general medical physician or internist that maybe doesn’t do pelvic exams, for example, or would not feel comfortable to make that kind of diagnosis, would have the woman see a gynecologist. Again, the abdominal imaging study, an ultrasound or CT scan of the abdomen would often be done at that point, and there, one would see the abnormalities which would lead, at that point, for a referral to a specialist in this area, which are gynecologist oncologists. Gynecologic oncologists are individuals who have been trained, first in OB/GYN, so that their focus is, obviously, on the female pelvic areas, and then, they have been specifically trained in gynecologic cancers. They're the individuals that have the greatest expertise, certainly from the perspective of the surgeries that are required, and they will help in the management subsequent to surgeries.

Melanie:  You mentioned possible surgery and chemotherapy as possible treatments. Give us an update on the advances in the treatment of ovarian cancer.

Dr. Markman:  Well, you know, there really have been a number of important advances over the last past several decades and increasingly important observations that are occurring recently. The surgery has become more successful; surgery has become less morbid, which means that everyone assumes that abdominal surgery is not a small thing. But increasingly, however, because of the availability of excellent surgeons around the country, understanding surgical techniques, the ability of women to actually do very well at surgery, and to, in fact, get out of the hospital really quite quickly has improved. In fact, the results of the surgery in terms of the ability to essentially remove any cancer that can be seen at the time of surgery has increased. Now, the fact that one can say that we don’t see any cancer left doesn’t mean it isn’t there. That’s the point, that either they know they left disease or, in the majority of patients, they see it, or even if they think they’ve gotten out what they can see—that is, the gynecological oncologist—there is an extremely high likelihood that there is still microscopic disease present, which means that’s why you have to continue with other therapy, which is the chemotherapy in an attempt to kill whatever is remaining. So, the surgery has improved, and the drug therapy we have has substantially improved. The chemotherapy that is used is increasingly better tolerated. We do have medications to control what has traditionally been the most concerning side effect, which is nausea and vomiting. So, if an individual woman was working, she is likely to be able to continue working, perhaps with a modified schedule, taking more time off to rest, but she should continue working. And other activities that an individual has engaged in, they can continue with. outpatient treatment, And we have new drugs that have been added. We have new drugs that affect the tumor, in terms of its new vessels that cancer forms, that do affect that—drugs called “anti-angiogenesis,” to attack the ability of these cancers to grow. We have new drugs that are actually looking at particular molecular targets that have been found in ovarian cancer—one that has recently been approved for use in the United States and others that are actually in investigation. There are dozens of trials ongoing. Now, there is interest in immune therapy in ovarian cancer. These are actively ongoing trials. So, we have increasingly effective drugs now, and we have a very large number of new strategies that are being investigated in trial, which will, hopefully, become available for routine care over the next several years.

Melanie:  In just the last few minutes, Dr. Markman, what should women who have recently been diagnosed with ovarian cancer be thinking about when seeking care?

Dr. Markman:  I think, obviously, that a woman and her family advising her want to make sure  that she seeks care by individuals who have experience managing gynecologic or female pelvic malignancies, as it is sometimes called. Gynecologic oncologists—that is their expertise. And the gynecologic oncologists often work with medical oncologists, like myself, who have a particular interest and expertise in the chemotherapeutic management of these malignancies. Now, many gynecologic oncologists take the responsibility for giving chemotherapy themselves, and others will focus on the surgery and work closely with medical oncologists as a team. The point is, they want to make sure they have people who have expertise in this area; they understand these malignancies; they understand their management; they understand the complications of the disease and the therapies that are being used. And that will give, I think, the patient her best chance at being with a team that can help her through this journey on to getting therapy done so she can get on with her life.

Melanie:  Thank you so much, Dr. Markman. You’re listening to Managing Cancer with Cancer Treatment Centers of America. For more information, you can go to cancercenter.com. That’s cancercenter.com. This is Melanie Cole. Thanks so much for listening.