Everyone is scared of ovarian cancer. And rightly so. It’s a disease that hits fast and hits hard. Early stage ovarian cancers are often asymptomatic and by the time signs and symptoms present, the prognosis is grim. The American Cancer Society estimates that 21,290 women will be diagnosed with ovarian cancer in 2015 and 14,180 will die of the disease. Ovarian cancer accounts for 5 percent of cancer deaths among women, causing more deaths than any other gynecologic cancer.
Updates on ovarian cancer reveal a good news/bad news scenario. The good news: Survival rates are increasing. The bad news: Treatment of recurrent ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. “The good news is that every year we push the media survival rate out a little farther,” says Mark E. Borowsky, MD, director of the division of gynecologic oncology at Christiana Care Health System. “The bad news is that even if we can extend their survival in a very meaningful way, 75 percent of patients with Stage III or Stage IV disease are going to die of their disease.”
Now we hear that less than half of the women eligible for a lifesaving cancer treatment are actually getting it. At some hospitals the percentage could be as low as 4 percent, according to a study published in August in The Journal of Clinical Oncology. The treatment in question—intraperitoneal (IP) chemotherapy—involves pumping strong drugs into a patient’s abdomen alongside traditional intravenous infusions. This treatment appears to be most effective if surgery has reduced or “optimally debulked” the size of any remaining cancer deposits to less than 1 centimeter or about half an inch.
The problem is many women do not have adequate surgery because they are operated on by doctors who do not specialize in gynecologic cancer. “They’re seen by general oncologists who don’t have the specialized knowledge of expertise in ovarian cancer,” says Borowsky. “When patients are not seen by a gynecologic oncologist, they’re much less likely to receive debulking surgery and IP.”
Another factor influencing survival rates is the nature of the cancer itself. Women with heritable BRCA1 or BRCA2 gene mutation appear to survive longer with ovarian cancer than women who do not have one of these mutations, according to a 2012 study published in the Journal of the American Medical Association.
One factor has been the development in the past five years of a group of drugs known as PARP inhibitors. These drugs treat cancers that have problems repairing their DNA and are particularly helpful for women with BRCA-driven cancers. A promising line of research is underway to identify a subset of patients who, while they might not carry germ-line BRCA mutations, might have some abnormality in the BRCA that would enable them to benefit from treatment with PARP inhibitors.
“If we can identify that subset of non-germ-line BRCA patients who benefit from PARP therapy, it may have broader applicability than just the 10 percent of patients who are germ-line carriers,” says Borowsky.
Delawareans wishing to support the fight against ovarian cancer can participate in the 7th annual Cindy Foundation Ovarian Cancer Research Run on Sept. 2 at Dravo Plaza on the Wilmington Riverfront. The event is named in honor of Cynthia “Cindy” DiPinto who lost her battle with the disease in 2009 at age 43. “She was amazing,” says Kim Gomes who joined with DiPinto’s family and other friends to organize the foundation. “She was full of life and energy. Just a fabulous woman.”
The Cindy Foundation stresses four things in the fight against ovarian cancer: awareness, education, research and a cure. Each year the event draws about 300 runners/walkers and raises about $8,000. The money goes to the Memorial Sloan-Kettering Ovarian Cancer Research Center, where Cindy received treatment and the Helen F. Graham Cancer Center & Research Institute’s Special Needs Fund, which pays for expenses not covered by insurance.
“On the selfish side, it’s a way for all of us to make sure that Cindy remains in everybody’s mind,” says Gomes, who worked in government relations with DiPinto. “Everybody loves Cindy. You can’t talk to anybody who didn’t just adore her. She was fabulous.”