What’s new with ovarian cancer becomes apparent when research is analyzed that carries us forward into new areas of early detection. This also will bring about improved treatment of ovarian cancer. Here are a few examples from the recent literature.
It is now apparent that there are at least two genetic loci, called by strange sounding names “Mdm2” and “erbB2” that are involved in the transition from normal ovarian cells to early ovarian cancer cells.
- When the ovarian cancer cells are ready to invade, an enzyme by the name of “heparanase” is excreted by the cancer cells (Ref. 3). Using monoclonal antibody technology these three cell markers may one day not only be used as a research tool, but could become a powerful detection and monitoring tool. This would make it easier for the physician to detect and treat ovarian cancer earlier.
- Ovarian cancer cells produce lysophosphatidic acid, which in turn is important for the further growth of ovarian cancer in the abdominal cavity when the cancer is producing ascites (=fluid build-up in the abdominal cavity). Lysophosphatidic acid in turn stimulates the production of “vascular endothelial growth factor (VEGF)”, which enables the cancer cells to form new tumor blood vessels in any organ where it metastasizes and also helps with ovarian cancer cell division in the abdominal cavity. As there are certain specific receptors involved in the communication between these substances, there is now a possibility for developing new less toxic medications in the near future to specifically block the cell metabolism of ovarian cancer cells. This would be very useful in patients with stage III and IV ovarian cancer patients.
- One cell marker, which has been known for some time, is the CA125 surface antigen. The authors of Ref. 5 have shown that this marker can be very useful for monitoring of those patients who develop a recurrence after chemotherapy of ovarian cancer. the researchers determined a baseline right after completion of chemotherapy and then did subsequent testing of CA125 levels in the blood. They found that an elevation above 2.5-times the baseline was particularly useful in defining a recurrence and typically would develop about 35 to 41 days following completion of chemotherapy in those patients who developed recurrences.This new knowledge gives the oncologist a powerful tool to know which patient needs more chemotherapy courses, because the probability of a positive chemotherapy response is higher when the tumor load is not overwhelming.
- Another application of the CA125 marker was utilized in the development of a vaccine for recurrent ovarian cancer using monoclonal antibodies against CA125 from mice.The patients with recurrent ovarian cancer after platinum chemotherapy were injected at intervals, and survival and toxicity was measured in phase I and II clinical trials. The overall survival benefit for vaccinated patients was 15 months compared to controls. The difference between those patients who mounted an immune response versus those who did not translated into an extra survival of 14.6 months regarding the responders. This positive effect will now be used for phase three clinical trials to determine what dosage of vaccination is most optimal. This type of approach has the potential for helping to improve the survival rates in stage III and IV ovarian cancer patients.
- Ginger extracts have been shown to have healing effects in ovarian cancer as discussed here.
Summary regarding ovarian cancer
Like in any cancer, early diagnosis leads to superior results with better long-term survivals as evident from the above table. This is accomplished by regular yearly pelvic exams at your physician’s office combined with the Pap test. In case of a suspicious finding your physician will arrange for the necessary tests and referrals.
If surgery is necessary, it would be best to ask for a quick referral to one of the Cancer Clinics where oncological surgeons and gynecologists can do the staging and cytoreductive surgery mentioned above. As mentioned before, the cytoreductive surgery leads to much better survival rates. Following this it often will be necessary to administer postoperative radiotherapy or combination chemotherapy as this has been proven to result in much better survival rates.
Ovarian cancer monitoring and prevention
Most women nowadays should be able to be detected in stage I of ovarian cancer, which has the best survival rates. But it is up to the woman to go for the regular pelvic exams and to insist on appropriate referrals. In terms of prevention there is a lot that can be done, namely to reduce fat intake, to increase the consumption of vegetables and to decrease alcohol intake to none or light levels only. Women who are genetically at a high risk to develop ovarian cancer (strong family history) may want to consider preventative ovariectomies. Using these simple guidelines many unnecessary cases of ovarian cancer could be prevented.
1. V.T. DeVita et al. : Cancer- Principles & Practice of Oncology, Vol.1, 4th edition. J.B.Lippincott Co., Philadelphia, USA, 1993. Ovarian cancer chapter.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T.DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Ovarian cancer chapter.
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4. Y.-L. Hu et al. J Natl Cancer Inst 2001 May 16;93(10):762-767.
5. MKTuxen et al. Br J Cancer 2001 May;84(10):1301-1307.
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8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc