Over the past 20 years, the battle against ovarian cancer has been frustratingly one-sided, with little change in survival outcomes. According to the Australian Institute of Health and Welfare, almost 1,500 women are diagnosed with ovarian cancer annually, most of them at the advanced stage. Yet despite long-term blood screening trials in the UK and US, there is still no viable early detection test. The five-year survival rate sits at just 43 percent making it one of the deadliest cancers for women.
Ovarian cancer may have us on the back foot but not for long says Professor David Bowtell, head of Ovarian Cancer Research at the Garvan Institute of Medical Research and the Peter MacCallum Cancer Centre. He says the key is to know the enemy better. “By understanding the disease we can now much better tailor genetic risk to help save lives,” he tells Yahoo7 Health.
Out Of The Shadows
We now know that ovarian cancer is not one simple disease but a collection of diseases that happen to hang in the same location. To confuse matters, most of the fatal forms of the disease are from cells outside the ovaries, like the fallopian tubes, which account for two-thirds of deaths. This explains why women with a genetic risk for the disease, like Angelina Jolie Pitt, go on to have those removed.
“We debated a name change but thought it would be more confusing,” says Prof Bowtell. “But it reflects a remarkable change in cancer in general from an ‘anatomical classification’ – breast cancer, kidney cancer – to more molecularly based ones. So there are types of ovarian cancer, for instance, that are more related to breast cancer; they share similar behavior in their response to treatment, genetic risk profile and wiring.”
This reclassification of ovarian cancer means treatment options are no longer one-size-fits-all. Instead, therapies are more nuanced, which could benefit patients like Letitia Linke, 36, who was diagnosed with ovarian cancer at age 34. “When I started I had no idea about the different types of cancers and treatments,” she tells Yahoo7 Health. “The first one didn’t work for my type of tumour, it was the standard treatment given to all ovarian cancers. Now we know more about it, we know what type of chemotherapy works. It’s more targeted, I’m not wasting time and I feel more confident.”
With two young sons and a two-hour commute to her nearest therapy centre, Letitia’s story further fuels the work of Prof Bowtell and his team. They’re focused on three key areas: new therapies for women with chemo-resistant ‘high-grade cancer’; examining why some women defy the odds and survive beyond prognosis; and researching the role of genetic mutations and how they may affect your inherited risk.
As Prof Bowtell explains, previously, researchers thought the inherited types of genetic ovarian cancer occurred in 5-10 percent of women. “We now understand it’s closer to 20 percent. With that change we can now substantially reduce [womens’] risk of developing the disease and improve treatments.”
There’s been much excitement lately around the development of immunotherapy in treating cancers like melanoma and lung, and small-scale trials are now exploring whether it can be applied to ovarian. Texan oncologists are working on an experimental immunotherapy that targets late-stage ovarian cancer, prolonging the time between relapses, while the University of Pennsylvania has used a two-step immunotherapy approach to achieve full remission in a patient.
It’s still early days and the studies are small, warns Prof Bowtell, but he is optimistic. “I’m hopeful that it will improve substantially beyond that.”
The Holy Grail, however, remains that elusive early screening which, like the Pap smear for cervical cancer, would ensure faster diagnosis and treatment. Until then women need to be aware of the warnings signs and consult their GP if they spot irregularities.
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