The Silent Operator
Ovarian cancer is generally detected when it is in stage III or IV. Early detection for this particular cancer is usually an incidental finding because there is no good screening for it. The symptoms are so non-specific that numerous patients think they have gastrointestinal problems for months prior to seeking medical help.
Ovarian cancer is a rare neoplasm in the general population but is present in over 40% of the BRCA mutation carriers and prophylactic oophorectomy beyond the age of 35 is recommended.
The tumor marker CA-125 is elevated only in advanced disease therefore is not useful to detect early disease but it is useful for following response to treatment and detecting recurrence.
For women who present with an ovarian mass in order to assess the possibility of malignancy prior to surgery, in addition to radiologic evaluation there is a new blood test called ova 1 recently FDA approved. Ova 1 with radiologic studies detected 92% of malignant ovarian masses compared to 72% without ova 1. Determining if an ovarian mass is malignant prior to surgery is extremely important because the surgery for ovarian cancer is much more extensive than surgery for a benign mass and needs to be done by a gynecologic oncologist.
Treatment for ovarian cancer most of the time involves debulking surgery preceded or followed by chemotherapy based on the amount of disease at presentation. Standard of care for several years now has been the combination of taxol carboplatin chemotherapy. Additional agents used for refractory disease have been taxotere, gemzar, cisplatin, cytoxan, topotecan, etoposide, vinorelbine and alimta. As far as newer agents, avastin (an antiangiogenic targeting VEGF) added to standard chemotherapy revealed improved DFS in phase III trials.
And on the horizon, a new class of drugs the PARP inhibitors, which block parp proteins from repairing damaged cancer cells seem to be promising in treating ovarian cancer. Still, there is much room for improvement especially as far as early detection.