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Natalya Danilyants, MD
Advances In Treating Ovarian Cancer
The Center for Innovative GYN Care

Advances In Treating Ovarian Cancer

Ovarian cancer is the deadliest of all gynecological malignancies. In 2005 alone, 22,000 women were diagnosed with ovarian cancer and 16,000 died from this disease.
New medical and surgical treatments have been successful in the management of ovarian cancer. Although some of these have shown an improvement in survival, the best management for ovarian cancer is early detection. Screening for ovarian cancer is more difficult than for cancers of the uterus and cervix. Unfortunately, many cases are already far advanced when a women first experiences symptoms.
Intraperitoneal Chemotherapy (IPC). IPC is the administration of chemotherapy directly into the abdomen after surgical debulking. Debulking refers to the removal of disease so that tumor nodules left behind are no greater than one half inch in size.
Clinical trials from the Gynecologic Oncology Group Protocol #172 demonstrated that patients undergoing this type of treatment had an increased survival of almost 16 months more than the similar treatment given intravenously. The agents used in Protocol #172 are IP administered cisplatin and taxol, along with IV (intravenous) taxol. Although the results show an improvement, the toxicity of this protocol is high half of the patients could not complete therapy by IP. In addition, these patients had higher sensory nerve problems, abdominal discomfort, and greater disruption of their normal quality of life.
Patients with tumors greater than one half inch and those with extensive adhesions are not good candidates for this protocol. The standard of care for treatment of ovarian cancer is still IV carboplatin and taxol. Hopefully, future refinements in the Protocol #172 will reduce toxicity allowing more patients to complete the regimen, resulting in greater survival.
Avastin is an agent developed by Genentech that blocks the growth of blood vessels to cancer cells. A receptor, found on both cancer cells and on the endothelial cells that form blood vessels, is called the VEGF receptor. VEGF vascular endothelial growth factor binds to these receptors triggering the growth of new blood vessels which are necessary for tumor growth. Avastin disrupts the interaction of the growth factor and the VEGF receptor, blocking further blood supply to the tumor, resulting in cancer cell death. Avastin is used with chemotherapy to accelerate cancer cell death.
Research has shown that ovarian cancer patients with high levels of the VEGF receptor benefit most by Avastin therapy. The side effects of Avastin overall are low, however problems with bowel obstruction and perforation have been identified in some patients. Currently, Avastin is only available for treatment of ovarian cancer through participation in research protocols.
Laparoscopic Surgery. Laparoscopy has been advocated recently for the treatment of early stage ovarian cancer. This approach allows patients to undergo removal of the cancer with small incisions, only one quarter of an inch, with faster recovery and return to normal activities as compared to open surgery.
Patients undergoing laparoscopy can also start chemotherapy much faster, and are excellent candidates for intraperitoneal chemotherapy since adhesion formation is limited with this approach.

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