By Pat Carragher - September 20, 2021
According to the American Cancer Society, approximately 21,000 women will be diagnosed with ovarian cancer in the United States this year. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system.
For Ovarian Cancer Awareness Month, we gathered a panel of experts including Dr. Robert Wenham, chair of Moffitt Cancer Center’s Department of Gynecologic Oncology, Dr. Jing-Yi Chern, gynecologic oncologist, and Laura Barton, certified genetic counselor. Here’s what they had to say in response to some of the most pressing questions about ovarian cancer:
Q: What is the current state of screening for ovarian cancer?
Chern: Ovarian cancer is very difficult to screen. We don’t have excellent tools available to us. The best way to screen or to prevent ovarian cancer is to have well woman exams, seeing your gynecologist every year and having an exam that can identify pelvic masses that otherwise wouldn’t be detected. We have ultrasounds and tumor markers, but unfortunately by the time there are positive tests, it’s usually a sign that something has already happened.
Q: What kind of clinical trials are available for ovarian cancer patients?
Wenham: We’re all excited that we got FDA clearance to proceed with a clinical trial for a new form of immunotherapy for ovarian cancer. It’s a form of therapy that uses a patient’s immune cells, and then reengineers them to look for a marker that seems to be expressed very selectively on ovarian cancer cells and in a high proportion of ovarian cancer cells. Hopefully in the next few months we’ll be able to start enrolling patients.
Q: What role does genetics play in ovarian cancer treatment and prevention?
Wenham: It’s not only revolutionizing, it has actually defined the field now. Gone are the days where somebody just comes in and gets a one size fits all treatment from their initial diagnosis. One of the things that we have which is really unique among centers is having a whole separate tumor board related to just genetics. We review the findings, and we talk about possible strategies for treating them.
Q: What genetic factors can increase your risk for gynecologic and ovarian cancers?
Barton: Depending on the genetic mutation or the genetic syndrome that somebody has, there’s a spectrum of cancer that we might see. Those BRCA genes that we all hear so much about with breast and ovarian cancer risk gets a lot of press. People sometimes are less familiar with the fact that we can see risk factors for male breast cancer, prostate cancer or pancreatic cancer. Usually, the screening recommendations are based on what specific gene or what syndrome we know a patient has that tells us what steps that we might be able to take to mitigate that risk.
Q: Why is it so important to keep track of your family health history?
Barton: One important reason is it can help guide not just for genetic testing, but also screening. For example, if I have a patient who has a strong family history of breast and ovarian cancers, and she’s aware of all the people in her family who have had cancer, we know what to test for. Even if we do testing and it’s negative, being aware of that family history can help guide screenings or sometimes even preventive surgeries depending on how significant that family history is.
Q: Are gynecologic cancers caused by HPV?
Wenham: HPV is a well-known causative factor for most cervical cancers. It’s also implicated in a lot of other genital tract cancers that include the vagina and the vulva. Although there are some other things like chronic irritation or lichen sclerosis that can also be responsible for those other cancers, for cervical cancer by and large, it’s mainly human papilloma virus.
Q: How can HPV-related cancers be prevented?
Chern: A lot of these are preventative. We have vaccines that can prevent HPV-related cancers and HPV-related diseases. It’s also related to vulva vaginal cancers, anal cancer and other disease sites, including the head and neck region. These vaccines are useful in preventing them and they can be given as young as age 9 and as late as age 45.