Role of Surgery in High-risk Ovarian Cancer

January 11, 2021

Information

January 10, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

ID6066

To CiteDCA Citation Guide

00:00Support for Yale Cancer Answers
00:02comes from AstraZeneca, a
00:04biopharmaceutical business that is
00:06pushing the boundaries of science
00:09to deliver new cancer medicines.
00:12More information at astrazeneca-us.com.
00:15Welcome to Yale Cancer Answers with
00:17your host doctor Anees Chagpar.
00:20Yale Cancer Answers features the
00:22latest information on cancer care by
00:24welcoming oncologists and specialists
00:25who are on the forefront of the
00:28battle to fight cancer. This week,
00:30it's a conversation about the role
00:32of surgery in high risk ovarian
00:34cancer with Doctor Mitchell Clark.
00:36Doctor Clark is an assistant professor
00:38of obstetrics and gynecology in the
00:40division of Gynecological Oncology at
00:42Yale University School of Medicine,
00:43where Doctor Chagpar is
00:45a professor of surgical oncology.
00:48Dr. Clark, maybe we can start off by talking
00:51a little bit about ovarian cancer.
00:53Many people talk about this as
00:56the cancer that whispers, tell us more about
00:58that.
00:59Although ovarian cancer is not the
01:01most common gynecological cancer
01:03that we encounter in our specialty,
01:05it is unfortunately the cancer that
01:07accounts for the greatest morbidity
01:09as well as the greatest mortality
01:11among the diseases that we do treat.
01:13You're absolutely right in saying that
01:15this is the cancer that whispers because
01:18unlike a lot of the other
01:20cancers we see in our practice,
01:22the symptoms of ovarian cancer are
01:23very nonspecific and often very vague.
01:25Tell us more about
01:28what those symptoms might be,
01:29because I'm sure that there are
01:31listeners out there going great,
01:33so there's a cancer that is
01:35potentially lethal that has
01:37symptoms that are really vague.
01:39How am I gonna know if I have this?
01:41Absolutely, for
01:43the most part, these symptoms occur as the
01:46ovarian tumors grow and as you can imagine,
01:48it starts off with a very small tumor
01:50and progressives to something that
01:52causes a lot of pressure in the pelvis.
01:54So I tell women anytime you feel
01:56that there's pain or pressure
01:58in the pelvis or in the abdomen,
02:00that's something that's concerning and should
02:02be brought up with your gyencologist.
02:04Beyond that, we do tell women to be
02:06aware of any changes in their weight,
02:09either weight loss or
02:09weight gain, and sometimes it
02:11can be as simple as something as
02:13bloating or a bit of constipation
02:15that is just out of characteristic from what
02:18they have been experiencing in the past.
02:20We do know that ovarian cancer tends
02:22to occur in women as they get older,
02:25particularly those who are
02:26past menopause.
02:27However,
02:27there still can be many cases of
02:29ovarian cancer in women that are
02:31younger than the menopausal status,
02:33and it's important to keep this in
02:35mind when gynecologists as well as
02:37primary care physicians are seeing
02:39patients with these vague symptoms.
02:52There are some rare
02:54types of ovarian cancer that behave very
02:57differently than the more common types
03:00that we see in the older population,
03:02and these can happen in young girls.
03:05So it is important that mothers and young
03:08daughters present to their pediatrician
03:10with any of these similar complaints
03:13related to increase in abdominal
03:14pain or a bit of bloating,
03:16or noticing something
03:19uncharacteristic compared to what it has
03:21perhaps been in the past as they were
03:23developing as an adolescent.
03:26Doctor Clark when we
03:27think about all of these symptoms,
03:29especially around
03:31the holiday time, it's pretty
03:33common to get a little
03:35bit of weight gain or in some
03:38of our cases a lot of weight gain,
03:40a little bit of bloating,
03:42a little bit of constipation.
03:44When is there a trigger point at
03:46which you say, this has
03:48been going on for X amount of time,
03:50I need to go and see the doctor,
03:52or is it really
03:54kinda see how it goes and if it gets
03:56to a point that's concerning to you,
03:58that's when you should see a doctor.
04:00Can you give us a little bit of a clue?
04:03Because some of these are so non specific,
04:05I'm sure all of our listeners
04:06are listening to this going,
04:08yep, I've had weight gain,
04:09I've had Constipation, I've had bloating.
04:11Oh my God,
04:12do I have an ovarian tumor?
04:14This is something that we're hearing
04:16very commonly or especially now
04:18during Covid with many people at
04:20home tending not to be as active,
04:22perhaps as they were before Covid.
04:24Many of the gyms and fitness regimens that
04:26our listeners were probably more engaged
04:28with pre covid are just not available,
04:31so we are finding patients
04:32coming in with these concerns,
04:34especially related to the
04:35bloating and weight gain.
04:37I tend to tell women that if they experience
04:39these symptoms that persist despite
04:41changes in their diet or perhaps
04:44their level of exercise that go
04:45beyond a few weeks to a month,
04:47these are things that should
04:49be brought to the attention of
04:50their primary care doctor,
04:51or they're gynecologist
04:53especially because these are very
04:54vague symptoms and I don't want
04:56to alarm our listeners and to say
04:57that everyone with Constipation or
04:59everyone with a bit of bloating is
05:01likely to have an ovarian tumor,
05:02but I think it is important for both
05:04the patient and the provider to keep
05:06these things in the back of their
05:08head as we try to identify as many
05:10women as possible in the early stages
05:12of this very challenging disease.
05:14And do you find that people with
05:17ovarian tumors tend to present with
05:19things that may signal
05:21a loss of ovarian function?
05:23Often times when we have tumors
05:25in various parts of the body,
05:28it'll affect the actual
05:30functioning of that organ.
05:31So when we think about ovaries and we
05:34think about production of estrogen,
05:36for example, people may
05:38have hot flashes, and so on and so
05:41forth as they go through menopause.
05:43But with ovarian cancer, if you
05:46don't have those symptoms,
05:47does that mean that that's likely OK?
05:49Or how often would you find
05:52people presenting with an ovarian
05:53tumor that actually presents with
05:55things like hot flashes and vaginal
05:57dryness and things like that?
06:02For the most part, these tumors do occur in women
06:04as they have exited menopause
06:06and so the ovarian function is
06:08already at baseline, quite low.
06:10But even in those women who are still
06:12having regular menstrual periods,
06:14who are perhaps in their late
06:1630s or early 40s?
06:18We haven't seen as much of a
06:20relationship between the hormonal
06:22status in the hormonal symptoms
06:24and a link between that in an
06:27underlying ovarian pathology.
06:28So so important for people
06:30to recognize that because they
06:32may be saying to themselves,
06:34while I'm not having
06:36hot flashes, I'm not
06:38having tremendous pain,
06:40but it really is a cancer that
06:42whispers the other question that
06:44our listeners may have is if you've
06:47had a history of ovarian cysts,
06:49often times people have gone
06:51to the gynecologist and maybe
06:53had an ultrasound or something,
06:56and they've been told, oh
06:57you've got ovarian cysts.
06:59Does that increase their risk of
07:01ovarian cancer?
07:04So ovarian cysts are a very normal part of every woman's menstrual
07:06history and reproductive history.
07:08Every time the cycle occurs,
07:10a cyst develops on the ovary and should
07:13regress after each menstrual cycle.
07:15What's important to remember is that
07:18as women exit menopause and are no
07:20longer having regular menstrual periods,
07:22cysys should not form
07:24regularly, and they should certainly
07:26not progress and become larger and
07:28more complex appearing on ultrasound
07:30or any sort of imaging.
07:32So just because a woman has had this in
07:34the past does not necessarily mean that
07:37she will go on to develop an ovarian cancer,
07:40but it is important for women who do
07:43have cysts, that may have suspicious
07:45findings on imaging that she follows
07:47regularly with her gynecologist to
07:49decide if and when it merits a referral
07:51to an oncologist for a more specialized opinion.
07:54Are there any women who
07:56are particularly at risk of getting
07:58ovarian cancer, or is this kind
08:00of an equal opportunity killer?
08:02There are a number of risk factors that
08:05make a woman more likely to experience
08:07an ovarian cancer in her lifetime.
08:09One of the strongest is family history,
08:12and when we think of family history,
08:14it can be divided into those women
08:16who have a known family history of a
08:18genetic syndrome that may make them
08:21more likely to experience a number of
08:23different cancers and those who are
08:25not necessarily related to a known
08:27genetic syndrome,
08:28but do have family members,
08:31grandmothers, mothers perhaps who
08:32did experience an ovarian cancer.
08:35And the other category would be
08:37those that do have a known genetic
08:39predisposition so those who are
08:42related to the BRCA gene and many
08:44women are familiar with that genetic
08:46syndrome as it relates to risk of
08:49breast cancer and ovarian cancer.
08:51But we are also understanding that
08:53there are other hereditary cancer
08:55syndromes like Lynch syndrome
08:57that can also increase a woman's risk of
08:59developing certain types of ovarian cancers,
09:01so it is important in those women who have
09:04strong family histories of cancers to
09:06speak with their primary care doctor,
09:08or if they do have an oncologist
09:11to consider genetic testing
09:12if it is indicated so that we can
09:14identify those women whom perhaps
09:16could benefit from some type of
09:18prophylactic procedure to reduce their
09:20risk of developing ovarian cancer
09:22down the road.
09:24What about women who don't have a family
09:26history or genetic predisposition?
09:28How common or uncommon is ovarian
09:30cancer in those women?
09:32In those who don't have those
09:33strong family risk factors,
09:35the risk is about 1 to 3% for their lifetime.
09:38Now that's quite small in comparison
09:40to some of the other cancers that
09:42we see in the gynecological tract,
09:45but the issue is that even though
09:47it is rare, like I mentioned,
09:49being that this disease does
09:50account for so much morbidity,
09:52and unfortunately,
09:53survival rates are just not as good as
09:56they are for the other cancers.
10:02And when we talk about
10:05high risk ovarian cancer,
10:06what exactly is that?
10:08Are there certain ovarian cancers
10:10that are more likely to result in
10:13morbidity and mortality than others?
10:15So as you mentioned
10:16regarding those cancers that do
10:18occur in the very young women,
10:21typically are less aggressive cancers and
10:23those younger patients do experience
10:28the more common type of ovarian
10:30cancers that we see,
10:32which we call high grade
10:35serous and this is a subtype of ovarian
10:37cancer that is quite bad behaving,
10:40but unfortunately is the most common
10:42type that we see and is the one that
10:45does present at advanced stage.
10:50I wanted to kind
10:52of delve a little bit more into that,
10:55so if women present with these kind
10:57of vague symptoms and they've
10:59listened to this show on Yale Cancer
11:02Answers and they've decided to
11:04go and talk to their primary
11:06care physician or their gynecologist,
11:08how is that worked up?
11:10I mean, what should women expect
11:12as they advocate for themselves
11:13and making sure that if they have
11:16an ovarian cancer it's found,
11:18or at least that it's ruled out.
11:21The thing I want to get across, and it's very
11:24important is that we do not have any
11:26screening test for ovarian cancer,
11:28and so women who've had a pap
11:30smear and a physical exam as
11:32part of their annual assessment.
11:34cannot necessarily be reassured that they
11:36do not have an underlying ovarian cancer,
11:39so women who have these symptoms that
11:41we've talked about should expect their
11:43doctor to perform a very thorough physical
11:46exam that does include a pelvic exam,
11:48and then usually this is
11:50followed up with some imaging,
11:52either by ultrasound or CT scan in
11:54conjunction with some blood tests
11:56that may help point their doctor in
11:58the direction that this may be an
12:00ovarian cancer that requires evaluation
12:02by a gynecological oncologist, and
12:04so women who are in
12:05the High risk group,
12:07so those women who have a
12:09very strong family history,
12:11the women who have a genetic predisposition,
12:16people who are at very high risk,
12:18there are some more advanced
12:20screening techniques.
12:21There's nothing for ovarian
12:23cancer in terms of blood tests
12:25or routine CT or ultrasound
12:27evaluations
12:28despite several large international trials,
12:30we have not been able to identify a
12:33modality of screening that has shown
12:36to reduce the incidence of this cancer,
12:38or to identify at a stage where
12:40we could intervene and make a
12:42significant difference in outcomes.
12:44Having said that, however,
12:45those women who do know that they harbor
12:48an underlying genetic predisposition
12:50to cancer like the BRCA gene,
12:52or Lynch syndrome, should
12:54follow regularly with a gynecologist
12:56who can talk to them about some of the
12:59increased surveillance that we can do,
13:01or perhaps intervention through surgical
13:03removal of the tubes and ovaries.
13:06At a stage prior to the development of a
13:08cancer that may be appropriate depending
13:10on the person's underlying genetic mutation.
13:14Yeah, so you're talking about
13:16removing the ovaries and the tubes
13:19before they get a cancer to reduce
13:21the risk that they will get a cancer.
13:24Does it reduce the risk to zero?
13:34Unfortunately, it
13:35is not absolutely 0, but it is quite close.
13:38It does bring the risk down to a
13:42below 4%. There are some
13:44inherent risks
13:46related to the lining
13:48of the abdomen called the peritoneum.
13:50This is an area of tissue that is near to
13:53where the ovary and tube would have been,
13:56but after removal of tubes and ovaries
13:58in a woman that's very high risk
14:01given her genetic predisposition,
14:02her risk is significantly reduced compared
14:04to what it would have been if she had not
14:08undergone that prophylactic procedure.
14:09Well, that's great information
14:10for people to know. We're going to
14:13learn much more about the surgical
14:15management of high risk ovarian cancer
14:17after we take a short break for a
14:21medical minute, please stay tuned to
14:24learn more with my guest
14:26Doctor Mitchell Clark.
14:27Support for Yale Cancer Answers
14:29comes from AstraZeneca, dedicated
14:31to providing innovative treatment
14:33options for people living with
14:36cancer. Learn more at astrazeneca-us.com.
14:37This is a medical minute about Melanoma.
14:40While Melanoma accounts for only
14:41about 4% of skin cancer cases,
14:44it causes the most skin cancer
14:46deaths. When detected early
14:48however, Melanoma is easily treated
14:50and highly curable. Clinical trials
14:52are currently underway to test
14:54innovative new treatments for Melanoma.
14:56The goal of the specialized
14:58programs of research excellence
15:00in skin cancer or SPORE grant is
15:02to better understand the biology
15:04of skin cancer with a focus on
15:07discovering targets that will lead
15:09to improved diagnosis and treatment.
15:11More information is available
15:13at yalecancercenter.org.
15:14You're listening to Connecticut Public Radio.
15:19Welcome
15:19back to Yale Cancer Answers.
15:21This is doctor Anees Chagpar
15:23and I'm joined tonight by my
15:26guest doctor Mitchell Clark.
15:27We're talking about the role of surgery
15:30in high risk ovarian cancer and
15:32right before the break Mitchell
15:35you talked about the fact that in
15:37women with a genetic predisposition,
15:39even though you can remove
15:41the tubes and ovaries,
15:43it doesn't reduce their risk down to zero.
15:46You can still get cancer on the peritoneum.
15:49That lining of the abdominal cavity.
15:51Although it does reduce your
15:53risk quite substantially,
15:55so my next question is in women
15:58who have been found to have ovarian cancer,
16:01we talked a little bit about the fact
16:04that this is a cancer that really
16:07presents with very nonspecific symptoms.
16:09You go to your gynecologist,
16:11or to your family physician,
16:13they do a thorough physical exam and
16:16then maybe an ultrasound or a CT scan.
16:19What happens next in terms of
16:22making the diagnosis?
16:24So after the results of these tests,
16:26many patients will refer to meet
16:28with myself or one of my colleagues
16:31to discuss whether or not all of
16:33the different aspects of the work
16:35up are pointing in the direction
16:37of an ovarian cancer. Typically,
16:39most women will come with the CA 125,
16:42which is a blood test that helps
16:44us understand if the findings
16:45on the CAT scan are consistent
16:47with the possible ovarian cancer.
16:49However, I do want to clarify
16:52for our listeners that this is
16:54not a test for ovarian cancer.
16:56It is really just one piece of the
16:59diagnostic evaluation that we undertake
17:00to help understand if the symptoms
17:02are related to an ovarian cancer.
17:04So once patients are referred to meet
17:07with us and these results are pointing
17:09us in the direction of an ovarian cancer,
17:12then we have to decide whether or not this
17:15patient is best suited by starting with us,
17:18an operation or a surgical
17:19removal of her ovarian cancer,
17:21or whether or not we need to
17:23consider starting with treatments
17:25such as chemotherapy.
17:26And we've really evolved over the last
17:29five to 10 years in understanding how
17:31to triage women to the appropriate
17:33first step in their cancer treatment.
17:36And how is that decision made?
17:38So we historically would take all
17:40women to surgery initially and there
17:43was significant morbidity associated
17:45with these very complex operations that
17:48involve removing all of the different
17:50areas of the abdomen and pelvis where
17:53we found these cancerous tumors.
17:55However,
17:56now we understand through rigorous
17:58international trials that there
18:00are women who actually benefit
18:02from starting with chemotherapy.
18:04Ovarian cancer is a very
18:06chemosensitive disease, as we call it.
18:08In that these cancer cells do
18:10respond to that systemic treatment
18:12and shrink the tumors down.
18:15In order for surgery to be
18:17accomplished with less morbidity
18:19and then perhaps in the past,
18:21just like in systemic treatment like
18:23immunotherapy and PARP inhibition,
18:25we're trying to do that same type of
18:28precision medicine in surgery as well.
18:30We want to look at each patient
18:32very individually and assess her
18:34underlying risk factors or underlying
18:37health status in order to decide,
18:39is this a patient who should
18:41be initially operated on,
18:43or is this a patient who for other
18:46reasons should start with chemotherapy
18:48and both of those options have been
18:51found to be equally efficacious.
18:53But oftentimes when we talk
18:55about treating people with chemotherapy,
18:57especially targeted
18:58therapy and immunotherapy,
18:59oftentimes there is a biopsy done
19:02that'll look at the tumor and tell
19:05us whether it has certain receptors.
19:07For example, in breast cancer,
19:09we talk about HER 2
19:11which is also found in other cancers.
19:14For immunotherapy we often look at
19:16checkpoint inhibitors PD one PDL1
19:18and so on, but thus far in the work
19:21up we haven't heard about a biopsy.
19:24So how do you make that decision of,
19:27we're going to treat
19:29with chemotherapy versus surgery
19:31or immunotherapy versus surgery?
19:32And what kind of systemic therapy to use?
19:35That's a great
19:37point. So when patients are first considered,
19:39whether or not they should
19:41go down the route of surgery.
19:43Or whether they should go down
19:45the road of chemotherapy.
19:47If chemotherapy is felt to be
19:48the best option for that woman,
19:50we do get a biopsy.
19:52As we mentioned, most ovarian
19:54cancers do present at advanced stage,
19:55unfortunately,
19:56but this does allow us to obtain
19:58a biopsy of one of these
20:00metastatic lesions somewhere
20:01in the abdomen and pelvis.
20:03In order to ensure that we do
20:05have the correct diagnosis,
20:06this also allows us to begin the
20:08process of undertaking genetic
20:10testing of the tumor so that we can
20:12understand what types of targeted
20:14therapies may benefit this patient.
20:15For women who go to surgery,
20:17that tumor will be sent to our expert
20:20pathologist during the operation so
20:21that they can have a look under the
20:24microscope while the patient is asleep
20:26in order to confirm that this
20:28is an ovarian cancer.
20:29By the time the patient sees us in the
20:32office with the combination of CA 125,
20:34the CT scan images as well as
20:36the distribution and location
20:38of the disease on the imaging,
20:40most times we are able to make a
20:42presumptive diagnosis of ovarian cancer,
20:44but you're very correct in saying
20:46before we initiate any type
20:48of systemic treatment,
20:49we do ensure that we have confirmation
20:51of the type of cancer that this is.
20:55I want to look at both of
20:58those arms of the tree individually.
21:00For patients who go to surgery,
21:02one of the things that you said was that
21:05the surgery tends to be quite extensive.
21:09And so walk us through what
21:12that surgery actually looks like.
21:14I mean, do you start by by doing a
21:16kind of surgical biopsy of the tumor
21:19and sending that to your pathologist?
21:21Do you take out the whole ovary
21:23and then what are all of these
21:26surfaces that you were talking
21:28about that are actually removed
21:30if the diagnosis of ovarian
21:31cancer is confirmed?
21:33So when women are taken to surgery,
21:35we are trying to make the decision of
21:38whether or not the disease can be removed
21:41in its entirety and what I mean by that
21:44is the goal of surgery in ovarian cancer,
21:47whether or not that surgery happens
21:48at the beginning of her cancer journey
21:51or whether it happens after some
21:53chemotherapy is to remove all of
21:55the visible ovarian cancer tumors.
21:56Now the ovary is open to the abdomen
21:59and pelvis inside a woman's body,
22:01and so these cancer cells have a
22:03tendency to try to get out and escape
22:06and attach to that peritoneum that
22:08I talked about before that can land
22:10on various surfaces
22:12working throughout the abdomen and
22:14pelvis and so it's important that we
22:17review those images prior to taking
22:19one with the surgery so that it helps
22:21us understand how extensive an
22:23operation might be. For some women
22:25their surgery might include removing
22:26the ovaries, the uterus, cervix,
22:28as well as the omentum,
22:30which is a fat pad that lays over the bowel,
22:33but for some women their
22:35surgery may be more extensive,
22:37including removal of perhaps the spleen,
22:39a segment of the bowel,
22:41every woman's cancer surgery
22:43is very individualized to her disease.
22:46And we take a great deal of time in ensuring
22:49that we select patients to take to surgery
22:52who are good candidates to have
22:54all of the visible tumors removed.
22:56We know from decades of research
22:58that the only value in surgery in
23:00ovarian cancer is when we can remove
23:02all of the visible disease if not
23:04down to a very tiny amount.
23:06If we don't feel that that
23:08can be achieved upfront,
23:09women will be triaged to that
23:11chemotherapy arm of the decision-making
23:13tree so that we can shrink down
23:15the disease at the outset.
23:17And then perform an operation at a later
23:19date that removes all their visible cancer.
23:22You know when you put it that way
23:24Doctor Clark, it sounds like the best
23:26option for the majority of women would be
23:29to have systemic therapy first, because
23:31if the cancer was resectable,
23:34having the chemotherapy first would shrink
23:37it down and still make it resectable,
23:40if not more resectable.
23:42And if the tumor was quite extensive,
23:45having chemotherapy or systemic therapy
23:48first would shrink that and make that
23:52option of surgery more attainable so
23:55it would seem to me that the
23:57patients in whom surgery first was a
24:00recommendation would be quite small.
24:02Is that right?
24:05Yeah, size is one of the characteristics that we look at in
24:07helping decide which patients will
24:09benefit from surgery at the outset.
24:11For patients who have disease that
24:13is beyond a certain size or located
24:16in multiple different places,
24:17we do know from research that those
24:20patients do benefit from this
24:22pre treatment with chemotherapy
24:23in order to reduce
24:25the size of their ovarian cancers,
24:27and as we've been discussing a lot today,
24:30most women do unfortunately present
24:31with this metastatic picture,
24:33and so we are finding more and more
24:35utility in using the chemotherapy at the
24:38outset of a patient's cancer journey.
24:40But I just want every listener to
24:42know if they do encounter a personal
24:44experience with ovarian cancer,
24:46that both options should be considered,
24:48and that's why it's so important that
24:50gynecological oncologist is involved
24:52in that decision making at the very
24:54beginning of her cancer journey.
24:57Is there a disadvantage to
24:59pursuing systemic therapy first,
25:00even if you have a small tumor
25:03and it's confined to the ovary?
25:06Would there be a disadvantage
25:09to doing systemic therapy first,
25:11could you avoid systemic therapy
25:13if you had surgery first?
25:16Ovarian cancer treatment is really a
25:18medley of chemotherapy and surgery,
25:20and the question is what
25:22combination and in what order?
25:24We do know for women that
25:27have smaller disease burden,
25:29that's typically confined to the ovary,
25:31or perhaps in locations,
25:33that would not require
25:35multiple surgical procedures,
25:37that they do actually have a survival
25:39benefit to initiating their treatment
25:41with surgery followed by chemotherapy.
25:44On the flip side,
25:45as we have mentioned,
25:47those with significant amount
25:49of disease in various locations
25:51have been shown to benefit from
25:53receiving the chemotherapy first.
25:55We almost never treat with
25:57one without the other,
25:58and this disease has been something
26:01that has been traditionally
26:03treated with both a combination of
26:05those two of those two options.
26:08And so where do you see
26:10therapy moving in the future?
26:12What are the exciting
26:14developments that you've seen,
26:15say in the last year or so?
26:18What are the exciting things
26:19that are coming down the pike
26:21that women who may be facing
26:23ovarian cancer should know about?
26:26Well, our dream in ovarian cancer is
26:28to see this disease detected at its
26:31preclinical or very early stages and
26:33the ability to detect this through a
26:36simple blood test or screening test
26:38would really revolutionize ovarian
26:40cancer treatment and the experience
26:42for patients who do face this disease.
26:44There are many groups who are working
26:46on developing tests like this,
26:48but they really are in the research
26:51setting only and until then we need to
26:53focus on how best to manage patients
26:56who present with advanced disease.
26:58We've seen a number of approvals and
27:00new drugs and new therapies in ovarian
27:02cancer just in the last one to two years.
27:05And when we think back to 10 years ago,
27:08the number of different treatments
27:10that a patient would have open to
27:12her are significantly increased,
27:14and we're excited to be able to
27:16offer patients treatment that can
27:18even be taken of an oral tablet once
27:21or twice a day at home.
27:22That may help reduce their risk
27:24of ovarian cancer coming back,
27:26we even see patients who
27:28experience ovarian cancer survival as
27:30a chronic disease and until we can
27:33develop a reliable screening tests
27:35that can detect this very early,
27:37we hope to improve outcomes and
27:40extend survival as long as possible,
27:42perhaps even until the next
27:46best thing comes down the pipeline.
27:48I mean,
27:49it certainly sounds exciting,
27:51especially when you think about
27:53where we started this conversation,
27:55which was talking about how ovarian cancer
27:59is a disproportionate killer of
28:01women with cancer as opposed to
28:03other gynecologic malignancies
28:05but the concept of finding it
28:07early and finding new treatments,
28:10especially oral treatments,
28:11is certainly exciting.
28:12Which brings me to my last question,
28:15which is,
28:17this era of Covid has made us all think
28:21a little bit more creatively about
28:24how we treat patients with cancer.
28:28Trying to avoid having them in
28:30hospital settings and so on.
28:31How has this affected your practice
28:34in terms of treating patients
28:35with ovarian cancer and what are
28:37some of the options that women
28:40have availed themselves of
28:41that they may not have
28:43previously?
28:46I have to say, one of the saddest things to see in the covid
28:49era is women who come in with delayed
28:51diagnosis and I know that that stems
28:54from personal concern of exposure and
28:56going into their health care providers.
28:59But I would encourage all women to reach
29:01out to their practitioners in order
29:03to establish either a telephone or a
29:05video visit so that they can have some
29:07time to meet with their practitioner
29:09and discuss some of the symptoms
29:11that we've been talking about today.
29:13We have really revolutionized our
29:14ability to access patients in their
29:16home environment or in an environment
29:18that is most convenient for them,
29:20and I hope the telephone and video
29:22video visits will be something that
29:24we can continue to use as we move
29:26forward outside of the covered
29:27area so that we can provide
29:30really meaningful and convenient care
29:32to people when they need it most.
29:35Doctor
29:35Mitchell Clark is an assistant professor
29:38of obstetrics and gynecology in the
29:40division of Gynecological Oncology
29:42at the Yale School of Medicine.
29:44If you have questions,
29:45the address is canceranswers@yale.edu
29:47and past editions of the program
29:49are available in audio and written
29:51form at yalecancercenter.org.
29:53We hope you'll join us next week to
29:55learn more about the fight against
29:58cancer here on Connecticut Public Radio.