6 Questions With an Ovarian Cancer Expert: Risks, Symptoms, Treatments

Knowing the risks of ovarian cancer is extremely important. Peter Dottino discusses the risks, symptoms and management of the disease.
BY Allie Casey
PUBLISHED October 07, 2016
Being aware of ovarian cancer risks and signs especially is important, as the disease is difficult to detect. However, the prognosis depends on the stage and grade of the cancer – so the earlier the detection the better. Because of this, the risks and symptoms of ovarian cancer is something everyone should know.
 
CURE interviewed Peter Dottino, M.D., director of Gynecologic Oncology at Mount Sinai Health System about the risk factors, symptoms and future in ovarian cancer.

Who is more likely to be at risk for ovarian cancer?

In general, ovarian cancer is a fairly rare disease, compared to other cancers. One in seven or eight women get breast cancer. One in 70 get ovarian cancer.

We know there’s a certain percentage, 15-18 percent, that’s going to be associated with those people carrying the BRCA gene. So knowing your family history is very important. And if you have loved ones who have breast cancer or ovarian cancer, you may want to be tested for the BRCA gene mutation. You could either see your treating oncologist or genetic counselor to see if you should be tested for the BRCA gene.

If you carry the mutation, there’s risk-reducing surgery that you can do, so you can almost eliminate your risk of getting ovarian cancer.

For the majority of people, about 85 percent of people who are going to get ovarian cancer, we still don’t know what gene causes the disease. We don’t know if it’s a single gene or a combination of different genes.

What symptoms should prompt an individual to see their physician about ovarian cancer?

The most important thing that I stress to patients body awareness. They say ovarian cancer is the “silent killer” and there’s no symptoms. Indeed, that’s false. The studies are very clear that there are symptoms.

The symptoms are very vague and at first it’s very different to piece them together. Usually, there’s a patient delay because they think the symptoms – whether it’s bloating, early satiety, frequent urination, pain during intercourse, change in bowel habits, slightly protuberant abdomen – are due to normal aging. When they see a doctor, he may treat for a urinary tract infection, for a diverticular problem or inflammatory bowel disease, because most people don’t think about ovarian cancer because in the general scheme of things it’s a relatively rare disease.

My message would be: if you’re having symptoms in your abdominal area that last more than seven days to two weeks, you should go to your physician and really say, “Prove to me that I don’t have ovarian cancer.” They should do the testing that would be necessary to do that. This way you don’t get blown off, and you don’t ignore symptoms that are representative of early cancer. The earlier that your cancer is detected, the more the curable it is.

Are there any emerging or experimental therapies in ovarian cancer treatment? What will the treatment landscape look like in five or 10 years?

There are a lot of laboratories directed toward finding ways to detect this disease early. In our lifetime, we’re going to see that, especially given this large-scale, multi-scale biology and genomics research going on.

We’ve discovered a way to measure cancer’s DNA in a person’s blood, specifically for ovarian cancer. So it allows us not only to do a better job of monitoring people during treatment, but also when they’re finished with treatment. This also allows us to detect disease almost seven to 12 months before it actually becomes visible, by picking up fragments of DNA in your blood with a simple blood test.

There are also also being discoveries made looking at different ways to do different lavages on your abdomen and then analyze the gene content that you find in the fluid that you take out. This will eventually be done as an outpatient procedure.

The other thing that is coming along is the use of immunotherapy. There’s so much similarity between the genetic mutational burden that ovarian cancer has and these other diseases have, which should make this one of the more ideal diseases to be treated with immunotherapy.

It may be like melanoma, where chemotherapy is no longer used. Or in this disease, it may be a combination of low-dose metronomic chemotherapy with immunotherapy.

Can individuals take any preventative measures to reduce their risk of ovarian cancer?

There’s no question that the most proactive thing you can do is take oral contraceptives, birth control pills. It’s been verified again in a very large-scale study that there seems to be a lower instance across the board in Europe, because so many more people are taking oral contraceptives. There’s no doubt that it does lower your risk of getting the disease.

What are the common adverse effects of ovarian cancer treatments?

No different than with chemotherapy or in immunotherapy.

What is your final takeaway or final note about ovarian cancer?

We always encourage people and their families to participate in the clinical trials that are out there. These clinical trials have gotten a bad rap, but clinical trials are how we move forward in science, by patients contributing to research. I think that’s really critically important.

And again, on the prevention side: listen to your body. If you feel something is not right, go to your doctor and don’t be blown off. Be persistent. For this disease, the earlier you detect it, the better you’re going to do.
 
 
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