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Disease Often Found at Its Deadly Late Stages

Posted on: Friday, 9 September 2005, 18:00 CDT

It is not unusual for ovarian cancer to be diagnosed after months or even years of vague symptoms including fatigue, digestive or gynecological complaints. While improved testing has made several other cancers - such as breast and colon - catchable at earlier, more curable stages, ovarian cancer still is typically found at its deadly late stages.

"Three-quarters are diagnosed at Stage III and IV, with bulky tumors in the upper abdomen or beyond,'' said Dr. Stewart Massad, associate professor and chief of the division of gynecology- oncology at Southern Illinois School of Medicine. A Stage III ovarian tumor has spread beyond the ovaries; at stage IV, the cancer has invaded another organ, such as the liver or lungs.

Massad and Dr. John Shaffer, a gynecologist-oncologist at Springfield Clinic, together treated about 25 invasive ovarian cancer cases from all over central Illinois in 2004. (There are several other types of ovarian cancer, including slow-growing or borderline tumors; invasive epithelial cancer is the most common and the deadliest).

Overall, Massad said, the five-year survival rate for advanced ovarian cancer remains at between 20 percent and 30 percent - incrementally better than it used to be but still a devastating diagnosis. (Some recent studies show an improved survival rate; the American Cancer Society now puts the overall five-year survival rate for ovarian cancer at 44 percent, but that includes the 19 percent of cases found at earlier stages.)

Currently, ovarian cancer is typically diagnosed with a combination of a manual exam, a transvaginal ultrasound and a blood marker test called CA-125. The CA-125 is notorious for elevated readings for reasons other than ovarian cancer, especially among younger women who have not gone through menopause.

"The positive predictive value of other screening tests - mammograms, PSA - is very good, such that you can rely on a positive test meaning something," Shaffer said. "An elevated CA-125 is not necessarily equated to ovarian cancer."

To some extent, Shaffer added, "elevated CA-125 keeps the two of us pretty busy ruling out ovarian cancer," referring to Massad's cases as well. "We spend a lot of time telling (patients) they don't need to go to surgery with their elevated CA-125, or telling their physician why they don't have to go to surgery."

In the 30 years that Shaffer has treated gynecological cancers, the big advances have been the recognition of how important it is to eliminate as much cancer as possible in the initial surgery, preferably by a specialist, a gynecologist-oncologist. In addition, new chemotherapies and combinations have added to the treatment options, while other drugs have been developed to counter side effects, such as nausea and dangerously low blood counts. These drugs have made longer-term chemotherapy more tolerable.

Both Massad and Shaffer think the next key development in ovarian treatment will be of multiple markers that help make an earlier diagnosis possible.

"Given what I read in the research, I would hope at least two more markers will be available by 2010, and hopefully earlier than that," Shaffer said.

"I don't think the future is in new treatments,'' he said. "The future is to find it earlier when the cure rate is in the 80 to 90 percent range."

Source: State Journal Register

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