Ovarian Cancer: A Physician’s Perspective

DR.LESLIE M. RANDALL is an obstetrician-gynecologist in Orange, Calif. She completed her fellowship training with University of California, Irvine’s Division of Gynecologic Oncology and is skilled in the comprehensive medical and surgical care of women with all gynecologic cancers. Dr. Randall upholds many service commitments, including assistant professor at the University of California, Irvine, School of Medicine and director of education for gynecologic oncology.

BSTQ: Why is ovarian cancer frequently misdiagnosed?

Dr. Randall: In reality, it’s somewhat rare, and the symptoms are very vague. Women complain of feeling bloated and getting full early, but these are symptoms that can occur with multiple benign diagnoses. Added to that is there’s not a good screening method; you can’t diagnose it early because it develops so quickly.

BSTQ: What are some of the most common risk factors?

Dr. Randall: Age is a risk factor. Postmenopause, the risk definitely goes up. Having a family history of breast cancer and ovarian cancer, or being a carrier of a gene mutation called BRCA1 or BRCA2, are known risk factors, as is having a condition called Lynch syndrome, an inherited condition that gives a person a higher risk of certain cancers of the digestive tract, gynecologic tract and other organs.

BSTQ: Are you seeing more women diagnosed with ovarian cancer at a younger age?

Dr. Randall: No. There are a certain number of women who are diagnosed pre-menopause, but most have some mutation. The mutations are definitely genetic; if we identify a mutation, we test blood relatives for that same mutation.

BSTQ: From a patient perspective, what are the advantages of being treated at a university hospital like the University of California, Irving (UCI)?

Dr. Randall: One advantage is the level of surgical expertise a patient has access to. At UCI, we have expertise in ovarian cancer surgery and various types of chemotherapy regimens. Ongoing clinical trials are also available. The other benefit is that we take a multidisciplinary approach to care that includes gynecological oncology, medical oncology, radiation oncology, genetics, nutrition counseling, nursing and interventional radiology. All of that is important to have with an ovarian cancer diagnosis.

BSTQ: Tell us about intraperitoneal (IP) chemotherapy. What are its advantages and risks?

Dr. Randall: This treatment is concentrated in the area where the cancer occurs. IP chemotherapy is delivered through an implanted subcutaneous port that drains into the cavity of the abdomen, allowing direct access for the drug to the peritoneal cavity where ovarian cancer is prevalent. Some clinical trials have shown that treatment with IP and intravenous (IV) chemotherapy extended median overall survival for patients with ovarian cancer by more than a year, compared with women treated with IV chemotherapy alone. IP use, however, can cause more frequent and more severe side effects than IV chemotherapy, including abdominal pain, nausea and vomiting.

BSTQ: Are there any new treatments or promising clinical trials?

Dr. Randall: The most promising trials include the PARP inhibitor, which stands for “poly (ADP-ribose) polymerase.” PARP is a family of enzymes found throughout the body that are needed for a form of DNA repair known as break excision repair. PARP inhibitors offer a much more targeted attack on tumors whose self-repair is already under fire. Olaparib (Lynparza, AstraZeneca) is one of the current U.S. Food and Drug Administration-approved PARP inhibitors for cancer treatment. Immunotherapy is also showing promise. This treatment involves the development of monoclonal antibodies that specifically recognize and attack ovarian cancer cells. These antibodies are man-made versions of the natural antibodies the human body makes to fight infection.

BSTQ: What are some of the best resources for developments in ovarian cancer research and treatment?

Dr. Randall: A few of my trusted resources includethe Society of Gynecologic Oncology (sgo.org),Foundation for Women’s Cancer (foundationforwomenscancer.org) and the National Cancer Institute (cancer.gov).