Several tests, surgeries, and a biopsy later, LaCamera, who lives in Sudbury, Massachusetts, was diagnosed with stage 3 ovarian cancer. “I was just like wow,” she recalls. “When I look back, I think about the symptoms I disregarded.” LaCamera says she “always felt discomfort and excused it.” She had frequent urination and pain in her abdomen, pelvis, and back. She also had bloating, or as she called it, a tummy roll. “No matter what I did for exercise I couldn’t get rid of it,” she says. She thought she was just getting older. When LaCamera went in for surgery, doctors found that her cancer had spread to 11 different organs. LaCamera isn’t alone in missing the symptoms of ovarian cancer. “The common symptoms of ovarian cancer are nondescript,” says Bobbie J. Rimel, MD, the director of cancer clinical trials and an associate professor in the department of obstetrics and gynecology in the division of gynecologic oncology at Cedars-Sinai Medical Center in Los Angeles. That’s why the cancer is usually not caught until later stages, when it can be deadly. “It’s a really tricky thing. My heart breaks for all these women who go from doctor to doctor [looking for answers],” Dr. Rimel says. Ovarian cancer is the second most common gynecologic cancer in the United States. It also accounts for more deaths than any other cancer of the female reproductive system, according to the Centers for Disease Control and Prevention (CDC).
Catching Ovarian Cancer Early
Research has led to better ways to detect high-risk gene mutations and assess a woman’s ovarian cancer risk, according to the American Cancer Society (ACS). If caught at stage 1, the survival rate for ovarian cancer is about 93 percent, per the ACS. At later stages, the survival rate drops down to 75 and 31 percent. Currently, the CA-125 blood test, which measures the amount of the protein cancer antigen 125 in the blood, isn’t accurate enough to screen for ovarian cancer, states the Ovarian Cancer Research Alliance. That’s because conditions such as menstruation, pregnancy, and uterine fibroids can increase the level of CA 125 protein and lead to false-positive results. The test can be used reliably only to monitor women with known ovarian cancer, says Rimel. But in a study published in 2017 in the journal eLife, a screening blood test for ovarian cancer developed by researchers at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute was shown to be more sensitive and specific with far fewer false positives. “It could be a game changer in detecting early stage ovarian cancer,” says Dipanjan Chowdhury, PhD, a professor of radiation oncology at Dana-Farber Cancer Institute in Boston and a coauthor of the study. The test monitors part of the genome known as microRNA, which are secreted into the blood from cancer or precancer cells. Specific patterns of microRNA can be used to detect ovarian cancer. With blood samples collected at Dana-Farber and other institutions from about 1,000 patients, Dr. Chowdhury says the test was able to diagnose the disease 99.1 percent of the time. But an accuracy rate of 99.9 percent or higher is what’s needed, Chowdhury says, in order to test the general population. “If you test 100,000 women with this accuracy [99.1 percent], we’re going to falsely diagnose 890 women with this test right now. That’s not okay. It is too high.” Currently, there is a clinical study underway at the Center for BRCA and Related Genes at Dana-Farber, called the MiDe Study, to check the accuracy of the test on high-risk patients, and potentially improve it. In a study published in Radiology in March 2022, researchers developed a new ultrasound scoring system that may be an easier way to determine whether tumors in the fallopian tubes and ovaries are potentially cancerous and need a further work-up, says Deborah Baumgarten, MD, a professor of radiology at the Mayo Clinic in Jacksonville, Florida. “This can potentially spare women from having unnecessary surgery,” says Dr. Baumgarten, who wrote a review of the study in Radiology. When investigators from the University of Rochester Medical Center, in New York, tested the system in 878 women at average risk of ovarian cancer, they found it was sensitive enough to pick up malignancies 93 percent of the time with 73.1 percent accuracy. By examining genetic differences between cancer cells within the same tumor, scientists can hone in on the best treatment for patients. By combining ultrasound images with computed tomography (CT) images, researchers at the University of Cambridge in England developed a new technique to do precision tissue sampling of tumors that can create a visual guide and result in fewer and more accurate tumor biopsies. In a study published in 2020 in European Radiology, investigators tested the technique in six patients and found it was more accurate to map and identify tissue samples for biopsy from large pelvic tumors than ultrasound alone, but cautioned that the technique still has to be tested in larger studies.
Fighting a Barrier in Treatment: Drug Resistance
People undergoing treatment, like LaCamera, can sometimes develop resistance to common chemotherapies, targeted therapies, and immunotherapies. While platinum-based chemotherapy is the first line of treatment for most ovarian cancers, it doesn’t always work for some patients, because their cancer either progresses or reoccurs. Drug resistance in chemotherapy is one of the main obstacles to beating cancer, because patients who develop drug resistance usually have a recurrence very quickly, according to Alessandro Santin, MD, a professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine in New Haven, Connecticut. That’s why he and other researchers across the country are evaluating the use of novel drug combinations to treat ovarian cancer when other drugs fail. In a study published in June 2022 in the British Journal of Cancer, Dr. Santin and colleagues examined the effectiveness of combining chemotherapy drugs ixabepilone and bevacizumab and compared it with ixabepilone alone for platinum-resistant ovarian cancer. They noticed an improvement in the time it took for the cancer to progress or worsen and the overall survival rate in the 76 patients who received the combination therapy compared with 37 patients who received ixabepilone alone. Cancer in the combination therapy group did not grow or spread for 5.5 months versus 2.2 months in the single therapy group, while the overall survival rate was 10 months and 6 months, respectively. “We’re not going to cure these patients. We want to prolong life here,” says Santin. In a study from the January 2022 Journal for Immunotherapy of Cancer, researchers looked at the safety and efficacy of camrelizumab plus famitinib in 37 patients with recurring ovarian cancer who had various degrees of resistance to standard platinum-based chemotherapies. Nine patients (24.3 percent) had a positive response to the combination therapy. It either shrank their tumors or their cancer remained stable while on the medication. Though the results were “encouraging” and side effects were “manageable,” the drug combination needs to be tested against individuals who do not receive the medication for comparison.
Finding the Treatment That Works
Since her diagnosis in February 2018, LaCamera has had two surgeries and five different chemotherapies, including two clinical trial therapies. It was in a research study she enrolled in from February 2020 until September 2020 that she experienced encouraging results. She had surgery the following month to remove a residual tumor and went into remission in early 2021. “That was the magic one,” she says. Without the help of her doctors identifying a suitable clinical trial, LaCamera says she wouldn’t be alive today. “But we need better detection to beat this insidious disease.”
