Ovarian Cancer: The Whispering Cancer
Sep 02, 2021 Cedars-Sinai Staff
With no effective screening available, limited public awareness and no readily detectable early symptoms, ovarian cancer is sometimes called the "whispering cancer."
"Compared to breast cancer, ovarian cancer is 10 times less common," says Dr. Kenneth Kim, director of Gynecologic Oncology at Cedars-Sinai. "Everyone knows someone who had breast cancer, and because of that, the awareness is much higher—the entire NFL wears pink during Breast Cancer Awareness Month, but most people don't know when to wear teal. It's almost a faux-pas to talk about gynecologic cancers."
The American Cancer Society estimates 21,410 women will receive a new diagnosis of ovarian cancer and 13,770 will die of the disease in 2021. It's the fifth-leading cause of cancer death in women, accounting for more deaths than other cancers of the female reproductive system.
"It's the whispering cancer. The way it comes about is insidious—so that's a problem."
Listen for the whisper
To date, no effective screening methods—either through lab work or imaging—have been found for identifying ovarian cancer. When patients do have symptoms, they tend to be symptoms that can have many causes and are easily dismissed.
"It's the whispering cancer," Dr. Kim says. "The way it comes about is insidious—so that's a problem."
Some of those symptoms include bloating, abdominal pressure, a feeling of fullness, diarrhea, constipation, acid reflux and nausea.
While these symptoms can have many causes, and ovarian cancer is rare, Dr. Kim encourages anyone who notices these symptoms lasting beyond a couple of weeks to pay attention to them and seek out care from their primary care physician or general OB-GYN.
"If you have symptoms that are lingering, seek care," he says. "Waiting on these symptoms is what leads to more advanced cancer."
PARP inhibitors a promising development
One of the most promising advances in treatment of ovarian cancer are PARP inhibitors, drugs that work by blocking a certain protein in cancer cells. When single-stranded DNA is damaged, this protein helps repair it.
BRCA cancer cells rely on this protein, as they cannot perform DNA repair when they have the BRCA mutation. If cancer cells cannot repair themselves, they will die, potentially slowing the progression of the cancer. The drugs can be used to treat cancer and they can also be used to delay or prevent recurrence of cancer.
"These kinds of targeted therapies really changed the landscape for how we treat ovarian cancer," Dr. Kim says. "They were the biggest advancement in treatment in 30 years."
Prior to the development of these targeted drugs, chemotherapy treatments for ovarian cancer had remained largely unchanged over the last several decades.
Because a relatively small number of people are diagnosed with ovarian cancer, research takes longer simply because it's more difficult to find an adequate number of patients to fill up and power a clinical trial. Because it's both a rarer cancer and a women's cancer, funding for research can be scarce, Dr. Kim says.
"We have a handful of PARP inhibitors to treat ovarian cancer now, and we have more developments on the horizon," he says. "We're in the era of immunotherapy and targeted therapy in cancer, and those treatments are in development for ovarian cancer, too."
Immune checkpoint inhibitors are a promising type of immunotherapy in use for other cancers that could become an ovarian cancer treatment. These drugs block proteins called checkpoints that prevent the immune system from producing too strong of a response and harming the body. Cancers can sometimes use these checkpoints to their advantage. Checkpoint inhibitors block these proteins, clearing the way for T cells to more effectively attack cancer cells.
Always seek expert care
Dr. Kim was drawn to gynecologic oncology because it provides, in his words, "the ultimate continuity of care." From diagnosis, through surgery and medical treatment until a patient's cancer is cured, gynecologic oncologists are with their patients for the entire journey.
One reason he was excited to come to Cedars-Sinai is because it is a long-standing, highly regarded program that started training gynecologic oncologists in 1971—one of the very first centers to treat these kinds of cancers and provide training for how to do it.
"From there, Cedars-Sinai has grown into one of the highest volume cancer centers in the United States and draws patients from all over the world," Dr. Kim says.
That's a reason for patients to be enthusiastic.
"All of the literature on this is very clear: If you have ovarian cancer, it's best to seek treatment at larger centers," he says. "You find the highest rates of survival when you go somewhere they are doing these surgeries and this kid of treatment day in and day out."