OB/GYNs
Take the right treatment path.
The triage of women to centers
of excellence is critical to the
optimal treatment and management
of ovarian malignancy.
Ovarian cancer is the leading cause of death from gynecologic cancers in the United States and the fifth leading cause of death from cancer in women.4 It accounts for 4% of all female cancers and 31% of cancers of the female genital organs. Each year, there are an estimated 22,000 new cases in the United States. Women who are postmenopausal are at the greatest risk for ovarian cancer.5 In their lifetimes, 1 in 69 women will develop ovarian cancer.6
Because the symptoms of ovarian cancer are mild, it is hard to detect early. In fact, approximately 75% of cases are first diagnosed at an advanced stage (Stage III). Overall, prognosis for these patients continues to be poor and is closely related to the stage at which they are diagnosed. Standard treatment consists of debulking surgery followed by chemotherapy.
Optimal Management of Ovarian Malignancy
Approximately 20% of women will develop an ovarian cyst or pelvic mass in their lifetimes, and many of these women will undergo unnecessary surgery. When ovarian cancer is suspected due to a pelvic or ovarian mass, a diagnostic and staging laparotomy should be conducted. Routine tests prior to surgery include a chemistry panel, CBC count, and other diagnostic tests.
If no determination can be made based on the diagnostic tests, an ultrasound should be performed to aid in the detection of any cysts or tumors. If surgery is indicated, the location in which the surgery is performed is critical to ensure optimal staging and removal of the tumor.
Developments, including cytoreductive surgery, primary platinum-taxane chemotherapy, and active second-line agents, have improved the 5-year survival rate in patients from 20% to 50%. Reports have shown that patients treated by gynecologic oncologists are more likely to undergo full surgical staging or an optimal cytoreductive operation.
Use of Multidisciplinary Teams
Recent studies have shown that patients treated by multidisciplinary teams in tertiary care centers have fewer complications and longer survival rates. The triage of women to centers of excellence is critical to the optimal treatment and management of ovarian malignancy. However, in the U.S. less than half of women with ovarian cancer receive their care by—or even in collaboration with—a gynecologic oncologist. There are numerous reasons for this, among them patient preference to remain with their local physician and health insurance. Tests that enable physicians to identify women at high risk for malignancy will be instrumental in the triage of patients to appropriate centers.
CA125™ is the most widely used tumor marker worldwide for ovarian cancer and is indicated for use as an aid in the detection of residual ovarian carcinoma in patients who have undergone first-line therapy and would be considered for diagnostic follow-up procedures.15
Even with the most recent advances, the need for a breakthrough in the ability to predict ovarian cancer malignancy is critical. Additionally, detection of a greater percentage of cancers in the early stages may improve outcomes.16
HE4: A Novel Serum Biomarker
A prospective study recently published in the journal, Gynecologic Oncology, found that women with elevated levels of a substance called HE4 in their blood might be more likely to have ovarian cancer.9 This is an encouraging find in the search for a way to better predict ovarian malignancy and differentiate between malignant and benign tumors. HE4 is not yet commercially available for sale in the US. Read more about this study.
