When 58-year-old Karen Howley LaCamera came to the emergency room in January 2018 with acute abdominal pain, she thought she was having another gallbladder attack. Doctors in the ER ordered a CT scan and told her she would likely need surgery to remove her gallbladder if things didn’t improve. She was released later that night. But when she got home, the ambulance called to tell her the problem wasn’t her gallbladder, but a tumor the size of an orange that was sitting on her ovary.
Several tests, surgeries, and a biopsy later, LaCamera, who lives in Sudbury, Massachusetts, was diagnosed with stage 3 ovarian cancer. “I was just wow,” she recalls. “When I look back, I think of the symptoms I ignored.”
LaCamera says she’s “always felt uncomfortable and apologized.” She had frequent urination and pain in her abdomen, pelvis and back. She also had bloating, or what she called a tummy roll. “No matter what sport I did, I couldn’t get rid of it,” she says. She thought she was only getting older.
When LaCamera had surgery, doctors found that her cancer had spread to 11 different organs.
LaCamera isn’t the only one missing the symptoms of ovarian cancer.
“The most common symptoms of ovarian cancer are unremarkable,” says Bobbie J. Rimel, MD, director of clinical cancer studies and associate professor in the division of obstetrics and gynecology in the division of gynecologic oncology at Cedars-Sinai Medical Center in Los Engel.
Because of this, the cancer is usually not recognized until later stages, when it can be fatal. “It’s a really tricky thing. My heart breaks for all these women going from doctor to doctor [looking for answers]” says Dr. Rimel.
Ovarian cancer is the second most common gynecologic cancer in the United States. It is also responsible for more deaths than any other cancer of the female reproductive system, according to the Centers for Disease Control and Prevention (CDC).
Detect ovarian cancer early
According to the American Cancer Society (ACS), research has led to better ways of detecting high-risk gene mutations and estimating a woman’s risk of ovarian cancer. At stage 1, the survival rate for ovarian cancer is about 93 percent, according to the ACS. In later stages, the survival rate drops to 75 and 31 percent.
Currently, the CA-125 blood test, which measures the amount of protein cancer antigen 125 in the blood, is not accurate enough to screen for ovarian cancer, according to the Ovarian Cancer Research Alliance. That’s because conditions like menstruation, pregnancy, and uterine fibroids can increase CA 125 protein levels and cause false-positive results. The test can only be used reliably to monitor women with known ovarian cancer, says Rimel.
But in a study published in the journal in 2017 eLife, a screening blood test for ovarian cancer developed by researchers at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, was found 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, professor of radiation oncology at the Dana-Farber Cancer Institute in Boston and co-author of the study.
The test monitors a part of the genome known as microRNA, which is secreted into the blood by cancer or precancerous cells. Specific patterns of microRNA can be used to detect ovarian cancer. Using blood samples collected from approximately 1,000 patients at Dana-Farber and other institutions, Dr. Chowdhury said the test could diagnose the disease 99.1 percent of the time.
But an accuracy rate of 99.9 percent or better is needed, says Chowdhury, to test the general population. “If you test 100,000 women with this level of accuracy [99.1 percent], we will now misdiagnose 890 women with this test. It’s not OK. It’s too high.” A clinical trial called the MiDe study is currently underway at Dana-Farber’s Center for BRCA and Related Genes to test and potentially improve the accuracy of the test in high-risk patients.
In a study published in radiology In March 2022, researchers developed a new ultrasound scoring system that may help determine if tumors in the fallopian tubes and ovaries are potentially cancerous and need further investigation, says Deborah Baumgarten, MD, a professor of radiology at the Mayo- Clinic in Jacksonville, Fla.
“This can potentially save women unnecessary surgeries,” says Dr. Baumgarten, who wrote a review of the study radiology.
When researchers at the University of Rochester Medical Center in New York tested the system on 878 women at average risk of developing ovarian cancer, they found that it was sensitive enough to detect malignancies 93 percent of the time with an accuracy of 73.1 percent recognize.
By studying genetic differences between cancer cells within the same tumor, scientists can refine 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 for performing precise tissue sampling of tumors that can create a visual guide and lead to fewer and more accurate tumor biopsies. In a 2020 study published in European radiologyThe researchers tested the technique on six patients and found that it was more accurate than ultrasound alone to image and identify tissue samples for biopsy of large pelvic tumors, but cautioned that the technique still needs to be tested in larger studies.
Tackling a barrier in treatment: drug resistance
People undergoing treatments like LaCamera can sometimes develop resistance to common chemotherapy regimens, 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 comes back. Drug resistance to chemotherapy is one of the major barriers to fighting cancer because patients who develop drug resistance tend to return very quickly, according to Alessandro Santin, MD, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine in New Haven, Connecticut. For this reason, 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 June 2022 in the British Journal of Cancerexamined dr. Santin and colleagues evaluated the effectiveness of the combination of chemotherapy drugs ixabepilone and bevacizumab and compared it to ixabepilone alone in platinum-resistant ovarian cancer.
They found an improvement in the time it took for the cancer to progress or get worse and in overall survival in the 76 patients who received the combination therapy compared to 37 patients who received ixabepilone alone. The cancer in the combination therapy group did not grow or spread for 5.5 months versus 2.2 months in the monotherapy group, while overall survival was 10 months and 6 months, respectively. “We will not cure these patients. We want to extend life here,” says Santin.
In a January 2022 study Journal of Cancer ImmunotherapyThe researchers evaluated the safety and efficacy of camrelizumab plus famitinib in 37 patients with recurrent ovarian cancer who had varying degrees of resistance to standard platinum-based chemotherapy regimens. Nine patients (24.3 percent) responded positively to the combination therapy. It either shrank their tumors or their cancer remained stable while they took the drug. Although the results were “encouraging” and the side effects “manageable,” for comparison purposes, the drug combination needs to be tested in people not receiving the drug.
Find the treatment that works
Since her diagnosis in February 2018, LaCamera has had two surgeries and five different types of chemotherapy, including two clinical trial therapies. In a research study she enrolled in from February 2020 to September 2020, she experienced encouraging results. She underwent surgery the following month to remove a residual tumor and went into remission in early 2021.
“That was the magic,” she says.
She would not be alive today without the help of her doctors finding a suitable clinical trial, LaCamera says. “But we need better detection to defeat this insidious disease.”
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