Most ovarian cancers are diagnosed late
Dr. Allan Covens, Head of Gynecologic Oncology at Sunnybrook Health Sciences Centre and professor at the University of Toronto, says that by the time symptoms develop, the majority of women with ovarian cancer have an advanced stage of the disease. Most are diagnosed in stage III and IV, compared to stage I or II for most breast cancers, for example. Since the disease is often caught later, 55 percent of women diagnosed with ovarian cancer die within five years.
Symptoms tend to be vague
One problem is that symptoms tend to be non-specific abdominal complaints. “They develop slowly over weeks to months. It’s easy to overlook — some abdominal swelling, bloating, indigestion — symptoms that people ascribe to things like weight gain or something they ate.” Mona Sherkin had a little bump on her stomach, and then a few weeks later, she looked six months pregnant. She had surgery for what doctors thought was an umbilical hernia, and that night, she was told she had ovarian cancer. “What’s really scary is that I was already close to stage IV, and the surgeon said the cancer had been growing in me for at least a year. I felt nothing.”
The disease is difficult to detect
There’s no reliable, accurate screening test for ovarian cancer, which means the disease is difficult to detect and often misdiagnosed. “We don’t have the equivalent of a PAP smear or colonoscopy or mammogram that detects early-stage disease. It usually takes some spreading outside the ovaries to start causing symptoms,” Dr. Covens says. Elisabeth Baugh, CEO of Ovarian Cancer Canada, points out, “The ovaries are very deep in your body. Unlike a breast, for example, it’s not something external that can be seen or easily felt.”
Some women are at higher risk
All women are at risk for ovarian cancer, but some are at greater risk than others. A woman is at higher risk if she:
- Is over 50;
- Has a family history of ovarian, breast, endometrial or colorectal cancer;
- Is of Jewish Ashkenazi descent (due to genetic mutation below); or
- Has a genetic mutation associated with ovarian cancer.
The BRCA gene mutation matters
Everybody has two BRCA genes. “These are tumour-suppressor genes that are used to prevent DNA damage and help with its repair,” Dr. Covens explains. When you have two defective genes, you have a problem repairing DNA damage and identifying abnormal cells. Eventually, some of those cells can turn into malignant tumours. Up to 60 percent of women with a BRCA mutation will be diagnosed with ovarian cancer. People with a BRCA gene mutation are also at increased risk of breast, pancreatic and prostate cancer. If you have family members with these cancers, Dr. Covens recommends asking your doctor for a referral to a genetic counsellor. If you have the BRCA gene mutation, talk to your doctor about cancer prevention options, including surveillance strategies, surgery to remove the ovaries and fallopian tubes, or oral contraceptives.
The standard treatment hasn’t changed
Publicly available treatments for ovarian cancer haven’t changed considerably since the 1990s. The standard treatment is a combination of chemotherapy and surgery. This works at first, but for 85 percent of women with advanced-stage ovarian cancer, the disease comes back. Sadly, their tumours at some point become resistant to subsequent rounds of therapy.
New targeted therapies are available
Promising new treatments are being developed as an alternative to the standard of care. New therapies such as PARP inhibitors and other biologics can target and inhibit tumour cells to repair the damaged DNA. These treatments are effective at targeting recurrent ovarian cancer, reducing disease progression and improving the quality of life for women like Mona. She began taking an oral PARP inhibitor drug two years ago when her ovarian cancer returned. Mona wants people to understand that cancer is no longer an automatic death sentence — it’s just part of her daily routine. She takes her medication, plays golf, does Pilates, cooks, helps with her grandchildren and, most importantly, she feels good. “There’s no cure,” she says. “As long as my tumours are small, I’ll stay on it.”
Women urgently need access to new treatments
While Health Canada has approved new therapies for ovarian cancer, they are not publicly funded in every province and territory. Mona receives treatment through the compassionate care program, but not all women have access. In the meantime, women who need the drugs are waiting, often with devastating consequences. Canada is really behind, Elisabeth says. “The provinces and territories, as well as drug manufacturers and insurers, need to work together to fund these treatments faster. In Canada, few new drugs have become available in the last 20 years. We need to offer the treatment that women could get if they lived in Europe or the States.”
Take action and help save lives
Visit ovariancanada.org/advocate for information on how to press for better outcomes for women with this disease. On Facebook and Twitter, you’ll find updates about community action to address the most fatal women’s cancer. You can also donate to enable advocacy efforts to continue. “Increasing research funding and improving access to drugs can save the lives of Canadian women,” says Elisabeth. “We need a lot of voices behind this. Ovarian cancer has been overlooked and underdiagnosed for too long.”
Learn more about ovarian cancer at www.ovariancanada.org.