Ovarian Cancer Diagnosis: The Importance of Biomarkers

Your oncologist has many options for the course of your ovarian cancer treatment. So how do they end up choosing which treatment plan to recommend? Doctors glean key information from indicators called biomarkers. Think of biomarkers as certain characteristics that each patient has that can help oncologists predict how they’ll respond to future treatment. Ultimately, the biomarkers for ovarian cancer are one of many factors doctors use to guide treatment decisions. We spoke to a Dr., to help us understand the role of biomarkers in making treatment decisions and predicting outcomes.

Success of First Surgery
The Dr. says that the most important biomarker for treatment success and decisions is how the first surgical tumor removal went. He says, “For advanced ovarian cancer, which is how most women present with the disease, some people forget or overlook [that] the most important biomarker is your initial treatment…[including] surgical resection.” The goal of the initial surgery is to remove as much of the tumor as possible, says the Dr. “The goal of surgery is to remove all cancer that you can see with a naked eye, and this remains a very strong bio marker of overall survival,” he explains. This is because women who have a successful first surgery live significantly longer than those who don’t have surgery.

Other biomarkers
According to a Dr., other than the outcome of initial treatment, the other biomarkers are:

• Age – The Dr. says this “is actually a tricky biomarker,” in large part because it usually packs two positive, or favorable, biomarkers in one. For one, younger patients typically do better with treatment because they can tolerate treatment better. As Levine puts it, “They can tolerate all of the treatments without treatment breaks, and with minimal toxicity.” Secondly, younger women are also more likely to carry BRCA mutations, allowing them to respond better to treatments like PARP inhibitors. In this sense, age is a two-fold biomarker.
• Performance Status
• Where you receive treatment –  The most important thing to note about the hospital where you receive treatment is how many ovarian cancer patients they treat. High volume cancer centers and surgeons who perform a high volume of surgeries have been shown to have better outcomes than those with fewer surgeries or patients. As Dr. Levine explains, “A number of studies have shown that if you go to a high volume center, a center that treats a lot of ovarian cancer, that your outcomes are dramatically better. So it’s both the center, and the surgeon, because surgeons who do this frequently and centers that treat ovarian cancer frequently, have processes in place … to incorporate all of the latest treatments, and give the best outcomes in the safest possible manner.”
• Tumor Genetics – In particular, the BRCA mutations are the most important genetic biomarker for ovarian cancer. It contributes to the development of early ovarian cancer in younger women, but if you do have the disease, then that mutation allows you to respond much better to certain treatments, such as PARP inhibitors.
• CA-125 – This is a protein that can be present in the blood and is “one of the best biomarkers for monitoring ovarian cancer treatments,” the Dr. says. By tracking levels of CA-125 in the blood, oncologists can determine whether your cancer has returned following initial treatment. Although it’s use as a way to initially detect cancer is limited, it is the most important biomarker for post-treatment monitoring.                              
  
   
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OVARIAN CANCER GUIDE

What Is Ovarian Cancer?
This cancer begins in the ovaries, the twin organs that produce a woman's eggs and the main source of  the female hormones estrogen and progesterone. Treatments for ovarian cancer have become more effective in recent years, with the best results seen when the disease is found early.
Ovarian Cancer Symptoms
Symptoms include:
Bloating or pressure in the belly
Pain in the abdomen or pelvis
Feeling full too quickly during meals
Urinating more frequently
These symptoms can be caused by many conditions that are not cancer. If they occur daily for more than a few weeks, report them to your health care professional.

Risk Factor: 1)Family History
A woman's odds of developing ovarian cancer are higher if a close relative has had cancer of the ovaries, breast, or colon. Researchers believe that inherited genetic changes account for 10% of ovarian cancers. This includes the BRCA1 and BRCA2 gene mutations, which are linked to breast cancer.  Women with a strong family history should talk with a doctor to see whether closer medical follow-up could be helpful.

Risk Factor: 2) Age
The  strongest risk factor for ovarian cancer is age. It's most likely to develop after a woman goes through menopause. Using postmenopausal hormone therapy may increase the risk. The link seems strongest in women who take estrogen without progesterone for at least 5 to 10 years. Doctors are not certain whether taking a combination of estrogen and progesterone boosts the risk as well.

Risk Factor: 3) Obesity
Obese women have a higher risk of getting ovarian cancer than other women. And the death rates for ovarian cancer are higher for obese women too, compared with non-obese women. The heaviest women appear to have the greatest risk.

Ovarian Cancer Screening Tests
There are two ways to screen for ovarian cancer before it causes symptoms or shows up during a routine gynaecological exam. One is a blood test for elevated levels of a protein called CA-125. The other is an ultrasound of the ovaries. Unfortunately, neither technique has been shown to save lives when used in women of average risk. For this reason, screening is only recommended for women with strong risk factors.

Diagnosing Ovarian Cancer
Imaging tests, such as ultrasound or CT scans , can help reveal an ovarian mass. But these scans can't determine whether the abnormality is cancer. If cancer is suspected, the next step is usually surgery to remove suspicious tissues. A sample is then sent to the lab for further examination. This is called a biopsy. Sometimes a sample taken with a needle can also be used for diagnosis.

Stages of Ovarian Cancer
The initial surgery for ovarian cancer also helps determine how far the cancer has spread, described by the following stages:
Stage I: Confined to one or both ovaries
Stage II: Spread to the uterus or other nearby organs
Stage III: Spread to the lymph nodes or abdominal lining
Stage IV: Spread to distant organs, such as the lungs or liver

Types of Ovarian Cancer
The vast majority of ovarian cancers are epithelial ovarian carcinomas. These are malignant tumors that form from cells on the surface of the ovary. Some epithelial tumors are not clearly cancerous. These are known as tumors of low malignant potential (LMP). LMP tumors grow more slowly and are less dangerous than other forms of ovarian cancer.

Ovarian Cancer Survival Rates
Ovarian cancer can be a frightening diagnosis, with five-year relative survival rates that range from 89% to 18% for epithelial ovarian cancer, depending on the stage when the cancer was found. But keep in mind that these odds are based on women diagnosed from 1988 to 2001. The treatments and outlook may be better for people diagnosed today. For LMP tumors, the five-year relative survival rates range from 99% to 77%.

Ovarian Cancer Surgery
Surgery is used to diagnose ovarian cancer and determine its stage, but it is also the first phase of treatment. The goal is to remove as much of the cancer as possible. This may include a single ovary and nearby tissue in stage I. In more advanced stages, it may be necessary to remove both ovaries, along with the uterus and surrounding tissues.

Chemotherapy
In all stages of ovarian cancer, chemotherapy is usually given after surgery. This phase of treatment uses drugs to target and kill any remaining cancer in the body. The drugs may be given by mouth, through an IV, or directly into the belly (intraperitoneal chemotherapy.) Women with LMP tumors usually don't need chemo unless the tumors grow back after surgery.

Other Therapies
Researchers are working on therapies that target the way ovarian cancer grows. A process called angiogenesis involves the formation of new blood vessels to feed tumors. A drug called Avastin blocks this process, causing tumors to shrink or stop growing . Avastin is approved for other cancers, but ovarian cancer researchers are still testing this therapy, which can have serious side effects.

After Treatment: Early Menopause
When women have both ovaries removed, they can no longer produce their own estrogen. This triggers menopause, no matter how young the patient. The drop in hormone levels can also raise the risk for certain medical conditions, including osteoporosis. It's vital that women have regular follow-up care after being treated for ovarian cancer.

 Moving On With Life
Women may find that it takes a long time for their energy to return after treatments end. Fatigue is a very common problem after treatment for cancer. Beginning a gentle exercise program is one of the most effective ways to restore energy and improve emotional well-being. Check with your healthcare team to determine which activities are right for you.

Risk Reducer:1) Pregnancy
Women who have biological children are less likely to get ovarian cancer than women who have never given birth. The risk appears to decrease with every pregnancy, and breastfeeding may offer added protection.

Risk Reducer: 2)  'The Pill'
Ovarian cancer is also less common in women who have taken birth control pills. Women who have used the pill for at least five years have about half the risk of women who never took the pill. Like pregnancy, birth control pills prevent ovulation. Some researchers think ovulating less often may protect against ovarian cancer.

Risk Reducer: 3) Tubal Ligation
Getting your tubes tied, formally known as tubal ligation, may offer some protection against ovarian cancer. The same goes for having a hysterectomy -- removing the uterus while leaving the ovaries intact.

Risk Reducer:4) Removing the Ovaries

For women with genetic mutations that put them at high risk for ovarian cancer, removing the ovaries is an option. This can also be considered in women over 40 getting a hysterectomy.

Risk Reducer: 5) Low-Fat Diet

While there is no definitive diet to prevent ovarian cancer, there is evidence that what you eat can make a difference. In one recent study, women who stuck to a low-fat diet for at least four years were less likely to develop ovarian cancer. Some researchers report the cancer is also less common in women who eat a lot of vegetables, but more studies are needed.

ps- this is only for information, always consult you physician before having any particular food/ medication/exercise/other remedies.

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