The Silent Killer: Fighting Ovarian Cancer
Written By Crina Capitana
INTRODUCTION
20%: the proportion of ovarian cancers detected in stages I-II… Also the survival rate of those diagnosed in stages III-IV1. In an era dominated by cancer breakthroughs, ovarian cancer’s diagnostic abilities have not only stagnated, but have been quickly caught up by national mortality figures2. Rightfully labelled as the “silent killer”, should we not overcome the lack of reliable screening3 in a symptomatically ambiguous condition, we risk thousands more women slipping out of the worrisomely small window for effective treatment. This article aims to provide guidance in two areas of the treatment pathway: diagnosis and future prevention methods— both striving toward a future where more women can overcome ovarian cancer.
DIAGNOSIS
Often presented as abdominal bloating, pain, and a feeling of nauseousness4, it’s sadly justifiable why ovarian cancer can be mistaken for Irritable Bowel Syndrome (IBS), endometriosis, ovarian cysts, or even milder conditions5. In a resource scarce environment, GPs are at a crossroads of the ideal investigation severity. Current guidelines suggest that if the previously mentioned symptoms appear, the patient should be left a few more days/weeks to see the symptoms’ progression. Should the patient return with persistent issues, the doctor will ideally order a blood test, which will hopefully also measure C-reactive protein and CA125, though not all routine blood tests do6.
Adding to complications, even if the patient is fortunate to have a blood test assessing C-reactive protein and CA125, whilst C-reactive protein does measure inflammation, it does not indicate the source of the body’s immune response. CA125 similarly is a marker for ovarian cancer, but can also flag-up several other non-cancerous conditions. Hence, neither of the two can serve as a reliable indicator of ovarian cancer, rather only as an aid in ruling it out. Therefore, upon prolonged symptoms, the most conclusive form of diagnosis remains an ultrasound, with treatment beginning within the target 62 days from the GP’s urgent referral7.
As illustrated above, there are several variables to reach a diagnosis in play, to say the least. Non-specific investigations, alongside half the UK population not seeking medical help due to feeling that they may be wasting a doctor’s time despite finding a potential symptom of cancer (e.g. a lump8), justifies why more than a third of women are waiting more than three months for a diagnosis from their GP9. More than a quarter of women are still seeing their GP three or more times before being referred for any tests10.
AWARENESS
Though the above is not comforting, we can learn two things: increasing awareness and changing attitudes of both the public and healthcare professionals has great potential for increasing our diagnostic pace. A prime example is a study by the Centre of Disease Control and Prevention. Using Insider Knowledge’s campaign materials and providing educational workshops, common misconceptions for the five main gynaecological cancers were addressed11. Participants saw an increase of awareness in identifying that Papanicolaou (Pap) test does not screen for ovarian cancer by 89.2%, genetic testing for ovarian cancer risk are available by 77.9%, and HPV is not a cause of ovarian cancer by 56.4%12 following completing the course.
In addition, every March during the UK’s Ovarian Cancer Awareness Month, several charities like Macmillan Cancer Support and The Eve Appeal share useful resources and assemble advocates to draw attention to this national issue. With women diagnosed with ovarian cancer being three times more likely to be diagnosed with mental health issues such as anxiety, depression, and adjustment depression13, finding a community that can support and empathise with their experience is vital in their overall well-being when fighting cancer. A shocking 60% of women with ovarian cancer are not being treated for their mental health condition14, despite a three times higher chance of developing Post-Traumatic-Stress-Disorder (PTSD)15. Hence, the importance of a support system -be it family, friends, or a trusted organisation- cannot be stressed enough.
Similarly, healthcare professionals have a critical responsibility to remain aware of ovarian cancer; namely GPs, who have a very difficult role as the patient’s first point-of-contact during their healthcare experience. A worrisome study by Target Ovarian Cancer found nearly half (44%) of GPs thought symptoms for ovarian cancer only appear in the later stages of the disease16. This suggests that GPs would highly benefit from awareness courses, such as those that Target Ovarian Cancer run in partnership with the RCGP17, or the award-winning module of the BMJ18. Already working under significant pressure, this extra layer of awareness provided by the courses could prove strongly beneficial in GPs’ ability to flag early signs of ovarian cancer during time-sensitive consultations with patients.
FUTURE TREATMENTS
Though we may be limited from a diagnostic perspective, several clinical trials are shaping our future expectations of beating ovarian cancer. OvarianVax is a prime example— a vaccination targeting altered BRCA1/2 genes. Normally functioning to protect us from ovarian cancer19, mutated gene carriers experience an increased risk of developing ovarian cancer; 65% and 35% of BRCA1 and BRCA2 mutations respectively. Currently, carriers of the altered genes are recommended to have their ovaries removed by the age of 3520, which, whilst protecting them from ovarian cancer, impacts their ability to have children.
Aiming to train the immune system to recognise over 100 proteins on the surface of the ovarian cancer, known as tumour-associated antigens, OvarianVax aims to equip the body with the tools to fight the cancer before the disease can occur21. With the goal of being widely available to women at high risk of ovarian cancer, this vaccine would not only extend thousands of women’s life expectancy, but do so whilst not sacrificing their ability to have children.
Moreover, the NHS’ Cancer Vaccine Launch Pad grants thousands of patients access to personalised cancer vaccines. Though not limited to ovarian cancers, patients found eligible will have their tumour analysed to identify mutations specific to their own cancer22. Then, using investigative technologies similar to those used in the COVID-19 vaccine23, a vaccine specific to their tumour is made. The vaccination will then usually then be administered post-surgery, to remove any possible remaining cancer cells. Despite this method relying on an initial diagnosis, as well as an operation, this scheme still shows extraordinary potential for overall cancer recurrence rates.
CONCLUSION
Though this article only briefly touches the surface of ovarian cancer’s complex patient-disease pathway, the one major take-away is that we can have hope. Given emerging technologies, we will reach a point where those at high risk of ovarian cancer will not have to sacrifice their fertility, nor their peace of mind over the cancer recurrence. Hence, our responsibility to address misconceptions as healthcare professionals, and equipping both ourselves and the general public with the tools to detect ovarian cancer will take us one step closer towards a world where we consistently and courageously beat ovarian cancer.
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