Ovarian cancer - Evaluation of Therapies

Ovarian Cancer

Ovarian cancer is a cancerous growth arising from different parts of the ovary. Most (>90%) ovarian cancers are classified as "epithelial" and were believed to arise from the surface (epithelium) of the ovary. However, recent evidence suggests that the Fallopian tube could also be the source of some ovarian cancers. Since the ovaries and tubes are closely related to each other, it is hypothesized that these cells can mimic ovarian cancer. Other types arise from the egg cells (germ cell tumor) or supporting cells. Ovarian cancer is a silent killer and is one of the deadliest threats to women’s health. The American Cancer Society says that about 20,180 American women will be diagnosed with ovarian cancer this year alone. Every woman faces a risk of 1:57 risk of getting ovarian cancer in her lifetime. The symptoms of ovarian cancer are not perceptible until the cancer becomes widespread and critical, which explains why thousands of women die of this dreaded disease every year. Although ovarian cancer is treatable, in most instances, it is detected late causing complications and death to ovarian cancer patients. Since to date there is no sure and effective way to diagnose or detect ovarian cancer in its early stage, specialists, research groups and cancer advocacy groups and the government organizations are doing every ovarian cancer research work they can to finally shed light into the gray areas of this deadly disease. Some organizations provide grants for those willing and interested to conduct an ovarian cancer research.

Two Percent of All Female Newborns in the United States Are at Risk of Getting Ovarian Cancer. As many as 30,000 U.S. women will be diagnosed with ovarian cancer this year. In 2006, between 15,000 and 16,800 women are likely to die from this silent killer. Ovarian cancer is the 5th leading cause of death among women, and it is responsible for about five percent of all cancer deaths. Chances are Patient's doctor may have misdiagnosed Patient. That is often the case. A recent British study found 60 percent of all U.K. general practitioners had misdiagnosed their patients. Three-quarters of British doctors surveyed incorrectly assumed that symptoms only occurred in the late stages of ovarian cancer. Based upon that information, it should be no surprise that Britain has one of the lowest survival rates for ovarian cancer in the Western World – of 6,800 cases diagnosed each year, more than 4,600 die.

A similar discovery was made by University of California researchers, who announced last year, “Four in 10 women with ovarian cancer have symptoms that they tell their doctors about at least four months — and as long as one year — before they are diagnosed.” According to their study of nearly 2,000 women with ovarian cancer, the researchers discovered physicians:

• First ordered abdominal imaging or performed gastrointestinal procedures instead of the more appropriate pelvic imaging and/or CA-125 (a blood test that can detect ovarian cancer).

• Only 25 percent of patients, who reported ovarian cancer symptoms four or more months before diagnosis, were given pelvic imaging or had CA-125 blood tests.

Patients with early symptoms are frequently misdiagnosed. Abdominal imaging or diagnostic gastrointestinal studies are less likely to detect ovarian cancer. According to the American Cancer Society’s website, “The most common symptom is back pain, followed by fatigue, bloating, constipation, abdominal pain and urinary urgency. These symptoms tend to occur very frequently and become more severe with time. Most women with ovarian cancer have at least two of these symptoms.”

By the time a woman reaches the fourth stage of ovarian cancer, her first-line treatment is often Carboplatin, Paclitaxel and Cisplatin as the specific chemotherapy for ovarian cancer. In the first stage, cancer is contained inside one or both ovaries. By stage two, the cancer has spread into the fallopian tubes or other pelvic tissues, such as the bladder or rectum. When the cancer has spread outside the pelvis area into the abdominal cavity, especially when tumor growths are larger than two centimeters on the lining of the abdomen, then ovarian cancer has reached stage three. The fourth and final stage of ovarian cancer is reached when the cancer has spread into other body organs, such as the liver or lungs.

If detected early, survival rates can be as high as 90 percent. Detected in the advanced stage, the survival rate falls to between 30 and 40 percent. Various imaging tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound studies can confirm whether a pelvic mass is present. A laparoscopy can help a doctor look at the ovaries and other pelvic tissue to in order to plan out a surgical procedure, or to determine the stage of the ovarian cancer. A biopsy, or tissue sampling, would confirm if there is cancer in Patient's pelvic region, and would help determine how advanced it is. An elevated CA-125 blood test typically suggests the cancer has progressed to the advanced stage.

About 50 percent of ovarian cancer patients are already at an advanced stage by the time a correct diagnosis is made. Only 10 to 14 percent of women with advanced cancer are likely to survive more than five years.

Evaluation of Therapies

While research shows drinking black (or green) tea or taking the herbal supplement gingko biloba may be useful, as a preventative measure, or to reduce risk, a woman has few choices when her cancer has moved to the advanced stage. In the first stage, a woman faces surgical removal of the tumor, and possibly one or both ovaries, to increase her chances of survival. Beyond that, her choice is chemotherapy. One major problem with chemotherapy is the side effects. The more advanced the cancer, the weaker one may be, reducing the survival rate potential. Survival rates have not changed very much over the past fifteen years. Chemotherapy can increase survival time by as much as 50 percent. But, quality of life suffers. The side effects and increased toxicity, accompanying chemotherapy, reduce how one spends the prolonged survival time.

Some of Paclitaxel’s minor side effects, as reported by Medline Plus, may include nausea, vomiting, loss of appetite, change in taste, thinned or brittle hair, pain in the joints of the arms or legs, changes in the color of nails, and/or tingling in the hands or toes. More serious side effects may include mouth blistering or fatigue. Some alarming side effects could include unusual bleeding or bruising, dizziness, shortness of breath, severe exhaustion, chest pain, or difficulty swallowing. The most common side effect of Paclitaxel is a decrease of blood cells. Carboplatin has its own list of side effects. It can reduce platelet production, which can interfere with Patient's blood’s ability to clot. Patient may become anemic, feeling tired or breathless. Nausea, vomiting, loss of appetite and a general feeling of weakness are common with this chemotherapeutic agent.

The latest breed of drugs, such as Eli Lilly’s Gemzar, are hardly getting praise. On March 10th, the Food and Drug Administration (FDA) said it was skeptical of the benefits Eli Lilly’s Gemzar, which was being used with Carboplatin to treat ovarian cancer patients. The FDA felt the 2.8 months increased survival time, provided by the Gemzar/Carboplatin combination failed to offset the treatment’s increased toxicity.

In January, the New England Journal of Medicine reported on a remarkable new delivery system of chemotherapy, called the “intra-abdominal, or intraperitoneal, chemotherapy. Those who received the “belly bath” as it is now being called by the media can survive 16 months longer than those receiving intravenous chemotherapy. The major drawback is that 60 percent of the women in the study were unable to complete all six cycles of this chemotherapy. Those who did survived longer, but only two in every five women were able to advance to the end phase of the therapy. One novel approach, now in Phase III trials at more than 60 research centers across the United States, is OvaRex ® MAb, a murine monoclonal antibody, a type of biotech drug derived from mouse cells. It is being tested by highly regarded United Therapeutics, based in Silver Springs, Maryland. Their lead drug Remodulin, an injection which treats pulmonary arterial hypertension, is currently being marketed inside and outside the United States. More than $32 million has been spent researching, and on the development of, OvaRex and may have it available on the market by 2008.

OvaRex was developed in Canada by a company called ViRexx Medical Corp, and first tested in that country. According to Dr. Lorne Tyrrell, Chief Executive of ViRexx, “The whole study has been set up with the FDA. This is a study where the drug has been given fast track approval and orphan drug status.” Dr. Tyrrell is also on leave (until OvaRex become commercially available) as a Professor of Medical Microbiology and Immunology at the University of Alberta, and Director of the National Centre of Excellence for Viral Hepatitis Research. OvaRex was tested in Canada, prior to the current Phase III trials in the U.S. “There have been a number of patients that have received OvaRex,” said Dr. Tyrrell, “We’ve had really no adverse effects from these patients.” Dr. Tyrrell explained the procedure, “After being injected intravenously, OvaRex binds to an antigen circulating in the blood.” An antibody’s general purpose is to neutralize an antigen. After an OvaRex injection, the murine monoclonal antibody binds to the CA-125 antigen.

In a way the body is tricked. But, the body is tricked in order to help “save” itself from the harmful antigen. When the OvaRex antibody is bound to the CA-125 antigen, the new combination is identified as a harmful unit. Before then, the antigen wanders through the body, without alerting the body’s defense systems, the dendritic cells, to attack and destroy the harmful antigen. Because the body is trained to identify and zero in on a foreign protein, in this case a mouse protein, it alerts the dendritic cells. Until then, the dendritic cells “tolerate” the cancerous cells. The tolerance is what permits the cancer to spread throughout the body. OvaRex seeks to break that tolerance. The murine monoclonal antibody is designed to target and bind exclusively to free floating CA-125 antigen. The dendritic cells refuse to tolerate the foreign protein. When the antibody binds with the free-floating antigen, the dendritic cells recognize the complex (antibody plus antigen) as being foreign and engulf the new unit. The dendritic cells break down the key proteins of this unit, presenting all parts on the cells surface. At the point, the body’s killer T-Cells are alerted to fight the internal threat to the body. Once activated, the T-Cells will replicate and create more killer T-Cells. Any tumor cells expressing the CA-125 antigen is targeted for destruction. The army of T-Cells move to attack the ovarian cancer tumor.

The principle behind OvaRex is to re-program the immune system to harness the body’s defenses to prevent the growth and spread of the ovarian cancer. Will it cure ovarian cancer? “In most cases, it will be a delay,” explained Dr. Tyrrell. “However, I think that, and everyone hopes that, often in some of these tumors, Patient’re making incremental progress through careful clinical trials and adding new therapy. Each thing we do that improves the outcome when Patient start to look at the long term benefits of these, we hope that one day we will be able to cure this disease. We think this is a step. This has the potential to be an important step at helping to stimulate immune response to achieve a better outcome. Hopefully, one day we can improve that to where it is a cure.” Among the most prominent organizations that promote awareness on ovarian cancer is the Ovarian Cancer National Alliance. It was formed in 1997 by seven ovarian cancer advocacy groups who joined forces to strengthen efforts to promote ovarian cancer education. Ovarian cancer research teams probe into several areas of ovarian cancer including its symptoms (both in the early and the latter stage), stages, risk factors, prevention, risk reduction, and treatment, with the aim of increasing awareness on this cancer. Knowledge on the said areas can be a woman’s greatest protection against this cancer.

However apart from the fact that there are many information gaps that still need to be filled, ovarian cancer researches are conducted in response to this cancer’s high mortality rate. In the United States, ovarian cancer is the fifth among the gynecologic cancers that place women at the brink of death. Over 50% of all women diagnosed with the disease are about to die within a period of five years, researches show. It is with this fact that ovarian cancer research groups are exerting their best effort to uncover hidden truths about ovarian cancer. Most ovarian cancer researches reveal that women with ovarian cancer show the following symptoms: persistent and baffling gastrointestinal discomfort, nausea, digestive disturbances, bloating or swelling of the abdomen, pain in the abdominal and pelvic area, fatigue, frequent urinating, and abnormal bleeding during the postmenopausal stage. A recent ovarian cancer research conducted by University of California shows that more than one-third of women diagnosed with ovarian cancer have shown the symptoms at least four months before they have been diagnosed with the cancer; hence, there’s a good chance that ovarian cancer can be diagnosed earlier.

Researchers explained that the reason why the cancer is detected only when it’s already in its advanced state is that doctors do not perform tests that could possibly diagnose the cancer immediately. Doctors would usually have the patients undergo abdominal imaging and some gastrointestinal procedures, which they say re not that effective in diagnosing this disease. Other ovarian cancer research works are concerned about improving treatment of ovarian cancer and preventing this disease. Many clinical studies are conducted to carefully analyze a drug’s potential in preventing high-risk women from developing ovarian cancer and in treating those in the early and latter stages of the cancer. A hysterectomy is not often a procedure that needs to be performed urgently, except in the case of cancer. Therefore, a woman considering the procedure should take time to investigate all her options, including other possible treatments. There are now new treatments for conditions that previously would have required a hysterectomy. Women advised to have a hysterectomy for a non-cancerous condition before being offered more conservative treatments may find it beneficial to seek a second opinion.

Deciding whether to have a hysterectomy can be a difficult and emotional process. By becoming informed about the procedure, women can confidently discuss available options, concerns and wishes with their doctor, and make a decision that is right for them. If Patient, too, have been questioning the necessity of a surgery for fibroids, prolapse, incontinence or any "cele" repairs, Patient will be reassured to know Patient have every right in doing so. The decision to undergo surgery of any kind is often difficult, so it is often useful to explore other alternatives before moving forward. Women, especially around the time of menopause, are too often advised to have major gynecological surgery for minor conditions that can be significantly improved with natural alternatives

Every 10 minutes, 12 hysterectomies are performed in the United States. That is over 600,000 per year, of which only 10% are due to cancer. This surgery most often does not correct the diagnosed problem and instead results in new afflictions. And, argues Dr. Stanley West, author of The Hysterectomy Hoax, nine out of ten hysterectomies are unnecessary. We need to ask ? How have these surgeries impacted the quality of life for women?" Nowhere in the gynecological literature did the study address the number of women for whom sex had become painful or impossible. Nowhere were there studies to track the number of marriages that failed or were severely compromised as a result of these post-surgical complications or alcoholism or drug addiction resulting from debilitating chronic pain. Women who have been hysterectomized experience a myriad of negative side effects, including chronic pain and fatigue, depression, and pain during sex. These are only a fraction of the long list of unwanted symptoms reported by women after surgery.

So, if Patient decide, or have already decided, that surgery is not an option, Patient are probably asking Patient'sself, "Now what?" I have asked myself this same question. But, I will tell Patient, there is no quick fix. As women we must understand our bodies to care for them in a positive way. The more I review this subject the stronger I feel about informing women before they make this important decision. Prevention is the key and hormone balance is the answer. For the most part those who are encouraged to have their uterus's removed are likely suffering from estrogen excess which is explained well by Dr. John Lee.

Balancing hormones involves working on a few fronts using simple strategies.

  1. Evaluate Patient's hormones using a saliva test - determine what is happening in Patient's body - ask Patient's self the question - are Patient estrogen dominant? Use a saliva test to find the answer.
  2. Optimize Patient's diet by lowering Patient's insulin levels. Over 2/3 of North Americans are overweight. This extra weight increases insulin levels causing estrogen dominance to increase. EAT 40/30/30
  3. If the saliva test shows the need, use a natural progesterone cream in the process of rebalancing Patient's hormonal system
  4. Exercise to reduce excess estrogen and to eliminate toxins
  5. Drink more water
  6. Supplement with wisdom using our hormone balancing program of fiber, indoles, efa, multi - fruit & veggi essence, calcium

Whilst it is impossible to generalize emotional and energetic responses, she highlights the issue of rage in ovarian cancers. She describes the ovaries as being 'female balls' which means they relate to an active participation in the world in a way that expresses our unique creative potential, as women, on an individual basis. She says: "...we as women must be open to the uniqueness of our creations and their own energies and impulses, without trying to force them into predetermined forms. Our ability to <i>yield</i> to our creativity, to acknowledge that we cannot control it with our intellects, is the key to understanding ovarian power." (p187, Women's Bodies, Women's Wisdom) She relates the issue of rage as deriving from being in an abusive relationship - not necessarily physically abusive, though of course this could be the case. And it may not necessarily be a personal or intimate relationship. It could be with work, societal, or even spiritual. But it embodies a way of relating and dealing with something or someone, where the woman involved feels controlled by the situation and does not believe in her ability to change it, or herself. It is a denial of her innate power and self-sovereignty. A denial of a woman's innate dignity, creativity, spirituality, and complexity.

Interestingly, Dr Northrup notes that ovarian cancer is linked to a diet high in fat and dairy food. Dairy products in Oriental medicine, are associated with the liver meridian. Meridians are energy conduits, and though they have a specific anatomy, they are not equated necessarily with the organs of the same name, as understood in conventional western medicine. The emotion associated with a liver meridian that is out of balance, is rage and anger. Oriental medicine believes that diseases start in our energetic body first, and then progress to the physical body. And certainly not all women who have a high fat and high dairy diet develop ovarian cancer. Dr Northrup suggests that women take care of their ovaries and uterus by reclaiming and expressing whatever this deep creative energy is for them. She suggests taking the time to do this daily. A recent scientific study has also found that drinking two cups or more of tea a day can reduce the risk of ovarian cancer by 46%. This study was done in Sweden over a 15 year period. Sweden is a country where there is a higher risk of ovarian cancer, as are other countries with a high dairy consumption (Denmark and Switzerland).