© 2018, GENASSIST, Inc.

By Keith S. Wexler, MBA,
CFO, Business Development Director, Life Sciences GENASSIST™, Inc.

Overview: The incidence of ovarian cancer is approximately 10 to 14 per 100,000 women, yet it is the fifth leading cause of cancer deaths in women.

The origin of most ovarian cancers were believed to originate from the cells on the surface of the ovaries.

However, many of the tumors appear to be similar to the cells in the fallopian tubes. For years removal of otherwise normal appearing ovaries was suggested as a way to avoid cancer in the ovaries.

Knowing that surgical removal of ovaries in women with normal ovarian function usually led to the requirement for hormone replacement therapy resulted in a discussion as to the age of the woman at which to consider that option when surgery was performed for benign disease.

Recently, the discussion has shifted to whether the same protection against ovarian cancer can be achieved with removal of the fallopian tubes and conservation of the ovaries.

Women at the Greatest Risk for Ovarian Cancer Include:

Women with one or more first and/or second degree relative(s) who had breast cancer before age 50 years
Women with one or more first and/or second degree relative(s) who has ovarian cancer
Women who have or have had breast cancer
Women who have used fertility drugs for more than twelve months
Women of Ashkenazi Jewish heritage
Women with a first and/or second degree male relative(s) with breast cancer
Women with a family history of Hereditary Non-Polyposis Colon Cancer (HNPCC)
Women with a mutation in the BRCA1 and/or BRCA2 genes
Women with a relative with a mutation in the BRCA1 and/or BRCA2 genes

Symptoms Suggesting the Possibility of Ovarian Cancer are “Vague” But May Include:

Abdominal bloating
Abdominal pain
Changes in bowel habits
Decreased appetite, difficulty eating
Difficulty with urination
Increased skirt or pant size
Lower back pain
Pelvic Pain or pelvic pressure
Sensation of abdominal fullness or feeling full after eating normally
Sensation or vaginal or rectal fullness
Swelling of legs

Symptoms of ovarian malignancy are often very subtle and may mimic cyclic hormonal changes in a menstruating or postmenopausal woman. Abdominal and pelvic examination may detect a mass, however even in the absence of findings on examination. Additional testing e.g. pelvic ultrasound, blood testing, computerized tomography (CT) or magnetic resonance imaging (MRI) may be indicated.

Ultrasound:

If the patient is still having menses, a GYN ultrasound should be performed within one week following the menses. If no menses, then the GYN ultrasound can be performed any time during the month. The GYN ultrasound usually takes 20-30 minutes and looks at:

Presence or absence of fibroids
Presence of a mass
Presence or absence of ovarian cyst(s)
Size of both ovaries
Size of the uterus
Thickness of uterine lining

Blood Tests:

Blood (serum) CA-125 has been available for many years. However, it is non-specific and may be elevated with benign disease:

Benign ovarian cyst(s)
Endometriosis
Uterine fibroids

Although CA-125 is commonly used in conjunction with pelvic ultrasound for screening in Japan and Great Britain, the United States has been more conservative in its use to attempt to avoid unnecessary surgery and its complications.

Mutations in at least 9 genes have been implicated in increasing the susceptibility to ovarian cancer. Panels for some of these mutations are becoming available. If patients are identified as being at increased risk by family history, mutational analysis or persistent symptomatology increased diagnostic screening is probably indicated.

If a pelvic mass is identified and suspected to be ovarian, HE-4 and OVA-1 blood tests will help identify those patients at greatest risk for ovarian cancer.

The OVA-1 blood test generates a “score” to calculate the likelihood of cancer, comprises 5 blood markers including:

Transthyretin (prealbumin)
Apolipoprotein A1
Beta 2 microglobulin
Transferrin
Cancer Antigen 125 (CA-125)

Recently, DNA in the tampons of women with a pelvic mass and open fallopian tubes identified 60% of patients with ovarian cancer (Erickson, B.T et al, OB/GYN 2014:124:881). Perhaps these advances will offer patients hope for earlier diagnosis and better cure rates.