Chemotherapy May Help Women With Early Ovarian Cancer

< September 29, 2004 > -- Women with early ovarian cancer may benefit from chemotherapy in addition to surgery, say researchers in the medical journal Cancer.

According to the authors of the new study, chemotherapy improves survival and reduces the risk of recurrence in women with stage 1 ovarian cancer (cancer that has not spread beyond the ovary).

Their findings did not clarify which patients would most benefit from adjuvant (treatment in addition to the surgery) therapy.

Finding Ovarian Cancer Early A Plus

Slightly more than one-quarter (27 percent) of ovarian cancers are caught while they are still confined to the ovaries. At this stage of the disease, women have a five-year survival rate of about 85 percent.

Many physicians do not recommend chemotherapy, as surgery turns out to be enough for 80 percent of patients with early-stage ovarian cancer.

The problem, however, is knowing for sure what stage the cancer is in - that is, the tumor's size and whether it has advanced from the original affected organ.

Staging for ovarian cancer is done surgically, during the primary operation to remove the tumor.

"Certainly, pathological staging done at the time of surgery is a lot more reliable than a series of CAT scans or something else, but they're not always done correctly," says Dr. Greg Bizette, a medical oncologist at the Ochsner Clinic Foundation in Covington, La.

One study showed that a second surgery to stage the disease put 25 percent of women in a more advanced stage than originally thought, and that 70 percent of these were upstaged to stage III, a far more serious condition.

When the disease is this far along, chemotherapy is recommended as a routine part of treatment.

For this reason, other physicians believe that adding chemotherapy is important because only 10 percent of women who are thought to have stage I disease actually receive adequate surgical staging.

Researchers Look at Many Studies

Given this large gray area, the Gynecologic Cancer Disease Site Group of Cancer Care Ontario decided to conduct a meta-analysis of randomized controlled trials published since 1965.

Thirteen such trials were identified which compared different therapies (over and above surgery) for women with stage I ovarian cancer.

Overall, the trials indicated about a 35 percent increased chance of survival for stage I patients and a 30 percent lower risk of the disease recurring for women who received chemo versus those who had not.

Platinum-based chemotherapy, which is standard treatment, improved overall five-year survival by about 8 percent.

These trials had many of the problems encountered in the real world - namely, not all of them were comparing apples and apples.

Eight of the trials looked only at women with stage I ovarian cancer. Most of the trials did not show adequate staging, and there was insufficient data on the dose, duration, and optimal regimen (the number of cycles) of the chemotherapy.

These problems highlight the need for better randomized controlled studies and, specifically, ones that use a standard staging procedure, said study author Dr. Laurie Elit, an associate professor of obstetrics and gynecology at McMaster University in Hamilton, Ontario.

Experts Recommend "Surgical Staging"

In the meantime, Dr. Elit and her colleagues recommend that women with suspected ovarian cancer receive surgical staging.

Optimal staging, experts say, includes extensive examination of tissue sampling from the entire pelvic area.

Those who have received optimal staging and whose tumors show good prognostic factors will probably do well without chemotherapy. Women who do not get optimal staging and who may have more advanced tumors should receive platinum-based chemotherapy.

"The conclusions are similar to those of previous studies," says Dr. Kevin Holcomb, director of gynecologic oncology at Beth Israel Medical Center in New York City. "This study shows that women who are optimally staged and have stage 1/grade 1 tumors have an excellent prognosis without adjuvant chemotherapy."

Post-surgery chemotherapy, he adds, appeared to be "most beneficial for patients with inadequate staging. Therefore, adequate staging is crucial in determining which patients will truly benefit from adjuvant chemotherapy."

Always consult your physician for more information.

Online Resources

American Cancer Society

Centers for Disease Control and Prevention (CDC)

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center

Find a Physician at
St. John's Mercy or call our Physician Referral Service at 314-FOR-DOCS.  

For more information on ovarian cancer, please visit health information modules on this Web site.

Ovarian Cancer Explained

The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer.

The following have been suggested as risk factors for ovarian cancer:

• early menarche - starting monthly periods early - before the age of 12
  
  
• late menopause (after the age of 52)
  
  
• age - over the age of 50
  
  
• hormone replacement therapy
  Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.
  
  
• infertility (inability to become pregnant)
  
  
• having a first child after the age of 30
  
  
• personal history of breast or colon cancer
  
  
• family history
  First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at a risk for developing the disease. The risk increases if two or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.
  
  
• fertility drugs

The following are the most common symptoms of ovarian cancer:

• general discomfort in the lower abdomen, including any/all of the following:
  
  
  • feeling swollen or bloated
  • a loss of appetite or a feeling of fullness - even after a light meal
  • gas, indigestion, and nausea
    
    
• weight loss
  
  
• diarrhea or constipation, or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder
  
  
• bleeding from the vagina
  
  
• build up of fluid around the lungs, which may cause shortness of breath

In many cases, symptoms may be so vague that they are easily ignored. The symptoms of ovarian cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

Diagnosis includes a medical history and physical exam, including a pelvic exam to feel the vagina, rectum, and lower abdomen for masses or growths.

A Pap test may be requested as part of the pelvic exam. The physician may also order other tests, including:

• ultrasound - an imaging technique that uses sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys.
  
  
• computed tomography (CT or CAT scan) - a non-invasive procedure that takes cross-sectional images of the brain or other internal organs, to detect any abnormalities that may not show up on an ordinary X-ray. The CT scan may indicate enlarged lymph nodes - a possible sign of a spreading cancer or of an infection.
  
  
• lower gastrointestinal (GI) series - X-rays of the colon and rectum using a contrast dye called barium.
  
  
• intravenous pyelogram (IVP) - X-ray of the kidneys and ureters, taken after the injection of a dye.
  
  
• blood test - to measure a substance in the blood called CA-125 - a tumor marker.
  
  
• biopsy - removal of sample of tissue via a hollow needle or scalpel.
  

Always consult your physician for more information.