March is Ovarian Cancer Awareness Month. Early detection of this devastating disease is essential. What’s being done?
Ovarian cancer kills 11 women every day in the UK and survival rates in the UK are amongst the worst in Europe. The outlook for women with ovarian cancer can be bleak. There have been very few new treatments approved for ovarian cancer in the last two decades; meanwhile, public and charitable funding for new research has dropped by one third (34%) in the past five years, according to figures from the NCRI (National Cancer Research Institute).
Statistics show that when a woman is diagnosed at the earliest stage of ovarian cancer, her chance of surviving for five years or more is over 90%, therefore, early diagnosis and investment in research is vital to ensure that survival rates improve.
On target to beat ovarian cancer
Target Ovarian Cancer is the UK’s leading ovarian cancer charity. Its medical research programme funds ovarian cancer research across the UK.
“Some of our current projects centre around finding new diagnostic biomarkers for ovarian cancer, DNA damage and repair in ovarian cancer; and finding novel treatments for rare types of ovarian cancer,” Rebecca Rennison, Director of Public Affairs and Services at Target Ovarian Cancer, says. “Target Ovarian Cancer has launched a new three-year campaign – TAKE OVAR – that aims to accelerate change and transform the futures of more than 25,000 women in the UK who are living with ovarian cancer – and thousands more who are yet to be diagnosed.”
Treatment options at any stage of ovarian cancer are limited, and ovarian cancer research lags behind research into other cancers, Rennison says: “The majority of women with ovarian cancer diagnosed today will receive by and large the same treatments patients were being prescribed 20 years ago, with a few exceptions.”
On 8 February, NICE invited Tesaro to submit a proposal for including the PARP inhibitor niraparib (Zejula®) in the Cancer Drugs Fund, for treating some types of recurrent ovarian cancer. Previously licensed for use in the UK by the European Medicines Agency, it can be used to treat women who have platinum-sensitive recurrent ovarian cancer. The drug works by slowing the progress of ovarian cancer by stopping DNA in cancer cells from repairing, promoting cell death.
PARP inhibitors could previously only be used to treat women who have a mutation in the BRCA1 or BRCA2 gene, however niraparib can be used whether or not women have a mutation in their BRCA1 or BRCA2 gene.
“The NICE funding recommendation for niraparib marked an important step forward in the availability of ovarian cancer drugs in the UK,” says Rennison. “While a handful of new drugs such as bevacizumab (Avastin®) and olaparib (Lynparza®) have become available in the past few years, these are only available to a small number of women with ovarian cancer. This was something Target Ovarian Cancer stressed when presenting evidence at the NICE inquiry on the future of niraparib, and we will follow its progress through the fast-track Cancer Drugs Fund.” At the time of going to press, the draft guidance was still open for consultation.
Other ovarian cancer drug developments in the pipeline include further PARP inhibitors such as rucaparib (Rubraca®), and immunotherapy treatment avelumab (Bavencio®).
Symptoms of ovarian cancer are frequent and persistent, and usually occur more than 12 times every month. They include:
- Pelvic or abdominal pain
- Increased abdominal size/persistent bloating
- Difficulty eating/feeling full quickly
- Needing to wee more urgently or more often
Other symptoms can include unexpected weight loss, change in bowel habits, and extreme fatigue. Any post-menopausal bleeding should always be investigated by a GP.
Women who regularly experience any of these symptoms – that are not normal for them – should visit their GP.
Sally Ryan, 45, was diagnosed withan aggressive form of ovarian cancer while pregnant with her first child.
In November 1998 I was 26-years-old, had graduated from university, and was just married. I’d noticed that there was an unusual lump on the lower right side of my abdomen, but put it down to too much partying. Then I fell pregnant in early December. The routine doctor’s appointment was anything less than routine. I was told I was six months pregnant, or at least there was the possibility that I was carrying twins. Over the following weeks I was sent for a scan. No baby’s heartbeat could be found. Instead there was a large cyst obscuring the view of everything.
I went back to the doctor and was immediately referred to the hospital. It was Christmas Eve. I asked what was happening and they said they were going to remove the cyst. I told them I was pregnant and they told me I would lose the baby. I asked if there were other options and was told that I could come back at 13 weeks’ gestation and have the cyst removed then as the baby would be more reliant on my placenta than my hormones.
At 13 weeks pregnant I was back at the hospital. The cyst was large and I looked heavily pregnant. The cyst was over 28cm in length, over a kilogram in weight, and difficult to take out. As it was being removed it burst. However, the baby was intact, and all seemed well. After three days in hospital the specialist came over to see me. He informed me he had removed most of my right ovary while removing the cyst. He told me the cyst had been cancerous. He told me it was ovarian cancer. He left.
I went home and spent the weekend wondering what the rest of my life would look like and how long it would be. I tracked him down at his private practice and went there on the Monday. I asked for clarification and he told me the skin of the cyst was cancerous and that it had touched many parts of my internal organs. He told me that the rest of my right ovary and fallopian tube would have to be removed after the baby was born to limit the possible spreading of the cancer. He said that I was the second person to have this particularly aggressive form of ovarian cancer and that the other patient had recently died.
I was lucky. The cancer didn’t spread, and I didn’t need any further treatment after the removal of my ovary and fallopian tube. Ovarian cancer is frightening. It’s quiet, and had I not been pregnant I wouldn’t have followed up on that small lump until it was possibly too late. That was 19 years ago. My son is now an apprentice carpenter and I have two other children. I’m going back to regular checkups this year as cancer continues to be a presence in my family.