When we spoke, she gave us insight into ovarian cancer and hope for the future.\u00a0 Here is more of our conversation:<\/p>\n There are different types of ovarian cancers, and the more common types of ovarian cancer generally affect post-menopausal women in their 50s and 60s.\u00a0 There is a sub-group of women who have a higher risk of ovarian cancer than the general population.\u00a0 They are women who have a genetic predisposition to certain tumours including ovarian cancer.<\/p>\n For the patient population that carries the BRCA mutation, the best evidence for risk reduction of developing ovarian cancer is the surgical removal of the fallopian tubes (tubes) and ovaries.\u00a0 The age in which we recommend removal of the ovaries depends on which type of mutation that they have.\u00a0 This is known as a prophylactic surgery.\u00a0 Prophylaxis in general, means prevention in medicine.\u00a0 Prophylactic surgery to prevent ovarian cancer is usually done laparoscopically meaning that it is minimally invasive. It is a smaller procedure and it not generally performed by an oncologist.\u00a0 It is done by a general gynecologist and there are a few fantastic clinics across Canada that specialize in risk reduction strategies for women.<\/p>\n They have surgical gynecologists and genetic counsellors so that there is a comprehensive plan for women who are at risk for developing ovarian cancer.\u00a0 They will undergo counseling, genetic testing and then, based on their family situation and once they are ready, they can have that surgery.\u00a0 It is an important and significant change in a woman\u2019s health to undergo removal of the tubes and the ovaries. It does, however, decrease the risk of ovarian cancer significantly, and it impacts their survival in a very positive way.<\/p>\n This really highlights the limitations of our genetic testing to date.\u00a0 There are some genetic mutations that are well-studied and we really understand their link to some cancers including ovarian cancer.\u00a0 There is still a very wide range of DNA and mutation changes that we still have not fully studied.\u00a0 There might be a mutation that is still not identified in a family that increases the risk for the individual in developing ovarian cancer.\u00a0 If they have a strong family history, some of the studies show that taking the oral contraceptive pill for an extended period of time (up to ten years) can reduce the risk of developing ovarian cancer.<\/p>\n One of the biggest challenges of ovarian cancer management is the lack of screening.\u00a0 For breast cancer, we do have a very good screening strategy for women who are at risk.\u00a0 Other cancers that we have proven tests for include colorectal cancer (a colonoscopy) or cervical cancer (pap smears).\u00a0 Those types of tumours are very well equipped because we can prevent them or catch them early.<\/p>\n There were several studies that included a large number of women that potentially might be at risk for developing ovarian cancer and to date there is not one test that is a screening test for the average woman for the prevention of ovarian cancer. Sadly, screening is not available.\u00a0 Prevention is available for women that are at risk with a genetic mutation with the surgical removal of the ovaries and the tubes.<\/p>\n It is a big challenge in ovarian cancer.\u00a0 The ovaries are situated inside the body, in the abdomen. They are quite small to begin with and when ovarian cancer is diagnosed, the majority of women have advanced stage disease, meaning that the disease has already spread.\u00a0 It spreads, most commonly, inside the abdomen. Women develop what are called deposits of small tumours throughout multiple locations of the bowel.\u00a0 Symptoms often relate to small changes in bowel function, distention or swelling in the belly and that can be attributed to many different things.\u00a0 Some people think it\u2019s related to indigestion, constipation or diarrhea.\u00a0 It can take several months before someone can truly think that it\u2019s abnormal.<\/p>\n There isn\u2019t one alarming symptom, such as bleeding or sudden pain where someone would say that it was abnormal enough to seek urgent medical attention.\u00a0 We encourage people to reach out to their family physician even if there is a slight change in their bowel habits or if they are feeling bloated or start to vomit.\u00a0 It is better to see your family doctor to have things double checked.\u00a0 If there is something there, you can get to see the oncologist quickly.<\/p>\n People often mix up the terms grade and stage. \u00a0The grade tells how aggressive is this type of cancer.\u00a0 A cancer that is low grade is not an aggressive cancer where if it is high grade, that means it\u2019s more aggressive.<\/p>\n Stage on the other hand tells us where is this cancer compared to the original location.\u00a0 In ovarian cancer for example, if it\u2019s contained to the ovary, that would be Stage I.\u00a0 Stage II would be a little bit further advanced, while Stage III is more advanced and Stage IV is metastasized.\u00a0 Cancer that is already at an advanced stage is usually Stage III and IV and it has spread beyond the pelvis and also includes the bowel, the inside lining of the belly, potentially the liver and possibly lung metastases.<\/p>\n Having said that, we can treat ovarian cancer successfully because 70% of women have the more common types of ovarian tumour called epithelial tumour and the majority of research is done in that particular group of women. \u00a0We know the types of medications that work, the type of surgery that works and we can often develop a very good and personalized treatment program.\u00a0 When we have a referral for suspected or confirmed ovarian cancer at Princess Margaret, we have a special ovarian cancer program.\u00a0 We have imaging done very rapidly and we have a weekly meetings to review these cases in a multidisciplinary fashion.\u00a0 These meetings include:<\/p>\n We make sure that if the person needs surgery, that we identify the locations of the tumour and the extent of the surgery that they need.\u00a0 We have a rapid plan for women with this disease and we initiate the treatment quickly.<\/p>\n Understanding the type of ovarian cancer and really any type of cancer is critical.\u00a0 It includes the biology of the tumour and the type of treatment that a woman would benefit from based on the type of tumour that she has.\u00a0 There are types of tumours in the ovary that happen in young women including teens and early 20s.\u00a0 They are very different than the very common types of tumours that can happen in women after the age of menopause.<\/p>\n In young women, we often see something called germ cell tumours.\u00a0 Ovaries have eggs cells that can change and become cancerous.\u00a0 The treatment for those types of tumours is very different from the common types of ovarian cancer that happen to women after menopause.\u00a0 After menopause, the types of tissue that change into cancer are the tissues that covers the ovaries or hold the ovaries together.\u00a0 The treatment for that type of cancer is different.\u00a0 There are different chemotherapies, different surgeries and the prognosis is different.\u00a0 Understanding the type of tumour that we are dealing with is the first step in personalizing the treatment for the woman.<\/p>\n We don\u2019t have a generalized protocol for everyone.\u00a0 Thanks to research, we do know what the most effective options there are for different types and stages of tumours.\u00a0 With every woman that we see, we discuss the treatment options, including options for clinical trials that they potentially may qualify for.\u00a0 We discuss the side effects of treatment.\u00a0 We also discuss the side effects of not treating the cancer which is also very scary.\u00a0 Not treating a cancer that is growing is also debilitating and has it\u2019s own set of side effects.<\/p>\n We recognize that this is a challenging time within a person\u2019s life so we have nursing support, social workers and psychosocial oncology.\u00a0 Our psychologists and psychiatrists specialize in woman and families going through cancer.\u00a0 There is an impact on patient, on her spouse, kids, parents and other family members who may also be scared if the mutation runs in their family.<\/p>\n What I usually tell my patients is that this is a significant period of time in their life.\u00a0 It will be busy,it will be intensive and you will go through a lot of treatment.\u00a0 We usually come to the best treatment strategy for that particular woman together as a team.\u00a0 Whether it is a combination of surgery, chemotherapy, clinical trials and targeted therapies \u2013 once we have a treatment plan, we get together every week so the person is not alone.<\/p>\n We have team members available in person or over the phone for questions, support or to vent.\u00a0 We always keep our eye on the big picture \u2013 long-term survival.\u00a0 It is such a momentous occasion when we have a clear CT Scan and the person goes into remission and that makes this journey worthwhile.\u00a0 The important thing is that we maximize quality of life, while at the same time, maximize our chance for the best survival outcome.<\/p>\n It is key for every person to have their own support system whether it is family or friends.\u00a0 It is critical to involve them in understanding the disease, treatment and journey.\u00a0 Predicting what will happen is important because some things may not be obvious and might be scary if they weren\u2019t aware that could happen. Once we do surgery for example, we do give a lot of information to the family members to help them anticipate what is normal after cancer surgery.\u00a0 Often the surgeries that we do for ovarian cancer are quite extensive.\u00a0 Patients might have changes to their bodies like ostomy bags which can change the function of the body for awhile and family members are often educated on what to expect and who to call for emergencies.<\/p>\n We encourage family members and support people to speak with our social workers, both for the sake of the patient but also for because they are going through the journey and transitioning that relationship into a caregiver relationship.\u00a0 Often, this is temporary and hopefully, once the cancer goes into remission, and the person recovers, the relationship dynamic can go back to normal.\u00a0 For a time, it will change. We need to recognize that it is a struggle and we can support both the patient and caregiver through that.<\/p>\n If they have a suspicion or are worried, and they see their family physician, I encourage people to ask any questions.\u00a0 It is better to call and be reassured versus waiting too long.\u00a0 They should ask what tests they may benefit from for the symptoms they are experiencing.\u00a0 They should also ask their family doctor what are they thinking of?\u00a0 What is their differential, meaning what are the list of concerns that family doctor has as the patient is listing these symptoms?\u00a0 What could be causing these symptoms and how is the family doctor planning to rule out those diseases? If one of them is ovarian cancer, they can ask, how can we rule that out? What tests will be helpful?<\/p>\n I agree that every person needs hope and there is always a lot of opportunities for treatment and clinical trials.\u00a0 Ovarian cancer has gone through a lot clinical trials and a lot of interesting research.\u00a0 There are more targeted therapies which are systemic, that are given either orally or intravenously and they are different than chemotherapy.\u00a0 They target specific mutations within a specific tumour.\u00a0 There are ongoing studies on immune therapy in ovarian cancer.<\/p>\n From a research perspective, it is an interesting time in ovarian cancer research.\u00a0 There are a lot of opportunities for knowledge in understanding of what is beneficial and how we can maximize survival in patients with ovarian cancer.\u00a0 There are also surgical initiatives.\u00a0 We have our own labs at Princess Margaret and our research shows that there is a link between the timing of chemotherapy and surgery and recovery from surgery with minimal complications.\u00a0 Not delaying chemotherapy is critical in terms of long-term survival.\u00a0 We have integrated surgical innovation and new technology that we use as standard of care at Princess Margaret. For women that have ovarian cancer and bowel surgery, we use infrared technology to identify the blood supply at the end of surgery to minimize the risk of complication.\u00a0 \u00a0We think that this will all improve both immediate and long-term outcomes.<\/p>\n I look at my patients and am empowered by them.\u00a0 There is something unique about a cancer diagnosis that puts everything into perspective.\u00a0 These woman are amazing.\u00a0 They are resilient.\u00a0 They go through extensive treatment and extensive surgery, and all of them go through it with grace and dignity.\u00a0 I am really proud of their journey.<\/p>\n Whether the outcome is complete remission or whether there is a recurrence, it is still the exact same person and that is really empowering.\u00a0 When treatment doesn\u2019t result in a complete remission and we have a recurrence, I often take that back to my research and say what can we do to improve this outcome?\u00a0 What type of tumours can we study further and get better treatment for? As a scientist at the University of Toronto, I take the challenging cases back to my lab and say how can we improve outcomes for the future so that every outcome is fantastic?<\/p>\n Cancer patients, including women with ovarian cancer, may have challenges with child care on treatment or appointment days.\u00a0 Princess Margaret Cancer Centre in Toronto\u00a0 has The Magic Castle which is a free child-care service for children up to 12 years old. They take care of your children so that you can go to your appointment or visit family at the hospital.\u00a0 One Life<\/a> is hosting its inaugural fundraiser on Saturday, May 15, 2021 to help pay for The Magic Castle and to provide childcare for the 1,000 children who use the service annually.\u00a0 To learn more, go to onelifegala.com<\/a>.<\/em><\/p>\n *Source \u2013 Canadian Cancer Society<\/a><\/p>\n **Source \u2013 Ovarian Cancer Canada<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"![\"Ovarian](\"https:\/\/divine.ca\/wp-content\/uploads\/2020\/10\/Uterus.jpg\")
Who is most likely to be at risk for ovarian cancer?<\/h2>\n
For women who have tested positive for the BRCA (Breast Cancer gene) gene, what preventative measures can they take to reduce their risk of ovarian cancer?<\/h2>\n
If a woman did not test positive for the BRCA gene, are there other precautions that they can take?<\/h2>\n
Ovarian cancer is also called the silent killer.\u00a0 What symptoms should women look out for?\u00a0 Why is it so difficult to diagnose?<\/h2>\n
Cancer is staged and graded.\u00a0 Speak to what each of the four stages means in terms of ovarian cancer?<\/h2>\n
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There isn’t just one type of ovarian cancer – explain the differences between the tumour types.<\/h2>\n
Women are often just as afraid of the treatment as they are of the disease.\u00a0 What should a woman know about her treatment options?<\/h2>\n
What is your advice to people that are caregivers or support people for cancer patients?<\/h2>\n
What questions should a woman be asking her doctor?<\/h2>\n
Every patient needs hope.\u00a0 What new treatments are on the horizon?<\/h2>\n
Finally, as a gynecologic oncologist, you have ups and downs and very few people think of the impact on the doctor.\u00a0 Sometimes you are providing people with news that they are in remission.\u00a0\u00a0 Sometimes, the news is sadder.\u00a0 How do you cope with days that aren’t so easy?<\/h2>\n