HJBR Sep/Oct 2020

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2020 47 Anthony C. Evans, MD, PhD Medical Director of Gynecologic Oncology Breast & GYN Cancer Pavilion Woman’s Hospital & Mary Bird Perkins– Our Lady of the Lake Cancer Center a combination of intravenous medications is the most effective means of eradicating remaining cancer after surgery. Special- ized treatment called targeted therapy is becoming more common as we learn more about the genetics and biology of cancers. These treatments target key processes that cancer cells use to maintain their health and disrupt them so that the cancer is ren- dered unable to grow and spread. Every woman is offered genetic assessment to define whether she has changes in DNA that can cause specific cancers, and pos- sibly be shared by other members of the family. There are special circumstances in which chemotherapy is done first to shrink cancer, followed by surgery for cancer re- moval, and additional chemotherapy to finish the treatment. The best plan of action can be formulated and implemented by the treating gynecologic oncologist. OVARIAN CANCER STAGES AND PROGNOSIS The stage of cancer refers to the extent to which it has spread. Remission and cur- ability is related to ovarian cancer stage, the amount of cancer that can be removed successfully with surgery, and the response to treatment. Generally, the classification (and five year survival) is as follows: • Stage I: Cancer is limited to ovaries (90 percent) • Stage II: Cancer has spread to nearby pelvic areas such as the uterus (70 percent) • Stage III: Cancer involving the abdo- men, e.g. bowel/omentum or lymph nodes (39 percent) • Stage IV: Cancer outside the abdomen or in the liver (17 percent) Removing advanced cancer is called debulking, and the more that can be re- moved, the better the odds of success. Can- cer response is also monitored by blood tests and imaging studies during chemo- therapy; a brisk response indicates a higher likelihood of durable remission. SIDE EFFECTS AND MONITORING All treatments in medicine can be ex- pected to have side effects. Surgery usually removes ovaries, tubes, uterus, and often, many other cancer-affected areas. Women under age 50 may experience hot flushes and other menopausal changes. Blood loss, infection, clots in leg veins (DVT), and pain may occur. Chemotherapy can cause hair loss, nerve changes in hands/feet, nau- sea, weakness, and constipation. Targeted therapy can cause a variety of side effects based on how they interact with the im- mune, circulatory, or other systems in the body. Most of these side effects can be pre- dicted and treated, averted, or suppressed. After remission has been accomplished, monitoring is done with regular check-ups to ask about symptoms, examine areas at risk, obtain blood tests, and do imaging, when appropriate. PREVENTION AND SCREENING Recent genetic advances have allowed identification of many women who are at risk by virtue of the DNA they inherited from their parent(s). A sufficiently high risk can justify preventive surgery to remove ovaries at risk for becoming cancerous. For the woman at average risk, protective factors include birth control pills (up to 50 percent decrease), longer duration of breast feeding children, number of preg- nancies (more is better), and certain sur- geries such as tubal sterilization, tube/ova- ry removal, and hysterectomy. Unfortunately, there is no reliable screening test for ovarian cancer. Pelvic ultrasounds and tumor markers can be helpful, but newer techniques are needed; current technology is not sufficient. Pap tests do not help with detection of ovarian cancer. Other imaging such as PET scans, MRI, CT, and plain X-rays are not practical or useful for early diagnosis, although they play a role in management. TEAM APPROACH Modern cancer care is a team effort. A coalition of professionals dedicated to all aspects of health is important. Attention to eradication of cancer is, of course, critical. Also important is maintaining good nutri- tion, control of side effects, emotional well- ness, social support, and regular exercise. A typical teammay include cancer specialists who use surgery, radiation, and chemo- therapy to treat cancer. Other providers in- clude nurse practitioners, physician assis- tants, navigators, dietitians, social workers, specialists in palliative medicine, spiritual needs counselors, physical therapists, and many others. Research has shown that ovarian cancer survival is improved by having treatment at a high-volume center. Women with ovarian cancer will be best served when managed at institutions with experience and a proven track-record of success. n Anthony Evans, MD, PhD, is the medical director of gynecologic oncology at the Breast & GYN Cancer Pavilion, a partnership between Wom- an’s’ Hospital and Mary Bird Perkins – Our Lady of the Lake Cancer Center. Dr. Evans specializes in diagnosis and treatment of cancers of the fe- male reproductive system. With more than 20 years of experience treating gynecologic cancers, he understands the importance of engaging his patients in their treatment plan and providing a thorough understanding of their condition and care options.