Why is getting the right diagnosis so important in ovarian cancer? Expert Dr. Kevin Elias explains how accurate testing and staging help identify the type and extent of disease, ensuring ovarian cancer patients receive the most appropriate and effective treatment while avoiding unnecessary or ineffective therapies.
Dr. Kevin Elias is a gynecologic oncologist and serves as the Lilli and Seth Harris Endowed Chair for Ovarian Cancer Research at the Cleveland Clinic, where he holds academic appointments in Gynecologic Oncology, Obstetrics and Gynecology, and Biomedical Engineering. Learn more about Dr. Elias.
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Transcript
Katherine Banwell:
What testing should be done following an ovarian cancer diagnosis?
Dr. Kevin Elias:
So, once a woman has been established to have ovarian cancer, it’s important that we start to subdivide what type of ovarian cancer it is. So, that includes understanding a little bit more about the genetic makeup of the ovarian cancer. We divide ovarian cancers broadly into two groups, what we call homologous repair deficient and homologous repair deficient cancers, or HR-proficient and HR-deficient tumors.
The reason that matters is that patients who have deficient tumors are much more likely to have a type of ovarian cancer that is familial. So, it could put the individual at risk for other cancer types, as well as other individuals in their family at risk for cancer. It also means that those are tumors that are more likely to respond to medications later on in therapy known as PARP inhibitors, as opposed to the proficient tumors in whom those types of therapies are not indicated. And those tumors are also much less likely to be genetic.
Katherine Banwell:
Are there advances in imaging that help guide this process?
Dr. Kevin Elias:
Unfortunately, not so much at the moment. We do have some imaging, particularly at Cleveland Clinic, which we’re starting to use for image-guided surgery. And so, there are certain medications which can be administered at the time of surgery itself to help us identify sites of disease that might not be readily visible to the naked eye. But that would be intraoperative decision-making. Not so much that there’s a difference in the imaging that we might get for preoperative evaluation or the imaging that we might get for post-treatment surveillance for a patient.
Katherine Banwell:
Dr. Elias, why is it so important to get an accurate diagnosis?
Dr. Kevin Elias:
Ovarian cancer can overlap with a lot of other different types of cancer, which can look very similar, both on imaging as well as on blood tests. Whenever we see an individual who has an unspecified cancer process which is involving multiple areas within the abdomen, while it could be an ovarian cancer, it could also be a uterine cancer. It could be a cancer from a gastrointestinal source, such as a colon or pancreatic or stomach cancer. It could even be something like metastatic breast cancer. And so, it’s very important, since the chemotherapy for each one of these medications is different, that we have an accurate diagnosis.
Katherine Banwell:
What questions, then, should patients ask about their ovarian cancer?
Dr. Kevin Elias:
So, first, it’s important that the diagnosis of ovarian cancer has been made with a biopsy, either a biopsy that was taken surgically or a biopsy that was taken by a radiologist. One should never receive chemotherapy based on either blood work alone, or it should not be based simply on what’s known as cytology. Sometimes patients will present with fluid in the abdomen or fluid around the lung, and the diagnosis is made only on the fluid analysis and not actually looking at the tissue itself.
There can be discrepancies sometimes between individual cells that might be present in fluid versus what you would see if you were actually looking at a slice of tissue. And so, patients should be made sure that the diagnosis is being made on an actual slide assessment of tissue. The second question that patients should ask is they should ask a little bit more about the subtype of ovarian cancer they have.
Most ovarian cancers are what are called serous cancers, S-E-R-O-U-S, like serious without the “i.” However, about a third of ovarian cancers fall under different subtypes, and those are sometimes given slightly different therapies. In fact, some types of ovarian cancer that are not serous, if they’re limited to just the ovary, chemotherapy might not even always be required for a very early non-serous type of ovary cancer. So, the subtype matters quite a bit.