It’s been dubbed women’s silent killer. It can strike without warning signs and there’s no diagnostic test. It’s ovarian cancer, and it has a five-year survival rate of just 45 per cent. By comparison, breast cancer’s survival rate is 90 per cent.
Victims and their families have uttered plenty of “F-words” on ovarian cancer diagnosis, but in this article we turn tables and focus on three F-words about the work of researchers who are building our knowledge on ovarian cancer.
Health authorities estimate there will be 1510 new cases in Australia this year, and it will kill an estimated 1046 Australian women.
Here, University of Queensland researchers tell how they are battling ovarian cancer, or the “silent killer”, on different fronts.
"Our biggest challenge with ovarian cancer is the lack of tools to detect the disease at an early, treatable stage."
Unfortunately a significant proportion of women are diagnosed with advanced-stage cancer because there are no specific warning signs in the disease's early stages.
Most diagnoses are in stages III or IV, when the cancer has spread well beyond the ovaries and the woman's five year survival-rate has fallen to 20 per cent.
You can therefore understand our urgent clinical need to develop techniques to identify ovarian cancer earlier, in stages before it becomes more serious by metastasising (spreading to other parts of the body).
There is currently no diagnostic test specifically for ovarian cancer.
My research targets this unmet need for a diagnostic test, through investigating small bubbles produced by cells, known as exosomes.
Many different types of cells – including cancer cells –release exosomes, and these have the extraordinary ability to capture a snapshot of what’s going on inside the cell.
This snapshot gives us a magnified view of an otherwise difficult-to-access site. Exosomes are an ideal biomarker to detect changes in the ovary, such as benign disease or early-stage ovarian cancer, before the appearance of physical symptoms associated with advanced-stage disease.
Exosomes are like handwritten letters in which cancer cells can send signals to normal cells to spread the tumour. My research goal is to use these exosomes as "liquid biopsies", enabling early detection of the disease without the need for more invasive procedures.
"The key to successful ovarian cancer treatment is a combination of surgery and chemotherapy."
Exactly which treatment is undertaken first depends on the patient’s age, her general health and what stage of cancer she has.
We typically recommend upfront surgery if we can render a patient disease-free through surgery.
In all other patients, we will recommend upfront chemotherapy over nine weeks before assessing if the patient has responded to this treatment and might now be suitable for a major surgical procedure.
Depending on the extent of the disease, surgery for ovarian cancer typically involves removing the uterus, both fallopian tubes and ovaries. We also remove some lymph nodes, the omentum (a curtain of fatty tissue which envelopes your abdominal organs) and, overall, as much cancerous tissue as possible.
These operations can be challenging and making it more of an ordeal, most patients will require more chemotherapy after surgery. Future research will focus on individualising treatment efforts to maximise their effectiveness.
Most ovarian cancer diagnoses are in post-menopausal women, but the disease does strike some young women. We try to preserve fertility in young women if possible, so they can conceive and carry babies in the future.
For example, if a teenager develops ovarian cancer, we often remove only one ovary instead of before chemotherapy.
"Readjusting to life after ovarian cancer treatment is a challenge in itself for patients. It's one that takes time and a certain kind of effort."
At UQ's 2018 Queensland Centre for Gynaecological Research patient information event, I spoke with many of the 150 patients and carers who attended.
They told me that patients felt very well looked after and really appreciated the care they received from doctors, nurses and other health professionals.
However once active treatment finishes, some women feel lost and emotionally drained. They asked, “What’s wrong with me? Why don’t I feel happy now that treatment is finished?”
As someone who works with patients undertaking their cancer recovery journeys after treatment, I know that this seemingly illogical reaction is totally normal.
While on active treatment, a lot of energy is required to deal with all the bodily changes, many appointments and the time spent in clinic or hospital. Other activities of daily living have to be postponed, meaning that at the end of the chemotherapy it can be difficult to even think about what you used to do before the cancer was diagnosed.
A ‘wellbeing plan’ can help in this situation. This can include scheduling regular times for exercise, meeting with close friends and relatives, and starting to socialise more widely again. It’s all about easing oneself back into the "normal life" which was unceremoniously disrupted by the intensive surgical and chemotherapy treatment.
Our team is currently working on the national ECHO trial funded by Cancer Australia, testing whether adding exercise during chemotherapy can improve the quality of life of women undergoing ovarian cancer treatment.
Should a patient's feelings of “being lost” persist, then it may be a good idea to talk to a counsellor, psychologist or even the Cancer Council Australia’s helpline, as feelings of emotional exhaustion can be draining.
The counsellor can suggest some activities to help get back into a healthy routine. In any case it is important for patients to just take one step and one day at a time, as recovery can sometimes take longer than expected.
Stages of ovarian cancer
Stage one: cancer is limited to the ovaries only
Stage two: one or both ovaries are affected, as well as other pelvic tissues.
Stage three: involves one or both ovaries; the cancer is in the abdominal cavity outside of the pelvis, or there is cancer in the lymph nodes in the pelvis, or around the aorta or in the groin.
Stage four: involves one or both ovaries with spread to distant organs such as the liver or lungs.
"I hope that my research, along with the support of the community, cancer foundations, UQ and my fellow colleagues in this field, will pave way for earlier diagnosis of ovarian cancer worldwide and better outcomes for our future generations. It's an honour to have the Lions Medical Research Foundation and the Ovarian Cancer Research Foundation supporting my research."
Dr Carlos Salomon
Lead researcher – Exosome Biology Laboratory, UQ Centre for Clinical Research | Lions Medical Research Foundation Fellow
"Research into better diagnosis and treatment of ovarian cancer is crucial to saving lives worth living. The Cherish Women’s Cancer Foundation and The University of Queensland engage in and enable ovarian cancer research at the highest international level. This research otherwise could not be done."
Professor Andreas Obermair
Gynaecological oncologist | UQ Academic Title Holder – Royal Brisbane Clinical Unit | Cherish Women's Cancer Foundation co-founder | Leader - Queensland Centre for Gynaecological Cancer Research
"I feel privileged working with women to improve their quality of life and wellbeing. The Cherish Women’s Cancer Foundation is supporting our research to make treatments kinder and recovery better for women in the future."
Professor Monika Janda
Professor in Behavioural Science, UQ Centre for Health Services Research