Ovarian cancer has bothered medical professionals for a long time, says Dr. Lucie Gilbert, director of gynecological oncology at the MUHC, because unlike in breast, colon and other cancers, very little progress has been achieved in the last three decades.
“Ovarian cancer rates are flat,” Gilbert says. “It is recognized that the reason is that the vast majority of women come to us in advanced stages.” Eighty per cent of patients are diagnosed in Stages 3 and 4.
Surgery works if you catch the disease when it’s confined to the organ that it started in, Gilbert says. “We felt if we somehow could diagnose the disease when it’s still in the ovaries, we wouldn’t be in the trouble we are in.”
Part of the problem is access to medical care and the fact that symptoms associated with ovarian cancer are not particularly gynecological. “Ovarian cancer is known to have symptoms that are very vague and non-specific, such as feeling bloated, urinary frequency, feeling full—these don’t seem like serious symptoms yet are known to be symptoms of ovarian cancer.”
In 2007, some of the most prestigious cancer societies advised women in the U.S. that if they have these symptoms, they should see their gynecologist and have a transvaginal ultrasound and a tumour marker CA125 blood test.
Based on this recommendation, Gilbert and her team set up a pilot project as a research study to see whether early diagnoses could be made if symptomatic women were given access to fast track diagnostic tests.
“We’re not talking about symptoms that have been there a long time—this is not ovarian cancer.” But if new symptoms have been present for at least two weeks, check it out.
“It’s the newness that is important, not the severity. If you wait for severe symptoms, it’s too late,” Gilbert says.
In the study, the DOVE program (Diagnosing Ovarian Cancer Early) participants did not have to wait for a referral, as Gilbert and her team felt that that was where the problem was. Waiting to see a physician, or being sent for other tests for seemingly garden-variety symptoms or waiting before a test could be done all may delay diagnosis.
“In our study we found this approach did result in diagnosing the disease earlier, but not in Stage 1, as we thought we would. We stumbled upon an accidental finding,” Gilbert said. “To our surprise we found that the worst type of cancer, High Grade Serous Cancer, which causes 90 per cent of ovarian cancer deaths, is not really an ovarian cancer but appears to start in the fallopian tube.” The cancer cells “seed,” or drop onto the ovary, which Gilbert says is almost like an innocent bystander. “From the public health point of view, this is the cancer that matters. By the time we do an ultrasound we find it enlarged, in stage 3. This is why it is being diagnosed late.” Given early access to tests, women were diagnosed late but at least in an operable stage.
Another finding of this study was that the subjects were not really representative of the general population of Montreal, and they decided to “take the clinic out into the community” to reach those in the highest risk group, women over 65.
With the help of CIHR, Gilbert and her team got one of four large grants given across Canada, $1.5 million to open 12 satellite centres in areas where there is a higher proportion of women over 50.
The initiative has a double purpose, Gilbert says. On one hand, it is a service given to women who may have symptoms that can develop into ovarian cancer. “We want women with symptoms to go to these clinics. One in 62 has a cancer, one in 122 has ovarian cancer.”
Gilbert says that to find the one, 121 women must be tested. “It is worthwhile. It may make the difference between them living and not living What we want is that women do not hesitate to bring up new symptoms, do not wait for them to get worse.”
Just as cancer cells can drop on the ovary, some can end up in the uterus. Gilbert and her team are investigating a special Pap test, hoping that it will pick up signs of illness earlier than the blood test or the ultrasound.
“Symptoms are a huge list and we’d like to narrow it down and streamline the process. At the moment it’s a very tedious long-hand process.”
At the centres, data are collected and analyzed and women fill out a questionnaire in the hope of learning to profile the disease better and to determine more accurately who needs access to prompt medical care.
Ovarian cancer is the fifth most common cause of death in Canada, and Gilbert says in Montreal each year we spend $20 million on chemotherapy just for this disease.
“What we are asking women is if there is anything different happening in the ovary, go and have the test.”
For more information on symptoms or medical care access, call the DOVE Diagnostic Centre: 1-866-716-3267, much.ca/studies/dove