Today, Tuesday, September 24, at 2:00pm ET we are opening up the AMA in THIS POST for your questions to Dr. Chapman-Davis. All questions that you have for Dr. Chapman-Davis should be posted as a reply to THIS original post.
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There is no exact wellness regimen that will prevent recurrence. I believe exercise is important as it limits stress and can help with strengthen your body to be able to fight cancer. Nutrition is important and there are a lot of various "diets" or books about nutrition but no one plan has been proven to prevent recurrence
according to research, increase risk of cancer is NOT seen with sugar intake directly. there may be an increase risk related to who your body responds to sugar for example if you are insulin resistant we know women who are overweight or diabetic have a higher risk for developing endometrial cancer. This is not the case with ovarian cancer
I also want to stress that all cells in the body depend on blood sugar (glucose) for energy. But giving more sugar to cancer cells do not speed up their growth
Often women post in this community because they are concerned about a rising CA 125, can you tell us more about how CA125 is used in monitoring for ovarian cancer?
Although rising CA125 may mean recurrence there are many causes for elevated CA 125 that may not mean return of your cancer. The trend of CA 125 is important and confirmatory imaging with actual measurable disease is a better indicator of actual recurrence
Since you are involved with clinical trials at your Weill Cornell, can you tell us about some clinical trials that are going on there that you are excited about?
we just opened the FIRST trial which will allow patients with advanced ovarian cancer the option to be enrolled to provide the standard chemotherapy with taxol and carboplatin versus standard with addition of immunotherapy, or addition of parp-inhibitor (zejula). What is unique about this trial is the addition of targeted therapies to standard chemotherapy as a first line option.
Checkpoint inhibitors are a group of drugs under the umbrella of immunotherapy. The two that are most discussed is Nivoulmab (optivo) and Pembrozulimab (keytruda). newer check point inhibitors are actively being researched as well. These immune checkpoint inhibitors are being used in many cancers with some excellent results for example in melanoma. In ovarian cancer it has not been proven to work as well as a stand alone drug. Most of the current studies including the FIRST trial I am working on are looking to used these drugs in conjunction with other targeted agents such as parp inhibitors or avastin, or standard chemotherapy to hopefully see an added effect. These studies are looking for benefit upfront, maintenance and in setting of recurrent disease
I am on Afinitor and Aromasin for a recurrence of pelvic and lymph cancer (fourth stage ovarian cancer)... in the last two months I have had more pain than ever and now have a recurrence of liver and lung as well. I am on a pain patch and dilautid and have been having the WORST time trying to go to the bathroom.... help! Any suggestions?
Unfortunately when taking narcotics " the dilaudid" for pain it can make you very constipated. the affinitor also can cause constipation. It is very important to have an aggressive bowel regimen. Colace at least three times a day. miralax daily (can increase to twice a day) and make every effort to have a bowel movement at daily or at least every 2 days.
Parp inhibitors have shown a lot of promise as a treatment for ovarian cancer, but sometimes women have difficult side effects such as stomach pains, nausea and vomiting or anemia. What would you suggest to a patient who is experiencing side effects like these? AdaAnn
There are a variety of parp inhibitors ( at least 3 ) so fortunately each have their own side effect profile. some have worse effects on GI system then others. If the symptoms are worse then consideration for decreasing the dose or changing to a different Parp are all considerations. Focusing on anti nausea meds and controlling pain is always the first step
also you can consider if you are just starting the medication, if you can control the side effects upfront usually the worse symptoms are in the first month. Things can then improve.
What’s new in genetic testing to those at risk for OC and possibility of recurrence? Also how does genetic testing have impact on treatment decisions? Shumwayl
Now that there is fda approval for olaparib (parp inhibitor) after first line treatment to prevent recurrence it is important to make sure all women with ovarian cancer have both germline panel genetic testing as well as molecular ( or tissue) testing of your specimen to determine if you have mutations like BRCA 1/2 not only in your blood but also in your tumor
Ovarian cancer patients here a whole lot of new vocabulary, can you help clarify some of the genetic testing terms. What is the difference between genetic and genomic testing? What is the difference between germline and somatic mutations?
genetic testing usually is relating to hereditary cancer syndromes or cancer that are passed on by family members each generation. This type of testing is considered germline testing. genomic testing is usually looking at the specific somatic mutations that are acquired by your tumor that led to the cancer but is not considered hereditary or can be passed on to other family members. Most patient are only interested in germline mutations such as BRCA, Lynch Syndrome, RAD 51. But because patients may be a candidate for targeted therapies not just based on germline mutations but also if their tumor acquired these "somatic mutations" . It is important for patient to have their tumor tested as well as blood test for germline mutations.
the Roma test is not a screening test or supposed to be used as a stand alone diagnostic test for ovarian cancer. It is used to help stratify women to having surgery with a gynecologic oncologist over a general gynecologist. This test is not 100% sensitive or 100% specific. pathology is the only way to diagnosis if there is actual cancer
low grade serous ovarian cancer is considered a different entity then the standard high grade serous ovarian cancer that most women are diagnosed with. Low grade serous tumors can arise from borderline or tumor of low malignant potential which are typically diagnosed in younger women or 30-40 year olds. Low grade serous tumors are not usually responsive to chemotherapy and surgical removal is the first recommendation for debulking all visual disease. As these tumors are "low grade" that also means slower growing and may not be responsive to chemotherapy but usually are ER+/PR+. This can provide options for hormonal therapy for treatment with good response after surgery
If someone is taking a parp inhibitor, how does the gynecologic oncologist decide to continue a patient on that treatment or take them off? How does CA125 play a roll in that decision? Rosemarymemo
When someone is being followed on a parp inhibitor it depends if this is given for maintenance or treatment. If CA125 is slowly rising an patient is asymptomatic I may continue. If it doubles or continues to rise more rapidly I would get imaging to identify if measurable disease or disease progression and then would take them off in that situation
Is there any link between ovarian cancer and cysts known as endometriosis of the ovaries? What is the normal course of treatment for these types of cysts? BeachSheller
endometriosis is common in women and for the most part is considered a benign (non cancerous entity). Endometriosis has been shown to be associated with specific and rare type of ovarian cancer endometrioid and clear cell type. while there is an association endometriosis alone is not considered a premalignant lesion and there is no data that prophylactic removal will reduce the risk of ovarian cancer. however OCP or birth control pills can help with treatment of endometriosis and decreases the risk of ovarian cancer in all users. Treatment for endometriosis can vary depending on your age, fertility choices and pain symptoms. Most women who undergo some type of imaging in patients with concerning features or enlarging masses some surgical intervention is usually warranted
Thank you to everyone who participated today and thank you for submitting your questions! And an especially big thank you to Dr. Chapman-Davis for taking the time to answer our questions today. Still have questions? Consider starting a new post on HealthUnlocked to discuss among your peers.
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