Women's Health

Why Is Ovarian Cancer So Difficult to Treat?

Why Is Ovarian Cancer So Difficult to Treat?

While many meaningful leaps forward have been made in various types of cancer in recent years, unfortunately, ovarian cancer is not one of them. This has left many experts and people who have the condition wondering, "why is it so difficult to treat ovarian cancer?"

A rare condition

Diagnosis for Ovarian Cancer typically does not come until the disease has progressed into advanced stages and becomes almost impossible to treat. This is often because the cancer has limited symptoms, and the ones that are present can often be dismissed as "normal" or an effect of another, more minor condition. 

For example, some of the most common symptoms are bloating, abdominal pain, pelvic pain, a sensation of fullness, the need to urinate frequently or with a sudden urgency. All of these are sometimes associated with menstruation, or in some cases, menopause - which occurs around the same time when many become afflicted with ovarian cancer. They can also be misdiagnosed as IBS or other bowel-related conditions.

Robert L. Coleman M.D. is the vice chair of Clinical Research in the Department of Gynecologic Oncology at The University of Texas MD Anderson Cancer Center, as well as a professor. He references the difficulty of noticing that there is a problem afoot due to the abdominal cavity's massive capacity, and how organs are protected inside of it. He states, "there's nothing that would specifically indicate something is going on, even if the ovary is getting quite large. It's not that ovarian cancer doesn't have symptoms, it's just that none of them are specific for early ovarian change."

Rita's story

Rita Ferguson had her own experience of the shock of discovering she had ovarian cancer, as her own symptoms seemed miniscule in comparison to such a huge diagnosis. She believed that she had diverticulitis, which is when either one or multiple of the small pouches in the digestive tract becomes inflamed or infected. While this was causing significant abdominal pain, she never imagined that it could have been something as serious as ovarian cancer; diverticulitis is very short term, and is usually able to be properly dealt with within weeks. Discovering something as serious as ovarian cancer seemed outside of the realm of possibilities.

It happened when she went in for surgery to resect her sigmoid colon when the doctors found the bigger problem - stage 4 ovarian cancer. Ferguson explains, "I had no expectation of cancer at all."

Ferguson was 67 at the time of diagnosis, and does not have the BRCA mutation, which are tumor suppressor genes.

Effect of a lack of viable treatments

Because treatments are so limited for ovarian cancer, the five-year survival rate is 45 percent, meaning less than half of the women who are diagnosed will live to see another five years. Thus, learning of the condition is devastating not only for the person who learns of it within themselves, but for their friends and family as well. The American Cancer Society has stated that around 22,440 women were diagnosed in 2017 within the United States.

A more common cancer, like breast cancer, receives far more funding from the American Cancer Society at around $88.2 million, compared to ovarian cancer's $26.3 million (both in grants for research).

At the moment, surgery, chemotherapy, hormone therapy, targeted therapy, and radiation therapy are available for the treatment of ovarian cancer. Usually, more than one will be used at a time, and the decision will often be made depending on the specific type of cancer, as well as its stage. The general status of your health, desire to have children, and other specific considerations are also often taken into account. Unfortunately, the efficacy of these are limited and can often lead to intense side effects and complications.

For many, clinical trials are the best bet as pre-existing treatments and therapies are by no means cure-alls. While there is certainly still a risk involved, many decide that they would like to take a chance. Clinical trials also usually cover the cost of care, which can be attractive to many, as the cost of cancer treatment tends to be very high. However, this is a very personal decision to make. While some would prefer being involved in a clinical trial over any other form of treatment, others would prefer to stay away from them entirely.

Often, people will also rely on "complementary or alternative methods," but these have very limited levels of efficacy. Some are herbs, diets, vitamins, massages, acupuncture, etc. If used in a complementary manner, which means that normal medical care is still being taken, and these forms of treatment are being used as supplements. However, some people decide to use these, and others, as a complete alternative, meaning that they forego receiving treatment from a doctor. While many feel confident that these methods are aiding them, there is clearly still need for further research and new treatments.

Impact of cutting costs

Because of the limited resources available to dedicate to ovarian cancer research, scientists have have to allocate them sparingly. The result has been largely in developing noninvasive manners of screening to better enable earlier detection of the cancer, before it has progressed.  This might be positive as it would potentially increase the efficacy of preexisting treatments, so far there have not been significant improvements made with these lines of study. Also, none of the new screening procedures have proven to be powerful enough to impact the rates of mortality. Even if progress in screening processes was made, the fact remains that many women who develop ovarian cancer do not go for screenings. Without dedicating funds to the development of treatments, these women will still be faced with the same fate regardless.

Elizabeth Swisher, MD is a professor in gynecologic oncology, as well as an adjunct professor in medical genetics at the University of Washington School of Medicine, and the director of the Breast and Ovarian Cancer Prevention Program at the Seattle Cancer Care Alliance. She offers her experience with the phenomena: "Across the board, cancer research has seen a decrease in funding due to federal and institutional budget cuts. This has disproportionately impacted ovarian cancer research and clinical trials more than other cancer types ... If we want to make progress with making new drugs accessible to people to help them live longer and save lives, we need support for clinical trials."

Unfortunately, the funding simply is not currently available to engage in as many clinical trials as necessary to develop new forms of treatment that may drastically impact people's lives. In the meantime, patients should ensure that they are screened regularly, so if there is a development of ovarian cancer, it can be caught in the earlier stages when current treatments are more effective.