07/20/2015
Dr. Schorge is the Chief of Gynecology & GYN Oncology at Massachusetts General Hospital and Medical Director of the GYN Oncology Program at Wentworth-Douglass Hospital.
Q: OVARIAN CANCER IS THE LEADING CAUSE OF DEATH FROM GYNECOLOGIC CANCER IN THE UNITED STATES. IS EARLY DETECTION POSSIBLE? WHAT SCREENING OPTIONS ARE THERE?
One of the reasons that ovarian cancer is responsible for more deaths than all the other gynecologic cancers combined [uterine, cervix, vulvar] is the lack of an effective screening test. CA125 is a serum marker used for monitoring patients with a known diagnosis, to determine if they are responding to treatment. However, it is not sensitive enough to provide early detection, as dozens of other non-cancerous conditions can cause the test to be elevated. In fact, the U.S. Preventative Services Task Force came out with a formal statement in September, 2012 that ‘there is no screening test’ for ovarian cancer – moreover, that attempts to screen actually do more harm than good, because some women end up having unnecessary surgery and complications.
Over the years, pelvic sonograms, panels of serum markers, and even proteomics have shown early promise only to not end up being proven effective for clinical use. Most recently, monitoring CA125 on an annual basis and looking for a slow rise has shown slightly more ability than doing nothing, but it is still a long way from being useful in the clinic.
The discovery that many ‘ovarian cancers’ actually arise in the tip of the fallopian tube has been one of the biggest events in the field. As a result, increasingly, women who would have had tubal ligation or hysterectomy for benign indications are now quite routinely having both tubes removed. There is early evidence that this can decrease the population risk of getting ovarian cancer down the line. The other way to reduce the risk of ovarian cancer is to be on birth control pills for a period of time.
Without a means of early detection, two-thirds of women are diagnosed with advanced stage III-IV disease. The sequence of aggressive surgery and combination chemotherapy is tricky, and one relevant point is that while fewer than half of patients will even see a gynecology specialist, of those who do, they can anticipate vastly better long-term outcomes. When a woman with ovarian cancer sees a gynecologic oncologist, they are much more likely to have an operation where all the visible tumors are removed and also be counseled about state-ofthe- art intraperitoneal (IP) chemotherapy.
We established the Gynecologic Oncology Program at Wentworth-Douglass in late 2008 through an affiliation program with Massachusetts General Hospital. Here, our program routinely offers IP chemotherapy the Seacoast Cancer Center. We also have a vibrant clinical trials program at Wentworth-Douglass, so we are able to participate in national studies, which is how we advance knowledge and determine best treatments for women diagnosed 5-10 years from now.
TALK ABOUT TREATMENT PLANS. WHAT’S NEW? WHAT INNOVATIVE TREATMENTS DO YOU PROVIDE?
Many ovarian cancers are the result of genetics, even in the absence of any family history. Therefore, currently all patients are referred to genetic counseling at WDH through the Mass General affiliation, and given a blood test to determine if they and their family members are at-risk. This is also important information at the time of disease relapse, since it may indicate that targeted therapy is an option. Most of the current excitement in the field has to do with novel therapies being tested in clinical trials, and we offer a number of such studies at Mass General for Wentworth-Douglass patients who are motivated to travel to Boston for that opportunity.
DESCRIBE YOUR TEAM AT WENTWORTH-DOUGLASS, AND WHAT A PATIENT CAN EXPECT.
We established the WDH Gynecologic Oncology Program in November 2008, and I have been the point person throughout the past 6-7 years. Kathy Quinn has been the GYN Oncology Nurse Navigator over the same duration. I perform a variety of complex surgical procedures at Wentworth-Douglass, while extraordinarily challenging operations are brought to Mass General. Kathy and I partner with the Radiation Oncology and Medical Oncology teams at the Seacoast Cancer Center in addition to Palliative Care, Hospitalists, OB-GYN groups, and leadership to facilitate the same level of care as my team at Mass General. We are fortunate to offer clinical trials here, thanks to the infrastructure provided by hospital leadership, so that patients have more options, help us to advance the field, and do not have to travel to Boston. I also see inpatient consults, outpatients, 2nd opinions, and we have developed a wonderfully accessible relationship with doctors in Dover and the surrounding communities.
HOW DO PATIENTS CONTACT YOU?
For more information about the Gynecologic Oncology program at Wentworth-Douglass, contact Kathleen Quinn, RN, BSN, OCN, Gyn Oncology Nurse Navigator, at 603-609-6024.