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New Blood Test Shows Promise In Early Detection Of Ovarian Cancer
Epithelial ovarian cancer (EOC) accounts for the most significant number of deaths from female reproductive system cancers.
Although effective treatments are available at early stages of EOC, timely diagnosis is difficult due to nonspecific presentation and signs. Thus, there has been intense interest in developing systems that can identify patients at high risk for a diagnosis of EOC before the disease spreads and becomes advanced.
A new paper published in the British Journal of Cancer explores the potential utility of glycoproteins as biomarkers of EOC. In the future, these types of models might allow the diagnosis of EOC to be made from a blood test.
Study: Diagnosing and staging epithelial ovarian cancer by serum glycoproteomic profiling. Image Credit: Shiflovski / Shutterstock.Com
Existing diagnostic guidelinesCurrently, a sequence of diagnostic tests is used to stage EOC, including imaging and blood tests for CA-125, an epithelial surface protein shed from EOC cells. However, these approaches lack specificity, and their sensitivity remains low in early EOC.
Moreover, about 20% of EOCs do not have increased CA-125. In fact, CA-125 levels can be raised in other non-cancerous gynecological conditions like endometriosis and uterine fibroids. Thus, CA-125 can be a more reliable marker for monitoring cancer progression and treating EOCs.
Early EOC is frequently missed, with non-cancerous conditions that present with a pelvic mass often prioritized for surgery. Ultimately, only about 20% of all pelvic masses are malignant, whereas up to 33% of early EOCs are more advanced following histological examination.
There is an unmet clinical need for sensitive and specific tests for early detection, staging of ovarian cancer, and for assessing malignant versus benign pelvic masses."
The current study used a case-control design to analyze serum glycoproteins by mass spectrometry, along with artificial intelligence (AI), to identify those that can distinguish EOC from other conditions and differentiate late from early EOC. A classification system using these markers was subsequently constructed and used to explore the underlying mechanisms that might account for these changes.
EOC vs. Non-cancerous massesA total of 27 differential biomarkers were identified, including several associated with ovarian cancer, such as alpha-1-antichymotrypsin, alpha-1-acid glycoprotein 1, and immunoglobulin G (IgG).
Incorporating these glycoproteins into a novel classification system for EOS showed high accuracy, sensitivity, and specificity of over 85% each, which increased with the cancer stage. This model also performed creditably when applied to healthy patients, as it presented values similar to those observed with benign tumors.
A prospective study on women with pelvic masses using this model showed similar expression patterns of these biomarkers. In this study, the accuracy, specificity, and sensitivity of the model was reduced to 72%, about 50%, and 74%, respectively.
Fucose residues and EOC progressionFucosylation appears to be increased in EOC, with tri- and tetra-antennary fucosylated N-glycans exhibiting the greatest association with EOC in a linear manner from early to late stages. As the tumor advanced in stage, there was a progressive shift from non-fucosylated to fucosylated forms of these glycopeptides.
These specific markers could help diagnose late-stage EOC, as a model classifier based on these proteins achieved over 90% accuracy and 100% sensitivity despite low specificity. With metastatic EOC, fucosylation continued to rise, whereas observed differential gene expression suggested highly branched fucosylated N-glycans.
Cytokines and EOCLate-stage and metastatic EOC was accompanied by changes in serum cytokines, including interleukin 6 (IL-6), IL-8, IL-10, and monocyte chemoattractant protein 1 (MCP-1).
These biomarkers, which typically originate from the liver and circulating immune cells, have been observed in both late-stage EOC and the peripheral tissues of affected individuals. Thus, common factors that are triggered by a change in cytokine levels underlie the common glycosylation processes at these sites.
ConclusionsAs noninvasive triaging and staging can influence treatment protocols for women with pelvic masses, these data represent an important step towards the advancement of EOC diagnostics."
For early diagnosis, blood glycoproteins modified by the presence of the disease that evokes a systemic response are preferable to cell-free or circulating tumor glycoproteins like CA-125.
Even biomarkers that are generated in the very early stages of disease can be efficiently detected by our analytical platform, allowing the diagnosis of disease in the early stage."
Further research is needed to validate these biomarkers and the models using larger, prospective, and independent cohorts. The role of these markers in the development and progression of these tumors should also be elucidated.
Journal reference:
Ovarian Cancer: How To Detect The Disease Early If You Have No Symptoms
Ovarian cancer is one of the leading causes of death among women. According to the American Cancer Society (ACS), a woman's risk of developing ovarian cancer is about one in 87, whereas the chance of dying from it is one in 130.
The good news is that many women recover from ovarian cancer following proper treatment, including surgery and chemotherapy. But unfortunately, the disease can be hard to detect if you rely solely on the onset of symptoms.
Ovarian Cancer Can Be Hard To Detect EarlySpeaking with the OnlyMyHealth team, Dr Ashwin K R, Consultant - Surgical Oncology, Aster Whitefield Hospital, Bengaluru, says, "Detecting ovarian cancer early is hard because it doesn't have clear signs, and there are no good tests to check for it regularly."
He adds that the ovaries are deep inside the body, which is why doctors can't easily find tumours through normal exams.
Also Read: Ovarian Cancer: Signs That Women Should Not Ignore
This is particularly worrying because ovarian cancers grow fast and can spread before symptoms show up.
Additionally, since the symptoms are not specific and people might not know about them, they might not see a doctor until the cancer has already grown a lot, Dr Ashwin notes, adding that certain symptoms related to benign conditions also overlap with ovarian cancer symptoms, leading to confusion and complicating the identification process.
For instance, digestive issues like bloating and changes in bowel habits, menstrual changes, urinary problems, pelvic pain, menopause symptoms, and benign ovarian cysts can all mimic ovarian cancer symptoms. While abdominal bloating can be mistaken for indigestion, pelvic pain might be attributed to menstrual cramps. These similarities can delay diagnosis and treatment, says the doctor.
How To Confirm Your Diagnosis?Symptoms alone should not be a determining factor in diagnosing ovarian cancer.
You can also undergo various tests and physical examinations to confirm or rule out the diagnosis. These include:
If doctors still suspect cancer, they might take a small sample of tissue from the ovaries for closer inspection, usually through a small surgery called a laparoscopy, says Dr Ashwin.
He adds that sometimes they might need to do a bigger surgery to look inside the belly and get more tissue samples.
Also Read: Accepting The Diagnosis Was Most Challenging: Digital Creator Esha Dhingra On Her Breast Cancer Journey
Early Symptoms Of Ovarian Cancer To Watch Out ForAccording to Dr Ashwin, ovarian cancer can show up in different ways and be different in different women. However, some common signs include:
"While experiencing one or more of these symptoms doesn't necessarily mean ovarian cancer, especially as they can be caused by other conditions, any new, severe, or persistent symptoms can indicate the condition and require further assessment," the doctor emphasises. This is particularly crucial for people with a family history of ovarian cancer or other risk factors.
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Ovarian Cancer During Pregnancy: Symptoms, Treatment, And Outlook
Ovarian cancer can occur during pregnancy, but it's rare. Most ovarian cancers found during pregnancy don't cause symptoms and are at an early stage. Treatment may include surgery, chemo, or both.
Ovarian cancer begins in the ovaries. The ovaries produce eggs that are used for reproduction. After uterine cancer, ovarian cancer is the second most common gynecological cancer, according to the American Cancer Society (ACS).
The National Cancer Institute (NCI) reports that the lifetime risk of developing ovarian cancer is about 1.1%. The likelihood of being diagnosed with ovarian cancer during pregnancy is even lower.
This article explores what to know about having ovarian cancer during pregnancy, including topics like symptoms, associated risks, and treatment.
It's possible to develop any type of cancer while pregnant. Researchers estimate that cancer complicates about 1 in 1,000 pregnancies with breast cancer, cervical cancer, and lymphoma being some of the most common.
Ovarian cancer can also happen during pregnancy. However, it's much rarer.
Research estimates that ovarian cancer affects 1 in 15,000 to 1 in 30,000 pregnancies, making up about 3% to 6% of abnormal tissue masses (neoplasms) diagnosed during pregnancy.
Many times, ovarian cancer is discovered during a pregnancy ultrasound. Because of this, about 90% of people who develop ovarian cancer during pregnancy are diagnosed at an early stage (stage 1).
The types of ovarian cancer pregnant people develop are also different. For example, germ cell and borderline tumors are more common in this group. Epithelial tumors, the most common type of ovarian cancer overall, can also occur.
Many pregnant people with ovarian cancer have no symptoms. When symptoms are present, they may include:
These symptoms are nonspecific and are also similar to those of pregnancy. Due to this, they can be overlooked. Many ovarian cancers in pregnant people are found during a pregnancy ultrasound.
Ovarian cancer during pregnancy is typically treated with surgery, chemotherapy (chemo), or both. Treatment choices can depend on factors like:
We review each treatment option in more detail below.
SurgerySurgery for ovarian cancer during pregnancy typically involves removal of one or both ovaries. The safest period of the pregnancy to do surgery is the second trimester. During this time, the risk of miscarriage is reduced.
If you have very early stage ovarian cancer that's only in one ovary, you may be able to have fertility-sparing surgery. This involves the removal of only the affected ovary.
If ovarian cancer is discovered during the third trimester, your doctor may recommend delaying surgery until after delivery.
Surgery at this point in the pregnancy is more difficult due to the uterus and fetus being larger. There's also a higher risk of preterm delivery.
ChemotherapyChemo can be safe and effective in pregnant people. Because the risk of congenital defects and miscarriage due to chemo is higher in the first trimester, when it's necessary, chemo is typically given in the second or third trimester.
During this time, chemo is still associated with a higher risk of:
Additionally, chemo can lead to a higher risk of infections or bleeding during delivery. This means that chemo will typically be stopped in the 3 weeks leading up to delivery.
Some examples of chemo drugs that may be used in pregnant people include taxanes like paclitaxel and platinum-based drugs like carboplatin. It's possible that a combination of these drug types may be used.
Pregnancy terminationIt's possible for many pregnant people with cancer to go on to deliver healthy babies. However, some pregnant people diagnosed with ovarian cancer may choose to terminate their pregnancy.
A 2020 research review notes that it's important to discuss termination of a pregnancy in situations where immediate cancer treatment would be needed.
This is particularly relevant when ovarian cancer is diagnosed during the first trimester, a period of time when cancer treatment is associated with higher risk to a developing baby.
A small 2020 study involving 85 pregnant people with ovarian cancer found that most individuals who chose to terminate their pregnancy did so when their cancer was diagnosed in the first trimester.
The previously mentioned 2020 research review notes that the 5-year survival rate for people with ovarian tumors in pregnancy is estimated to be between 72% to 90%.
This is much higher than the relative 5-year survival rate of ovarian cancer, which is 50.9%, according to the NCI. The improved outlook for pregnant people is likely due to a few things:
If you've been diagnosed with ovarian cancer during pregnancy, the factors that can affect your outlook and the outlook of your developing baby include:
Since every person with cancer is different, it's important to have an open conversation with your doctor about your individual outlook. They can take all the factors above into consideration to give you a better idea of what to expect.
It's possible to get ovarian cancer during pregnancy. However, having ovarian cancer while pregnant is very rare.
Many pregnant people with ovarian cancer don't have symptoms. The cancer is often diagnosed at an early stage during a pregnancy ultrasound.
The treatment of ovarian cancer during pregnancy can include surgery, chemo, or both. The type of treatment that's recommended for you can depend on factors like the type of cancer you have, its stage, and where you are in your pregnancy.
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