OFFICE OF RESEARCH ON
WOMEN'S HEALTH
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PINN
POINT ON WOMEN'S HEALTH
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PODCAST 5
OVARIAN CANCER
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RECORDED
AUGUST 28, 2007
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DR. VIVIAN W. PINN
Office of Research on
Women’s Health
DR. EDWARD TRIMBLE
Clinical Investigations
Branch
Cancer Therapy Evaluation
Program
Division of Cancer Treatment
and Diagnosis
National Cancer Institute
This transcript produced from podcast audio provided
by Educational Services, Inc.
P-R-O-C-E-E-D-I-N-G-S
ANNOUNCER: From the National Institutes of Health in
DR.
PINN: Welcome to another episode of Pinn
Point on Women’s Health. Each month on
this podcast we’re taking a look at the latest developments in the areas of
women’s health and the medical research that affects our lives. For the podcast today I’m delighted to
welcome Dr. Edward Trimble, who is Head of the Gynecologic Cancer Therapeutics
and Quality of Cancer Care Therapeutics in the Clinical Investigation Branch,
the Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis,
at the National Cancer Institute here at the NIH.
To
boil that down, Dr. Trimble heads up most of the research related to
gynecologic cancers and has worked so much with the Office of Research on
Women’s Health in keeping us educated about and involved in research related to
women’s gynecologic cancers. I’m so
delighted to have him here with us today but first some hot flashes from the
world of women’s health research coming up in just 60 seconds when we continue
with Pinn Point on Women’s Health.
ANNOUNCER: Uterine fibroids, the most common
non-cancerous tumors of the uterus. If
you’re suffering with uterine fibroids and are between the ages of 25 and 50,
the NIH invites you to take part in a clinical study. All study tests and related treatments are
provided at no cost and compensation is provided. For more info call 866-999-5053 or log on to
clinicaltrials.gov. The National
Institutes of Health is a non-profit government agency, part of the U.S.
Department of Health and Human Services.
DR.
PINN: Welcome back to Pinn Point on
Women’s Health. I want to take a look at
some of the hot flashes in the news regarding women’s health research from the
recent several weeks. One, there was a
recent article published related to estrogen’s secret role in obesity. We know that so many women and, in fact, men
also have questioned why is it that it appears that when women go through
menopause they seem to put on weight or at least many women appear to. Is there a physiologic or biologic reason for
that?
Well,
the answers aren’t all clear but from the American Chemical Society’s meeting
held during the month of August of this year, there was some research
presented, of course, it was not based on human findings but from basic
research that suggested that the female sex hormone, estrogen in the brain may,
in fact, play a role in what happens to women during the time of
menopause.
In
some of the animal experiments that were described at this meeting, researchers
showed how estrogen receptors located in the hypothalamus serve as a master
switch to control food intake, energy expenditure and body fat
distribution. That research seemed to
support a link between estrogen and the regulation of obesity and the accumulation
of abdominal fat which is linked to heart disease, diabetes, and cancer.
Dr.
Clegg, an Assistant Professor of Psychiatry at the University of Cincinnati
Academic Health Center, is directing these studies and pointed out that the
accumulation of abdominal fat puts both men and women at a heightened risk of
cardiovascular disease, diabetes, and insulin resistence, and that women are
usually protected from these negative consequences as long as we women carry
our weight in the hips and the saddlebags.
But when we go through menopause, that body fat seems to shift to the
abdomen and then we may begin to have to face some of these complications. Now, there is more research needed to really
define this but at least it’s interesting to see and I think perhaps exciting
to see that research is beginning to really help us understand the questions
that so many ask about why it appears that we see an increase in weight gain in
women after menopause.
Another
point that’s been in the news recently is again going back to the Pap smear,
which we have discussed previously. We
all know about the interest in the vaccine for the Human Papillomavirus and the
question about testing for the Human Papillomavirus but there’s been recent
publications again and recent interest in making sure that women and young
girls who are sexually active also remember that even in a time of an HPV
vaccine and where we’re learning more about the HPV virus and its role in
cervical cancer, that one should not forget the importance of the Pap
smear.
Of
course, we hear different recommendations about the time between when Pap
smears should be taken and repeated but the most important point is that Pap smears
are the most common cancer screening procedure and even as we learn more about
the HPV vaccine, we do not want to forget the importance of the Pap smear. And ladies, if you’ve not had your Pap smear
recently, talk to your physician about getting one.
I want
to also remind you that coming up in the future we will be discussing
vulvodynia. What is vulvodynia, well,
it’s pelvic pain of longstanding duration.
Some call it “the pain down there” or feminine pain, and I’m not going
to say much more about it today except to promise you we will be addressing
that very soon because the Office of Research on Women’s Health and the
National Institutes of Health along with a number of collaborators including
the National Vulvodynia Association, will be launching in October 2007 a public
and professional education campaign to ensure that more healthcare providers as
well as more women are aware of the effects of vulvodynia, how to diagnosis it,
and what to do about it.
And
finally, as a hot flash that I’ve used before, I want to remind you, if you or
your physician or your nurse or someone in your family or your community is interested
in participating in a research study, you can find out what current NIH
research studies are going on by going to the Web site, clinicaltrials.gov,
g-o-v for government. This is the
National Library of Medicine’s Web site that lists clinical trials that are
underway, which ones are still recruiting, what is being looked for in
volunteers for those studies and it provides for you instant access to what is
currently being studied in research about some of the conditions that may be affecting
you or members of your family or community.
We’ll
have more updates in the next podcast.
And coming up next I’ll visit with Dr. Trimble for a discussion about
ovarian cancer. We’ll be right back with
more Pinn Point on Women’s Health.
ANNOUNCER: Aristotle had this problem, so did Thomas
Jefferson, and they went on to do great things.
If you stutter, you could do something great, too, by participating in a
National Institutes of Health Stuttering Study.
Participants will be compensated.
Travel assistance is available and all study related tests are provided
at no cost. Call 866-999-5553 or visit
clinicatrials.gov. Do something
great. The NIH is a non-profit
government agency of the Department of Health and Human Services.
DR.
PINN: Welcome back to Pinn Point on
Women’s Health. Today Dr. Ed Trimble,
who is Head of Gynecologic Cancer Therapeutics and Quality of Cancer Care
Therapeutics at the National Cancer Institute, is with us to discuss a topic
that I know is of great concern to so many, that of ovarian cancer.
We know
that September is actually National Ovarian Cancer Awareness Month so this
seems a perfect opportunity to address what we know about and what we’re
learning about and what we still need to know about ovarian cancer. We know that ovarian cancer remains the
leading cause of death from gynecologic cancer among women in the
But most
importantly, National Ovarian Cancer Awareness Month, which is in September,
provides an opportunity for us to renew our commitment to fight this disease
and to talk about what research is doing to help us do that. So I’m delighted that we have with us Dr.
Trimble who is going to help us learn more about ovarian cancer. Dr.
Trimble, tell us, why is ovarian cancer important for women and their
healthcare providers to know about?
DR.
TRIMBLE: We know that ovarian cancer
occurs in about 20,000 women in the
DR.
TRIMBLE: We now know based on work done
by Dr. Barbara Goff at the
Now, just
having one of these symptoms for one day does not mean that one is at high risk
for ovarian cancer. Rather, having any
one or a combination of these symptoms almost daily for more than a few weeks
is worrisome. So if a woman has these
symptoms that persist for more than two or three weeks, then it is important to
see one’s doctor and to ask about the possibility of ovarian cancer.
DR.
PINN: well, let’s say a woman has some
of these symptoms and decides that maybe she should go to her doctor to try to determine
if she has or to make sure she doesn’t have ovarian cancer or if she has, that
she can get that diagnosis early. What
would a physician do to test for ovarian cancer? What would you do? What would a physician do when a woman goes
to her doctor and says, “I’ve got some of these symptoms, I wonder if I have
ovarian cancer,” what would the physician do?
DR.
TRIMBLE: Well, one of the most important
things that the physician should start with is a family history. We know that in about five to 10 percent of
cases, women may have inherited a predisposition to ovarian cancer. So it’s important to find out about any
family history of cancer on both the mother and father’s side. The most common patterns involve breast and
ovarian cancer in families. Slightly
less common for ovarian cancer is a syndrome which involves colon cancer in
both men and women as well as endometrial cancer in women and to a lesser
extent ovarian cancer in women. So it’s
important that the physician establish whether a woman is at an increased
genetic risk for ovarian cancer because we do have some genetic tests which can
be done for appropriate patients.
The
next thing, of course, is a physical exam.
It’s important for a woman to undergo a abdominal and gynecological exam
to see whether there are any large masses that can be felt on physical
examination. Following that, a serum
blood test which would evaluate a marker called CA125. This is a marker that is expressed by cells
that occur in the lining of the abdomen.
It can be elevated by a number of benign conditions such as
endometriosis and fibroids, as well as by ovarian cancer. So it’s not an ideal screening test but it
can help us find out whether something abnormal is going on in a women’s
abdomen.
The
other test that we often will rely upon is a pelvic ultrasound. Ultrasound provides the best picture of the
ovaries, particularly if it be done through the vagina. So often we will recommend a trans-vaginal
ultrasound to look at the size and consistency of the ovaries.
DR.
PINN: Now, you’ve mentioned CA125. I don’t know if you get them but I can tell
you in the Office of Research on Women’s Health, it is not uncommon for us to
be copied on e-mail messages that are being sent out to women all over the
area, all over the country saying ovarian cancer could be stopped if women
demanded a CA125 test. That it ought to
be a routine test that women ought to get.
I think you talked a little bit about this test, but could you respond
to what we so often see, which is a blanket recommendation for women to get a
CA125 as though it is the answer to screening for ovarian cancer?
DR.
TRIMBLE: Well, we all would love to have
a very accurate test for ovarian cancer.
We do not have that test yet.
CA125 is not sufficiently sensitive or specific to function as a good
test for ovarian cancer. For example, a
number of benign conditions, which are very common among women such as uterine
fibroids and endometriosis can cause low level elevations of CA125. So if we were to screen all women with CA125,
we would discover elevations of CA125 among many. There would obviously be great concern among
women and their healthcare providers and they would then undergo extensive
work-up, which might include ultrasound, it might include laparoscopy, might
include open abdominal surgery. All
these procedures, particularly the laparoscopy and the surgical exploration
carry with them some risks and when we’ve done large studies in which large
populations, thousands of women were screened with -- for ovarian cancer --
using a CA125, what we found was that an unacceptable number of women were
being taken to surgery for benign conditions.
The vast majority of women did not have ovarian cancer.
So
that we were subjecting more women to surgery than we were finding ovarian
cancer. Now, we are researching right
now how we can improve upon CA125, whether there are additional blood tests
that can be used in conjunction with CA125, so that it would be part of a good
screen for ovarian cancer. We don’t have
that screen yet but CA125 will probably be part of the answer to that question,
namely how can we find a good screen for ovarian cancer.
DR.
PINN: In other words, looking for what
we refer to in our research agenda in women’s health as biomarkers. Could you maybe explain? We use that term biomarkers. I’m not sure everybody knows what that really
means, so I’ll ask you as the expert to explain what a biomarker is and do we
have any recent progress in terms of defining biomarkers for ovarian cancer?
DR.
TRIMBLE: Well, a biomarker is a general
term that we use to describe a test drawn on the blood which may detect a
variety of things going on in the blood.
It may be a test done on other tissue removed from the body that we
believe is associated with either an increased risk of cancer or a
pre-cancerous condition or in some cases an early cancerous cell. The goal would be that we would be able to
combine a use of biomarkers with an accurate history with a good physical exam
and with imaging studies to find diseases early when they remain
treatable.
DR.
PINN: September is actually National
Ovarian Cancer Awareness Month and we have talked about or unfortunately I
mentioned of deaths from ovarian cancer but we want to provide some hope for women
who are listening to this podcast. What
can you tell us about some of the new research related to ovarian cancer and
what do you think is going to help us break this riddle of early diagnosis of
ovarian cancer and overcoming that diagnosis once it is made?
DR.
TRIMBLE: Well, as I mentioned, I think
the most recent data on symptoms is very important because it does give women a
handle on when to see a doctor and on how we can get women diagnosed relatively
early. In addition, as I mentioned, we
are doing a lot of work looking at biomarkers, seeing what we can combine with
CA125. A number of those studies are
underway and we are very hopeful that within a few years we may have a more
accurate screen for ovarian cancer.
In
addition, we now know the importance of accurate surgical staging and surgery
to remove as much of the cancer as possible.
We have now developed a discipline among obstetricians, gynecologists
called gynecologic oncology. People who
practice this specialty of gynecologic oncology undergo special training in
surgery and chemotherapy and quality of life and survivorship issues for women
with ovarian and other gynecologic cancers.
So we’ve learned that it’s very important that if a woman is thought to
have the possibility of ovarian cancer, that she see a gynecologic oncologist,
that she undergo surgery if she needs to have surgery with a gynoncologist, and
that a gynoncologist be involved in her care if she’s diagnosed with ovarian
cancer.
DR.
PINN: Is there other research related to
ovarian cancer that I haven’t asked you about that you’d like to let our
listeners know about?
DR.
TRIMBLE: Well, one important area that I
did want to mention was a recent announcement from the National Cancer
Institute back in January of last year recommending that women who undergo
optimal surgical cytoreduction and are found to have Stage 3 ovarian cancer,
which unfortunately is the most common stage, get part of their chemotherapy
directly into the abdomen and part in a more traditional approach, through a
vein.
We’ve
learned that the combination of intravenous and intraperitoneal chemotherapy
resulted in a 13-month increase in survival, a very significant increase in
survival compared to women who only got the intravenous chemotherapy. So we’re trying to get that word out. We’ve made an announcement on the basis of
three large studies which the NCI supported and we believe that more women are
having the benefit of this approach.
We’ve done an expensive -- extensive effort to educate doctors and nurses
and patients about this treatment innovation.
And we are hopeful that it’s spreading more widely in the community.
DR.
PINN: I know that was a slip when you
said expensive rather than extensive, but actually that was a good slip because
it reminds me to point out what an investment the National Institutes of Health
is making in helping us learn more about ovarian cancer through research. Actually, it’s estimated that in 2007, the
National Cancer Institute will invest an estimated $95 million in ovarian
cancer research and the Centers for Disease Control and Prevention is estimating
its ovarian cancer spending to be almost $5 million during 2007.
And of
course, our sister agency, the Department of Defense, also has an ovarian
cancer research program in which it’s expected to invest an estimated $10
million this year. Now that’s a
substantial amount of money, but I note for those who have experienced ovarian
cancer either themselves or in their families, no one thinks that that amount
of money is sufficient until we actually have the cure. But I think the positive news is that at
least we are investing not just funds but energies and efforts into this area
of research and I do believe as you have suggested that we’re beginning to have
some hope for being better able to define this condition and to be able to
treat it and to cure it while at the same time of course, we want to think
about prevention and early diagnosis.
But I
want to move back a little bit. You
referred to Stage 3 ovarian cancer. Just
for our audience’s benefit, could you describe or explain what you mean by
Stage and when it comes to ovarian cancer?
DR.
TRIMBLE: Certainly. With most solid tumors or cancers that are
not leukemia or lymphoma, we have historically defined them as being at a Stage
1, 2, 3, or 4. And 1 is generally the
earliest cancer, 4 is the most advanced.
For ovarian cancer, Stage 1 cancers are those that are limited to the
ovary. Stage 2 is when the cancer is
still very early but it has spread to adjacent tissues whether in the pelvis or
in some cases the fallopian tube.
Stage 3
is a cancer that has spread either to the abdominal cavity or the
retro-peritoneal lymph nodes behind the abdominal cavity and a Stage 4 ovarian
cancer is one that has spread beyond the abdominal cavity. The most common site that we see is that
ovarian cancer can spread to the pleural space which is on the outside of the
lungs. When we look at our statistics,
we see that women who have early stage, Stage 1 ovarian cancer, have good long-term
survival. About 90 percent of women
found to have Stage 1 disease will be alive at five years and about 85 percent
at 10 years.
Unfortunately
for women with Stage 3 disease, only 30 percent are alive at five years and
only 20 percent are alive at 10 years.
So we know we need to do two things.
First, to figure out a better way to diagnose ovarian cancer early so
that more women will have a chance of a long-term survival and we also need to
improve our treatment for women found to have the more advanced stage disease.
DR.
PINN: Let’s see if we can do some quick
summary points before I ask you what I haven’t talked to you about that is
important for our listeners to hear. But
let’s see if we can do some quick summary points as though we were quizzing our
audience on what they’ve learned from what you’ve said. So what are the major risk factors for
ovarian cancer that women should know about?
DR. TRIMBLE: Well, the strongest risk factors are family
history. So it is important that a woman
know her own family history of cancer on both the mother and father’s
side. And go over that with her
healthcare providers. And additional
risk factors for ovarian cancer include never having children. The things that we know will protect against
the development of ovarian cancer include the use of oral contraceptive pills
which we think reduces the risk of ovarian cancer by about 50 percent, as well
as having one’s ovaries removed, which we think provides at least 90 percent
protection against the development of an ovarian or primary peritoneal cancer.
DR.
PINN: And knowing the risk factors, what
are some of the symptoms that might be considered indicative that we should be
worked up for the possibility of ovarian cancer?
DR.
TRIMBLE: Well, as I mentioned, there’s a
constellation of symptoms that can signal the possibility of ovarian cancer and
these include sensation of bloating, pelvic or abdominal pain, difficulty
eating or feeling early satiety, a sense of fullness after one has just started
eating a meal and then urinary urgency or frequency. Now, these are common symptoms which women
may have for a day or two. And just
having those symptoms for a day or two should not be a reason for concern. But if one has those any or several of those
symptoms almost daily for more than a few weeks, then that’s an important
signal and one should see a doctor or healthcare provider as soon as possible.
DR.
PINN: Now, you talked about once you
might have some of these symptoms and you know about your risk factors if you
go to the physician that you might have screening tests and you may have some
imagining tests. And you may be found to
have enlarged ovaries, but not all enlarged ovaries means cancer. Could you maybe just talk a little bit about
some of the reasons for enlargement of the ovaries that might be confused with
ovarian cancer?
DR.
TRIMBLE: There are a number of benign
conditions that can cause ovaries to be enlarged. When we look at the women who undergo surgery
for an enlarged ovary, the worry that there may be cancer. The vast majority of patients, probably 85 to
90 percent do not have cancer. In fact,
there is a benign condition that is causing the ovarian enlargement. These can be cysts on the ovary. It’s not unusual for an ovary to developed cysts
both before and after menopause.
It can
be related to endometriosis which is a very common phenomenon in which
endometrial cells which normally live in the lining of the uterus for some
reason take up housekeeping on the outer surface of the ovaries. We don’t know why they do this but sometimes
they do and they also can cause masses or cysts.
In
addition, there may be an overgrowth of benign cells inside the ovary which can
cause a growth or an ovarian enlargement.
We don’t know why these cells do grow to form a mass but they certainly
can. In addition, there can be scar
tissue that’s formed between the ovary and the wall of the abdomen or the small
bowel or the large bowel that looks like an enlarged ovary but is actually not
an enlarged ovary.
DR. PINN: I think we’ve really covered a lot about
ovarian cancer and what’s happening with ovarian cancer. And so I’d like to ask you, what is the major
takeaway message that you would like to make sure that the listeners to our
broadcast get today?
DR. TRIMBLE: Well, I think there are three. First, the symptoms that I mentioned are
important and women need to keep track of their symptoms and if they have them
daily for more than a few weeks, then they need to see a healthcare provider
and say, “I’m worried about the possibility of ovarian cancer”.
Secondly,
as I mentioned, the family history is extremely important and a woman should
know about the cancers that occur -- that have occurred in her family on both
sides of the family, both the mother’s side and the father’s side. And if there are a number of cancers there,
then the woman and the healthcare provider need to decide whether she should
have genetic counseling or whether -- or consideration of surgery to prevent
her from developing cancer.
And third,
the most important thing is the -- is a woman need to know that if she needs to
have surgery to rule out ovarian cancer, then she should see a gynecologic
oncologist which is a specialist in the treatment of women either at risk for
developing gynecologic cancer, including ovarian cancer or who have been found
to have gynecologic cancer and ovarian cancer.
Those specialists have training specifically in the diagnosis, surgery,
staging, chemotherapy, symptom management, and quality of life for women with
ovarian cancer. It is important that a
woman have access to gynoncologists.
DR.
PINN: And with this podcast coming out
of the Office of Research on Women’s Health, let me ask you to give a final
comment related to the importance of research here at the National Institutes
of Health and our increasing hope for dealing with the issue of ovarian cancer.
DR.
TRIMBLE: Well, I want to take this
opportunity to express my thanks for our really collaborative efforts across
the U.S. Government focused on ovarian cancer research. We, at the National Cancer Institute, are
very grateful for the support that we’ve had from Dr. Pinn and the Office of
Research of Women’s Health as well as our colleagues at the National Institute
for Child Health and Human Development who have a number of interests in
ovarian development.
We also
work closely with our partners at the Department of Defense and their
congressionally mandated Ovarian Cancer Research Program as well as our
colleagues at the Centers for Disease Control and Prevention, who have a very
effective educational campaign focused both on individuals at risk of cancer,
individuals with ovarian cancer, as well as healthcare practitioners with that
campaign focused on ovarian cancer.
DR.
PINN: Well, thank you, Dr. Trimble, and
I’m pleased that you ended your comments by pointing out how collaboration
between agencies, investigators, researchers, and healthcare providers really
will help us provide better health and healthcare for women. We’ll be back with a few final thoughts for
this month with Pinn Point on Women’s Health continues.
ANNOUNCER: Aristotle had this problem, so did Thomas
Jefferson and they went on to do great things.
If you stutter, you could do something great, too, by participating in a
National Institutes of Health Stuttering Study.
Participants will be compensated.
Travel assistance is available and all study related tests are provided
at no cost. Call 866-999-5553 or visit
clinicatrials.gov. Do something
great. The NIH is a non-profit government
agency of the Department of Health and Human Services.
DR.
PINN: And now, a few final
thoughts. You have just heard my
interview with Dr. Edward Trimble, who is head of the Gynecologic Cancer
Therapeutics and Quality of Cancer Care Therapeutics in the Division of Cancer
Treatment and Diagnosis at the National Cancer Institute, here at the NIH. We invited him to join us because we have
long appreciated his efforts in looking at gynecologic cancer and overseeing
research related to gynecologic cancer in addition to knowing that he is
actively involved in taking care of women and their issues. So we learn a lot from him.
I think
the major message that we got from him today is that there is active research
going on but that we have learned a lot about the risk and how to diagnose and
how to treat and improve outcomes for women who may have or may develop ovarian
cancer. But research is continuing so
that we can learn better how to prevent this disease by more importantly, how
to make an early diagnosis of this condition so that outcomes can continue to
improve.
But the
bottom line is, that we want to get across that there is a message of hope here
in that we’ve made much progress over the past 10 to 15 years over what we did
know and while we still don’t have all the answers, much work is going forward
with people like Dr. Trimble and others who are being funded not only by the
NIH and the National Cancer Institute but by other sister agencies and
government and even private groups to help us learn more through research about
those questions for which we don’t have answers related to ovarian cancer.
And the
bottom line is, just as we talk about with almost every condition that we
discuss related to women’s health, women need to be more attentive to their own
bodies and their own health, be familiar with your bodies and know when you
need to go to your physicians or your healthcare providers or your clinics to
get your physical examination and be sure you’ve got information about yourself
when you go for that checkup.
Thank
you for joining us on this episode of Pinn Point on Women’s Health. In a moment the announcer will tell you where
to send your comments and suggestions for future episodes. I’m Dr. Vivian Pinn, Director of the Office
of Research on Women’s Health at the National Institutes of Health in
ANNOUNCER: You can e-mail your comments and suggestions
concerning this podcast to Marcia Love at Lovem@od.NIH.gov.
Pinn Point on Women’s Health comes from
the Office of Research on Women’s Health and is a production of the NIH Radio
News Service, News Media Branch, Office of Communications and Public Liaison at
the Office of the Director, National Institutes of Health,
(End of PODCAST.)