Acerca del cáncer de ovario | Términos sobre el cáncer | Cáncer de ovario y biomarcadores importantes

Learn About
Ovarian Cancer
& Biomarkers

The first step in making a decision about maintenance therapy is to understand ovarian cancer and knowing your biomarker status. This information can help you learn more about what doctors know and don’t know about ovarian cancer and maintenance therapy.

Learn About Ovarian Cancer
& Biomarkers

The first step in making a decision about maintenance therapy is to understand ovarian cancer and knowing your biomarker status. This information can help you learn more about what doctors know and don’t know about ovarian cancer and maintenance therapy.

About Ovarian Cancer

Cancers are diseases in which cells divide out of control. The cancer cells can invade nearby tissues and spread to other parts of the body through the blood and lymph systems. Cancer can start anywhere in the body.

  • Ovarian cancer starts in the ovaries.
  • Primary peritoneal cancer starts in the lining of the abdomen (peritoneum).
  • Fallopian tube cancer starts in the fallopian tubes.

To keep things simple, we will refer to them all as ovarian cancer. All three of these cancers are treated similarly. For many women with newly diagnosed advanced ovarian cancer, surgery plus chemotherapy has the best outcomes.

Cancer Terms

Cancer Stage

Cancer staging categorizes cancers by the size of the tumor and if it has spread to nearby tissues, lymph nodes or distant organs. Cancer is typically staged at the time of diagnosis. Even if your cancer later grows or returns, the assigned stage does not change. Cancer staging descriptions are specific for each type of cancer.

Cancer Grade

Grade refers to how abnormal the cancer cells look under a microscope compared to the normal cells from the organ with the cancer. For example, low grade cancer cells look more similar to normal cells and tend to grow and spread more slowly than high-grade cancer cells which typically behave in a more aggressive way. Grading systems are different for different cancers.

Remission

Remission is a decrease in or disappearance of signs and symptoms of cancer. In partial remission some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared. Complete remission is also called NED, or “no evidence of disease.” Even in complete remission, there still may be cancer in the body.

Progression-free Survival

Progression-free survival is the length of time a patient lives during and after cancer treatment when the disease does not get worse. In other words, the cancer does not return, grow more, or spread to other areas of the body. Progression-free survival is sometimes shortened as PFS. In clinical trials, doctors measure progression-free survival as one way to show how well treatments work.

Overall Survival

Overall survival is how long a person lives after being diagnosed with a disease. In clinical trials, doctors measure overall survival as one way to see how well treatments work.

Recurrence

Cancer can come back after treatment, even if tests showed no cancer. This happens when the treatment did not remove or kill all the cancer cells. The cancer cells that survived treatment were too small to see in follow-up tests. The few remaining cancer cells may multiply. Eventually, these can be detected.

When cancer comes back, it is called a cancer recurrence (or recurrent cancer). Cancer can come back in the same place it started, or it can come back in other parts of the body.

When cancer comes back:

  • In the same place it started, it is called a local recurrence.
  • Near where it started, it is called a regional recurrence.
  • Farther away from where it started, it is called a distant recurrence.
Ovarian cancers often come back, but doctors can’t predict whose cancer might come back or when. Most women with recurrent ovarian cancer will go on and off treatment for life.
Newly Diagnosed Patients With: Recurrence Rate After Completion of Initial Therapy
Large-volume advanced disease (stage III and IV) 80-95%
Small-volume advanced disease (stage III and IV) 60-70%
High-risk limited disease (stage I and II) 20%
Low-risk limited disease (stage I and II) 10%

Knowledge Check

Most advanced ovarian cancers come back after successful treatment.

True

Correct. About 75-80% of advanced ovarian cancers come back after successful treatment.

False

Incorrect. About 75-80% of advanced ovarian cancers come back after successful treatment.

Ovarian Cancer and Important Biomarkers

Important things to know to make a decision about maintenance therapy

Your treatment options may be influenced by mutations in your cells, mutations in your tumor, and biomarkers in your tumor.

Mutation

A mutation is a change in the DNA of a cell. This can come from a mistake in copying the DNA when a cell divides. The change can also be caused by exposures in the environment that damage DNA.

Somatic Mutations

A somatic mutation is a change in DNA that can happen in any cells of the body except for sperm and eggs. Somatic mutations cannot be passed on to children.

GermLine Mutation

Germline mutations are DNA changes in germ cells (egg or sperm cells). These are passed from parents to their children (hereditary). People who inherit a germline mutation have that mutation in every cell of their bodies. With ovarian cancer, the most common germline mutations are in the BRCA1 and BRCA2 genes. There are less common germline mutations that can also increase the risk of developing ovarian cancer.

Genes

Genes are pieces of DNA that are passed on from parent to offspring. Many genes have the information for making specific proteins.

BRCA1 and BRCA2

These are genes that normally help suppress cell growth. BRCA1 is on chromosome 17, while BRCA2 is on chromosome 13. A person who inherits certain mutations (changes) in the BRCA1 or BRCA2 genes has a higher risk of breast, ovarian, prostate, and other types of cancer.

Tumor Biomarkers

Tumor biomarkers are biological molecules produced or found in the tumor of a person with cancer. Biomarker testing helps find these changes or markers in the tumor. Biomarkers can be DNA, RNA, protein, or other tumor changes that are specific to the tumor. These biomarkers can help predict the likelihood that a certain kind of cancer treatment will work for a specific patient. BRCA mutations or HRD are types of biomarkers.

HRD (Homologous recombination deficiency)

DNA is made up of two strands. When there is a break in both strands, proteins in the cell repair the break. This repair is called homologous recombination. Some tumors have mutations that stop the cell from being able to do this repair. This inability is called homologous recombination deficiency (HRD). A tumor with HRD is referred to as HRD positive (HRD+). BRCA1 and BRCA2 mutations make a tumor HRD positive, but other reasons can also cause a tumor to be HRD positive.

HRD Status for Women with Ovarian Cancer

Why is it important to know my biomarker status?
Finding out whether your cells or your tumor cells have these biomarkers is important when making decisions about maintenance therapy. Studies suggest that maintenance therapy with medications called PARP inhibitors are most effective in women with:

  • certain mutations (including hereditary BRCA1 and BRCA2 mutations)
  • a somatic BRCA mutation (not hereditary), or
  • tumors with homologous recombination deficiency (HRD+).

How do I learn my biomarker status?
Genetic testing with a sample from blood or other cells from the body can determine whether you have a germline mutation. To find out if you have a somatic mutation or HRD, your doctor can send your tumor for testing.