Mayo Clinic Q&A

Mayo Clinic medical oncologist Dr. John Weroha discusses the latest treatments for ovarian cancer.

Show Notes

Ovarian cancer is the fifth-leading cause of cancer death among women in the U.S. When ovarian cancer first develops, it might not cause noticeable symptoms. It often goes undetected until it has spread within the pelvis and abdomen. 

"Unfortunately, ovarian cancer often presents with very common symptoms, and these common symptoms are things that everybody will complain about at some point," explains Dr. John Weroha, a Mayo Clinic medical oncologist. "For example, constipation, bloating, maybe a little weight gain. These are very common symptoms, and oftentimes, people just kind of blow it off as being normal. So, that's how it hides and grows."

Once ovarian cancer is detected, treatment depends on the stage when the disease is diagnosed. Stage 1 — the lowest stage — indicates that the cancer is confined to the ovaries. At this stage, a cure may be achieved with surgery alone. By stage 4, the cancer has spread to distant areas of the body. At this point, treatment is more complex, often involving drug therapies and potentially immunotherapy, which uses the immune system to attack cancer cells.

Dr. Weroha encourages patients to explore all their treatment options, including clinical trials

"I think one of the biggest misconceptions that I see with patients is that clinical trials are supposed to be a last resort, and that is absolutely not true," says Dr. Weroha. "What we do at Mayo, and really everywhere else, is we try to bring clinical trials to our patients — not because we want to test whether or not this brand-new drug works, but we already believe the drug works. We think it's going to work, and we want to give that to our patients because they can't get it any other way, except through a clinical trial." 

On the Mayo Clinic Q&A podcast, Dr. Weroha discusses the latest treatments for ovarian cancer.  

What is Mayo Clinic Q&A?

Mayo Clinic Q&A

Narrator: Coming up on Mayo
Clinic Q&A. Ovarian cancer is a

growth of cells that form in the
ovaries and can quickly multiply

destroying healthy tissue.
Ovarian cancer remains a very

deadly disease in part because
it's often diagnosed at later

stages. If the cancer has
spread, it's even harder to

treat. But there have been
advances that many hope will

improve the prognosis.

Dr. John Weroha: I would say
over the last decade, there has

been a huge shift in the way
that we treat ovarian cancer. I

think the biggest impact has
come from a family of drugs

called PARP inhibitors, PARP.
This family of drugs have

completely revolutionized the
way we treat ovarian cancer from

the initial diagnosis, through
the recurrence, and the entire

spectrum really of ovarian
cancer treatment.

DeeDee Stiepan: Welcome everyone
to Mayo Clinic Q&A. I'm Deedee

Stiepan, sitting in for Dr.
Halena Gazelka. Ovarian cancer

ranks fifth in cancer deaths
among women, accounting for more

deaths than any other cancer of
the female reproductive system.

Ovarian cancer often goes
undetected in the early stages,

and once the cancer has spread
to the pelvis and the abdomen,

it's more difficult to treat.
Treatment options for ovarian

cancer depend on the stage at
which the cancer is diagnosed.

Joining us to discuss the latest
treatments for ovarian cancer is

Mayo Clinic medical oncologist,
Dr. John Weroha. Welcome to the

program, Dr. Weroha. Thanks for
joining us.

Dr. John Weroha: Hello, and
thank you for inviting me. It's

my honor to be here and my
pleasure to talk about something

that's really important for what
I do.

DeeDee Stiepan: Absolutely. So,
let's start off how common is

ovarian cancer?

Dr. John Weroha: So, it's
actually not the most common

cancer in women. But as you
pointed out, it is the most

deadly. It's about the 11th most
common cancer in women, so it's

not up there in terms of being
common, but it's definitely up

there in terms of being very
serious.

DeeDee Stiepan: And why is it
that ovarian cancer is often

diagnosed at later stages?

Dr. John Weroha: Unfortunately,
it presents with very common

symptoms, and these common
symptoms are things that

everybody will complain about at
some point, for example

constipation, bloating, maybe a
little distension, maybe a

little weight gain. These are
very common symptoms, and

oftentimes people just kind of
blow it off as being normal. So,

that's how it kind of hides and
grows.

DeeDee Stiepan: Okay, gotcha.
And so, is it mostly just those

common symptoms? Are there any
other signs and symptoms of

ovarian cancer?

Dr. John Weroha: There could
also be some pain. Depending on

where the cancer is there can be
pain, but there's usually no

bleeding. So, that's not going
to be a trigger. Sometimes

people will eat a little bit of
food and feel full very quickly.

We call it early satiety. That's
just a sign that there's a lot

of pressure going on in the
abdomen. Some women will have

increased urgency to use the
restroom. I often describe it as

symptoms or signs of being
pregnant.

DeeDee Stiepan: Are there known
risk factors for developing

ovarian cancer?

Dr. John Weroha: There are a few
risk factors. I think the

biggest one that that we know
about is having a family history

of breast or ovarian cancer,
because there is a gene that can

become mutated. And if that gene
is mutated, it can definitely

increase your risk of developing
ovarian cancer in the future. I

would also point out too, that
we refer to this as ovarian

cancer, but there are other
cancers that we kind of clump

into the same group, fallopian
tube and primary peritoneal

cancer, they are all treated the
same. And it's possible that

ovarian cancer and fallopian
tube cancer actually have the

same origin.

DeeDee Stiepan: You mentioned
treatment, so let's get into

that. How is ovarian cancer
typically treated?

Dr. John Weroha: Yeah, so the
standard of care across the

country is going to be some
combination of surgery and

chemotherapy. There's
differences and it's probably

not too important about whether
you do surgery first followed by

chemo, or chemo first followed
by surgery, but there is some

combination of that.
Chemotherapy is very standard.

It's Carboplatin and Paclitaxel.
Another standard way to give

chemotherapy is intraperitoneal,
meaning the chemotherapy is

delivered directly into the
abdomen through a catheter. But

most people these days, I think
are giving the chemotherapy

through the veins in the arm.

DeeDee Stiepan: So, how do
physicians decide what the best

treatment approaches are for the
patient?

Dr. John Weroha: The major
decision is whether you do

surgery first or chemo first,
and that decision is based on

risk factors. How likely is
somebody to do well or not well

with a surgery first option, and
the surgeons are very good at

making these predictions as to
who is going to be a good

candidate for upfront surgery,
versus those patients who really

need to have chemotherapy first,
which we call a neoadjuvant

chemotherapy, followed by
surgery, and then followed by

yet even more chemotherapy. So,
there are things that we look

at, for example the surgeons
will look at the extent of

disease, how much cancer is
there throughout the body, and

is there a good chance that they
can remove it all with surgery?

If the answer is yes, then
probably surgery will happen

first. The other thing they will
look at some blood work. In

that blood work, they will pay
attention to the nutritional

status of the patient. And we
assess this by looking at a

protein called albumin. So,
albumin reflects the nutritional

status. And if that is too low,
then that patient has really

high risk for a bad outcome and
will probably not have surgery

first. Those are just a few of
the things that we look at.

DeeDee Stiepan: Okay, so is Mayo
Clinic's approach to ovarian

cancer treatment, is it
different from the approach used

at other cancer centers?

Dr. John Weroha: I would say for
the most part we're the same

around the country. But I would
say that we tend to do more

upfront surgery followed by
chemotherapy, where other

institutions may prefer to do
upfront chemotherapy followed by

surgery, followed by more
chemotherapy. But I think the

other thing that we would do
differently is we are constantly

looking for clinical trial
options to basically give our

patients a therapy that we think
will be better than the current

standard of care, but we haven't
proven it to be better yet.

DeeDee Stiepan: Can you tell us
about some promising new

treatments that are being
developed for ovarian cancer?

Dr. John Weroha: Yeah, so I
would say over the last decade,

there has been a huge shift in
the way that we treat ovarian

cancer. I think the biggest
impact has come from a family of

drugs called PARP inhibitors,
PARP. This family of drugs have

completely revolutionized the
way we treat ovarian cancer from

the initial diagnosis, through
the recurrence, and through the

entire spectrum really of
ovarian cancer treatment. These

PARP inhibitors have really
changed. The current clinical

trials are really focused on how
do we make those PARP inhibitors

work even better. And in
addition to that, we're seeing a

lot of clinical trials that are
using what are called antibody

drug conjugates. These are drugs
where there is an antibody that

recognizes a very specific part
of the cancer cell, but it

brings with it a chemotherapy
that's attached to this

antibody. And this approach
allows the chemotherapy to go

directly to the cancer and
minimize the toxicity of the

normal tissues like bone marrow,
and liver, and kidney, and that

sort of thing. So, I have a
feeling that the next wave of

new therapies to get approved
will be one of these antibody

drug conjugates. We're seeing
very promising results with one

in particular.

DeeDee Stiepan: Well, that is
great news to hear. Dr. Weroha,

is there anything else that you
wanted to add? Anything else you

think is important for people to
know?

Dr. John Weroha: I think one of
the biggest misconceptions that

I see with patients is that
clinical trials are supposed to

be a last resort, and that is
absolutely not true. What we do

at Mayo, and really everywhere
else, is we try to bring

clinical trials to our patients,
not because we want to test

whether or not this brand new
drug works, but we already

believe the drug works. We're
already biased. We think it's

going to work. And what we want
to do is we want to give that to

our patients because they can't
get it any other way except

through a clinical trial. And
the other thing I would point

out is that these clinical
trials give you the opportunity

to receive a drug that might be
the next blockbuster drug of the

future, and we believe it to be
a great drug, otherwise we would

never even offer it to our
patients. The reason why you

shouldn't consider a clinical
trial late and you should

consider clinical trials early,
is because many of them will

exclude you if you've had too
much chemotherapy in your lifetime.

DeeDee Stiepan: Very interesting
points. Thank you so much for

adding that. Our thanks to Mayo
Clinic medical oncologist, Dr.

John Weroha, for being here
today to discuss the latest

treatments for ovarian cancer.
Thanks so much for your time. We

appreciate it.

Dr. John Weroha: My pleasure.

Narrator: Thank you. Mayo Clinic
Q&A is a production of the Mayo

Clinic News Network and is
available wherever you get and

subscribe to your favorite
podcasts. To see a list of all

Mayo Clinic podcasts, visit
newsnetwork.mayoclinic.org. Then

click on podcasts. Thanks for
listening and be well. We hope

you'll offer a review of this
and other episodes when the

option is available. Comments
and questions can also be sent

to
mayoclinicnewsnetwork@mayo.edu.