Heating Up Ovarian Cancer
BALTIMORE, Md. (Ivanhoe Newswire) - About 22,000 women are diagnosed with ovarian cancer each year and more than 14,000 die. It’s a sneaky and serious cancer that’s often caught too late. But, now doctors are heating up ovarian cancer and saving lives.
This year, Helen Szablya and Charles Dann are celebrating 20 years of marriage. It’s a milestone they weren’t sure they’d both live to see.
Five years ago, tests showed Szablya had stage four cancer. A tumor so big that doctors said they couldn’t even see her ovaries.
“The doctor called me in the next day, he said, I need you to understand you have got a very serious kind of cancer,” Szablya told Ivanhoe.
“Eighty-percent of ovarian cancers are diagnosed very late,” Armando Sardi, MD, Chief of Surgical Oncology, Mercy Medical Center in Baltimore, told Ivanhoe.
Dr. Sardi offered Szablya a new and aggressive treatment called HIPEC. First, he removed all traces of her tumor along with her spleen, gall bladder, ovaries, uterus, appendix, fallopian tubes and part of her liver. Then, he put catheters in Helen’s abdomen and delivered heated chemotherapy.
“Heat kills cancer cells but also enhances the effects of chemotherapy,” Dr. Sardi explained.
The chemo circulates for 90 minutes and reaches about 109 degrees Fahrenheit. Researchers are studying HIPEC as a first line therapy for women with ovarian cancer in a phase-two trial.
“We are trying to see if we can be more proactive in preventing more women from recurring,” Teresa Diaz-Montes, MD, Gynecologic Oncologist at Mercy Medical Center told Ivanhoe.
Szablya has been cancer-free for five years.
“It saves your life!” Szablya said.
“It’s really quite amazing to understand what Helen has gone through and what amazing odds she’s overcome,” Dann said.
Now, this couple is looking forward to celebrating many more anniversaries together.
HIPEC has been used in patients with stomach and colon cancers and in those who have had their ovarian cancer recur in the abdomen. This new, phase-two study is testing the approach as a first treatment for ovarian cancer. Patients still receive standard chemotherapy following HIPEC. Researchers are now enrolling patients. There are no geographic limitations to the study. Patients can enroll by contacting our office at 410-332-9294.
BACKGROUND: About 22,000 American women were expected to be diagnosed with ovarian cancer in 2013. Around 14,000 were expected to die. According to Mercy Medical Center, more than 70 percent of women with ovarian cancer are diagnosed at stage 3 of the disease. This is an advanced stage. (Source: Mercy Medical Center)
SIGNS/SYMPTOMS: Doctors at the Mayo Clinic say it’s not clear what causes ovarian cancer. Cancer begins when healthy cells somehow acquire genetic mutations. These mutations turn normal cells into abnormal cells. Healthy cells grow, multiply and die at a set time. But cancer cells are out of control. When abnormal cells accumulate a tumor or mass is formed. Then the cancer cells invade nearby tissues. They can break off from the initial tumor and spread to other parts of the body. Typically, the current treatment for patients in the advanced stage is cytoreductive surgery or debulking, then chemotherapy. Some patients are also then treated with hyperthermic interperitoneal chemotherapy. (Source: http://www.mayoclinic.org/diseases-conditions/ovarian-cancer/basics/definition/con-20028096)
NEW TECHNOLOGY: There's a new study that is testing HIPEC or hyperthermic interperitoneal chemotherapy as the first treatment for ovarian cancer. Patients will be randomized to two arms. One arm will receive the current standard of care (cytoreductive surgery followed by systemic chemotherapy) and the second arm will receive cytoreductive surgery with HIPEC followed by systemic chemotherapy. Systemic chemotherapy delivery circulates throughout the body. The HIPEC treatment is different because it delivers to cancer cells in the abdomen. This allows for higher doses of chemotherapy. The heat can also improve how the tumors absorb the drugs. It can destroy microscopic cancer cells that remain in the abdomen after surgery. Doctors first remove visible tumors within the abdomen. This could take 10 to 15 hours. Once as many tumors as possible are removed, for an hour and a half, the heated sterilized solution is delivered to the abdomen. The solution penetrates and destroys remaining cancer cells. The solution is then drained from the abdomen. This treatment is an option for patients with advanced surface spread of cancer within the abdomen without disease involvement outside the abdomen. Dr. Sardi at Mercy Medical Center in Baltimore used this treatment on his patient Helen Szablya who had primary peritoneal carcinoma which is very similar to epithelial ovarian cancer. Even using a high-powered microscope, it is difficult to tell the difference between the two. In fact, the treatment and prognosis is the same. For additional information, visit www.mdmercy.com or www.ClinicalTrials.gov.
Armando Sardi, MD, Chief Surgical Oncologist at Mercy Medical Center in Baltimore talks about a new way to treat ovarian cancer.
When is ovarian cancer usually diagnosed?
Dr. Sardi: In the United States, and really throughout the world, 80 percent of the ovarian cancers are diagnosed very late. That means it already has spread beyond the ovaries through other areas of the abdomen. And when that occurs, then you have what we call a Stage III disease.
How can it spread?
Dr. Sardi: Ovarian cancer tends to remain in the abdomen for a long period of time. The ovary ruptures and these cells just implant everywhere else. The appropriate surgery for that is to go in and remove all of the tumor, wherever it is. Now we are adding the hyperthermic intraperitoneal chemotherapy.
What is that?
Dr. Sardi: Heat kills cancer cells, but also enhances the effect of the chemotherapy. The idea is to deliver high concentrations of chemotherapy in the abdomen after the whole tumor is removed to kill every other cell that maybe around. The recurrence of the tumor coming back after just removing the tumor is very high.
Why is it that heat kills cancer cells?
Dr. Sardi: It disrupts a lot of things in the cell itself. It damages what we call the cell membranes, the coverage of the cells. It actually allows the cell to be more able to be attacked by other systems to kind of break the structure of the cell to the point that then chemotherapy and other treatments such as radiation can actually penetrate better.
Is this the first study where you’re actually heating the chemo?
Dr. Sardi: For ovarian cancer, it’s at the beginning; we have already a lot of experience. I have been doing this for 20 years and we have already treated a lot of women with ovarian and primary peritoneal and fallopian tube cancers that after the tumor has come back, we have been able to help and many of them are alive.
What’s the difference with this trial then?
Dr. Sardi: It’s done at the first time. The patient only gets one operation, complete treatment, and then does chemotherapy. Contrary to what happens to most women now, is that they come to us after the first surgery or chemotherapy and then they fail. Not only is the surgery’s more complicated, but we are dealing with more difficult decisions and more injuries and more problems and complications related to the treatment, and more difficult to do it of course.
Can you describe one of your patients?
Dr. Sardi: Tumors are present in different ways, but you really can clearly see the difference when compared to normal tissues. In one patient’s case, she actually bled the day she was taken to surgery before she entered the operating room. Fortunately it happened at the same time that we were ready to operate. Her tumor ruptured and was bleeding a lot by the time we got in.
Is she cancer free then?
Dr. Sardi: Right now, yes.
How hot do you heat the chemo?
Dr. Sardi: Up to 44 Centigrade, that is about 170 to 180° Fahrenheit.
What’s the dangers of that?
Dr. Sardi: If you increase the heat too much, you actually start damaging normal cells. So you have to be careful with that. It’s a balance. We have done multiple studies not only us, but other groups and we have been able to identify the safety range of the heat.
What’s the downside? Why wouldn’t you just always do this first?
Dr. Sardi: In medicine you actually have to prove things work better than what is the standard of care. Actually, we have many patients who will actually tell us forget about the study, I want to do it. And that’s one of the limitations of many studies in the past in different diseases.
Is this going to be the way we save more women’s lives?
Dr. Sardi: I think so, and actually in ovarian and fallopian tube cancers, which are more common cancers than other cancers that we do frequently, the number of people that can be saved is going to be better, a lot higher. That has to be proven, but I think what we have been able to do now is working together with the gynecology/oncology, and we will be able to provide the best care for the patient.
In a time when money matters, when it comes to healthcare, you would think one surgery would be much better than two surgeries.
Dr. Sardi: It isn’t the money part. But when you talk about the complications and the stress for the patient, it’s even greater. Actually now that you talk about money, it’s interesting because, this operation with whole hospitalization, depending on where you are, varies in price. It’s around $100,000. Plus or minus dependent on what happens. But one treatment of chemotherapy is between depending on where you are between $12,000 and $30,000 and that’s done every three weeks.
Does this cancel out the chemo that you have to do after surgery?
Dr. Sardi: We still give the chemotherapy, but then the chemotherapy has a better chance to work. It is well known that the response to the chemotherapy in the vein given after the surgery depends on how much chemo you left behind. And it’s not to say oh, I just removed 99% of the tumor. It’s how big the tumor was left behind, so if you have a tumor greater than 2mm, the chance of that doing well with the chemotherapy long term is very low, actually pretty insignificant.
Dr. Sardi: I think it’s very important to talk, with the gynecology/oncology doctors. They see most of the women first, so I think the connection to work together to make sure that it’s all got on the first time, one operation, and working together, makes a difference for the patient.
FOR MORE INFORMATION, PLEASE CONTACT:
Armando Sardi, MD
Chief Surgical Oncologist
Mercy Medical Center, Baltimore