Moffitt studies test for ovarian cancer
By WES ALLISON
© St. Petersburg Times, published February 18, 2001
TAMPA -- The bitter reality for Dorothy Salm, Sandra Weicherding, and women like them is that ovarian cancer can be beaten if it's caught early. But because it's so difficult to find, and its symptoms are so ambiguous, most tumors are diagnosed too late.
Now, however, researchers at the H. Lee Moffitt Cancer Center and Research Institute and elsewhere are trying to develop a simple blood test that could detect early stage ovarian cancer, potentially saving tens of thousands of women's lives.
Of the 24,000 American women in whom ovarian cancer is diagnosed each year, nearly two-thirds will die, most within five years. Its vague symptoms -- bloating, cramping, indigestion -- usually aren't felt until the cancer has begun to spread.
And unlike breast, prostate or colorectal cancers, there is no good screening test for it. Mrs. Weicherding, 60, of Valrico went to her gynecologist in November 1998 because her belly was swelling, but her cancer wasn't diagnosed for another two months. By then it had spread to the lining of her abdomen.
"He did everything, checked me out, looked me over, said everything is fine," Mrs. Weicherding said Friday. "Some kind of blood test, or some kind of a test women can get on a regular basis, would be wonderful.
"Because if you catch it in its first or second stage, your chances of survival are much much better than what I've got ahead of me."
Mrs. Salm, 66, of Tampa also was given a diagnosis of ovarian cancer two years ago.
"I had a small lump on my groin; I felt it when I took a shower," she said. "I played tennis, and I thought it was a hernia."
Their doctors don't talk in terms of curing their cancer, only controlling it. But when ovarian cancer is caught at Stage I, while the cancer is still confined to the ovaries, up to 95 percent of women can be cured.
Working with a grant from the American Cancer Society, researchers at Moffitt are investigating the theory that ovarian cancer patients have elevated levels of a special antigen, called LPA, in their bloodstream, and that this antigen can be readily detected, even at early stages.
If it proves true, then testing for LPA could become routine, just like mammograms for breast cancer, PSA blood tests for prostate cancer in men, and sigmoidoscopies and other tests for colorectal cancers.
"For ovarian cancer, anything that seems to work will be promising. . . . because there just isn't anything that can detect ovarian cancer at an early stage," said Dr. Dawn Willis, a scientific program manager for the American Cancer Society, which provided $425,000 for the study.
"Even (having) a pelvic exam every year doesn't pick it up. When it starts going, it goes pretty fast, and before that it's not detectable by manual examination."
Lab tests and small studies suggest LPA should work as a marker. What's needed now is a large study to determine whether it works in a wide variety of women, with a variety of cancer stages. To do this, Moffitt investigators are working backward:
Through July 2003, Moffitt wants to enroll every woman younger than 80 in Hillsborough and Pinellas counties who is suspected of having ovarian cancer or in whom it is diagnosed.
Dr. Rebecca Sutphen, director of genetic counseling and testing service at Moffitt and the study's lead investigator, said she expects them to number 400 to 500. For a control group, 100 healthy women also will be tested for lysophosphatidic acid, or LPA.
"In the data that we have so far, which is limited, it's showing that it is elevated in women who have ovarian cancer, and it's elevated even in Stage I cases," Sutphen said.
"That's the critical part, because if it's elevated in Stage I, you can use it as a screen."
Ovarian cancer cells apparently shed LPA molecules, just as prostate cancer sheds antigens called PSA. Researchers hope a LPA test will prove as reliable as the PSA test, which has become a routine test for men older than 40.
As part of the Moffitt project, the American Cancer Society also is funding research at the Cleveland Clinic in Ohio aimed at finding the best way to measure LPA. The Cleveland Clinic was among the first centers to tie LPA to ovarian cancer, when it reported in 1998 that of 10 patients, nine had elevated levels. Another study of 48 ovarian cancer patients there showed all had elevated levels of LPA.
Doctors have tried to use another molecule, called CA-125, to screen for ovarian cancer, but it isn't detectable enough in early stages. Dr. James V. Fiorica, chief of gynecologic oncology at Moffitt and co-investigator of the LPA study, said CA-125 can help monitor cancer in women who already have been given the diagnosis, but little else.
The standard treatment for ovarian cancer is surgical removal of the ovaries and chemotherapy, but 65 percent of patients die. Its victims include comedian Gilda Radner and, more recently, actor Madeline Kahn.
"The survival rate is low. They know that. Before we embark on treatments, we'll tell them what the goal is; we'll tell them what the expected cure rate is," Fiorica said. "And on the positive side, 35 percent isn't none."
Ovarian cancer usually occurs during or after menopause, when each of a woman's two ovaries has shrunk to the size of an almond. Often, it hits women who are the picture of good health, such as Mrs. Weicherding and Mrs. Salm, a once-avid tennis player with an enviably positive attitude.
"I tell everybody they should smoke and drink and lay around on the couch and get fat," she said only half-jokingly. "To a point. But those things happen."
Ovarian cancer was diagnosed in Mrs. Salm the same day as the funeral for a neighbor who died of it. She underwent surgery soon after she showed the lump to her gynecologist, but the cancer already had spread to her lymph nodes.
She has been in and out of the hospital and is frequently sickened by the cancer-killing drugs she takes. Her husband, Peter, has become an accomplished nurse, giving her injections that help her blood cells recover from chemotherapy. She hopes other women become more aware of ovarian cancer than she was.
"It's too late for me," Mrs. Salm said. "But I think living two years, from what they told me at the beginning, is not too bad."
For more information
For information about this study, contact the Moffitt Cancer Center in Tampa at (813) 903-4971.
For information about ovarian cancer:
American Cancer Society: www.cancer.org or (800) 227-2345
National Ovarian Cancer Coalition: www.ovarian.org
Ovarian Cancer Research Notebook: www.slip.net/~mcdavis/ovarian.html
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