Ovarian cysts and ovarian cancer
Ovarian cancer is the most common gynaecological malignancy in Singapore, and is the leading cause of death from gynaecological malignancies. This high mortality is a direct reflection of the late diagnosis of this condition. 4 out of 5 (80%) of women with ovarian cancer present in the late stages of disease where the chances of survival are poor.
On the other hand, if diagnosed in the early stages of the disease, survival rates can exceed 95%, and occasionally even without the need for chemotherapy. Dr Choolani and his team have been working on the early stage detection of ovarian cancer, and have made some progress in this direction.
Except for a very few cases, generally all ovarian cancers are accompanied by the presence of an ovarian cyst, thus his dictum ‘No cyst, No cancer’. This generalization works in more than 95% of cases, and is a good place to start looking for early ovarian disease.
Another important source to aid the diagnosis is to test the patient’s blood, looking for tumour biomarkers. The traditional tumour marker (CA125) for ovarian cancer is reasonable for late stage disease, but not very good for early stage disease. Dr Choolani and his team are exploring the use of novel proteomic markers and strategies for the early stage detection of this disease.
At the same time, once a patient is diagnosed with cancer, often the issue of survival and prognosis becomes paramount. The team has also explored biomarkers in the blood to attempt to address this question.
In this invited review, Dr Choolani discusses the modern strategies to combat the vexing issue of ovarian cancer.
A deeper understanding of the biology of this disease would allow us to speed up discoveries that would lead to early detection and also perhaps novel therapeutic strategies.
Current belief is that incessant ovulation is the cause of ovarian cancer, but the evidence to support this hypothesis is still tenuous. The team is exploring the possibility of an accumulation of toxic chemicals within the ovarian tissue as a possible source of genetic changes that lead to cancer formation.
The team recently catalogued the genes implicated in ovarian cancer. They plan to study these genes in greater detail and their interactions that could lead to the development of ovarian cancer.