Kaja Michalczyk

M.D.

Pomeranian Medical University

Resident Doctor, Department of Gynecological Surgery and Gynecological Oncology

PLCO (Learn more about this study)

PLCO-1187

Mar 29, 2023

The delays in ovarian cancer treatment and their effect on OS

Ovarian cancer remains the leading cause of death among gynecological cancers. Early cancer diagnosis allows for a better patient prognosis. However, due to its asymptomatic progression and limited screening methods, most patients are diagnosed in advanced stages when the disease has already metastasized. Epithelial ovarian cancer accounts for approximately 90% of ovarian cancers. Its treatment consists of radical surgery and either adjuvant or neoadjuvant chemotherapy. However, due to chemoresistance and high recurrence, the 5-year patient survival rates remain at approximately 35-50% (Torre et al. 2018). So far, there are no highly specific and sensitive markers that allow early EOC diagnosis. Multiple trials attempting ovarian cancer screening have been made using combined protocols consisting of cancer antigen 125 (CA 125) and HE4 (human epididymis 4) serum markers as well as transvaginal ultrasonography. However, even in high-risk populations of BRCA 1 and 2 positive patients, the methods were ineffective in EOC screening (Menon et al. 2009; Siva 2007).
According to FIGO classification, there are IV stages of ovarian cancer, starting from stage I, where the cancer cells are limited to a single ovary, to stage IV with distant metastasis. The biological behavior of ovarian cancer (OC) is unique and markedly differs from classic hematogenous cancer metastasis as it is found in most cancers. In ovarian cancer, the exfoliated/ruptured cancer cells are transported throughout the peritoneum in the peritoneal fluid and primarily disseminate superficially within the peritoneal cavity and infiltrate surrounding tissues and the omentum; however, later, with cancer progression and increasing tumor size, it starts to compress visceral organs.
The advanced metastatic disease remains the greatest challenge in ovarian cancer treatment. Compared to primary tumors, metastatic tumors share a wide spectrum of mutations and are chemotherapy-resistant (Vang et al. 2013; Shah et al. 2009; Paris et al. 2006).

Current surgical ovarian cancer treatment aims in complete cytoreduction – sometimes involving complete resection of the ovarian tumor, reproductive organs, omentum, and sometimes sigmoid colon, yet in some patients, the total excision of the lesions is not possible.
The scope of the treatment can cause fear and anxiety among patients as well as require specific preparations including medical imaging (CT, MRI) medical consultations, dietary preparations, psychologists, etc. that can result in treatment delays.

We hypothesize younger patients begin cancer treatment sooner than older populations of patients due to fewer comorbidities. We hypothesize greater Ca125 and FIGO staging to adversely correlate with the beginning of cancer treatment due to poorer patients’ medical conditions. We suppose patients with lower income and further distance from the medical treatment centers have lower compliance and a greater time span between OC diagnosis and OC treatment.

Aim 1
The aim of our study is to evaluate
if the timing between OC diagnosis and initiation of treatment (neoadjuvant chemotherapy or radical surgery) affects patient OS.

Aim 2
To determine if patients’ age or presence of any comorbidities influences the time span between OC diagnosis and the beginning of OC treatment.

Aim 3
To assess if there is any correlation between different OC biomarkers (including CA125 and HE4 concentration), FIGO staging, and the duration between OC diagnosis and treatment

Aim 4
To determine if patient characteristics influence the timing of the beginning of cancer treatment (distance to the hospital, patients’ education, patients’ marital status, ethnicity)

We propose to utilize the existing data from the Prostate, Lung, Colorectal, and Ovarian (PLO) Cancer Screening Trial to examine the specific associations on a large cohort of patients.

Anita Chudecka-Głaz, Associate Professor, Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland

Janusz Menkiszak, Associate Professor, Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland