- picking up low grade Ovarian Cancer (OC) is different that picking up high grade OC
- 50% of OC cancer arises in the fallopian tubes
- OC takes an average of 4 years to develop, stage 1&2 disease size is < 1cm
- Focus should be on finding low volume disease
- CA-125 over time
- Autofluorescense high resolution imaging
- Ultrasound with microbubbles
- ctDNA (circulating tumor DNA)
(Risk of Ovarian Cancer Algorithm) study 53% of the women had a CA-125 < 35 yet had invasive ovarian cancer.
Some points Dr Levine made include:
- Genomic scarring may occur. It is a mechanism of DNA repair which leaves a scar or signature . Those signatures can be used to classify tumors .
- Chemoresistant tumors contain an extensive number of alterations – including BRCA1& BRCA 2
- There are other mutations (6% of the women have a pTen mutation) but we few to date are clinically actionable. In other words we know about mutations but there are no treatments currently available for that mutation.
- Tumor tissue will change and evolve over time so it is important to profile the tumor in the time it needs to be treated.
- ctDNA ( circulating tumor DNA) can be found in blood plasma. It may be able to be used to monitor for recurrence and response .