OVARIAN CANCER: A DIAGNOSTICIAN'S DIRECTIVE (R. Bard, MD)

OVARIAN CANCER AT A GLANCE: (NIH)

* Estimated New Cases in 2023: 19,710
* % of All New Cancer Cases:  1.0%
* Estimated Deaths in 2023: 13,270
* % of All Cancer Deaths:  2.2%
* (2013–2019) 5-Year Relative Survival:  50.8%

Rate of New Cases and Deaths per 100,000: The rate of new cases of ovarian cancer was 10.3 per 100,000 women per year. The death rate was 6.3 per 100,000 women per year. These rates are age-adjusted and based on 2016–2020 cases and deaths.   Lifetime Risk of Developing Cancer: Approximately 1.1 percent of women will be diagnosed with ovarian cancer at some point during their lifetime, based on 2017–2019 data. Prevalence of This Cancer: In 2020, there were an estimated 236,511 women living with ovarian cancer in the United States.

OVARIAN CANCER: A DIAGNOSTICIAN'S  DIRECTIVE
By: Dr. Robert L. Bard
[PDF DOWNLOAD] 

Ovarian Cancer continues to be identified as the "SILENT DISEASE" primarily due to its ability to remain undetected until it has metastasized. Often, metastasis goes to the liver and bones, starting off with a very small cystic area in the ovary. Ideally, we need specialized equipment that can show 3 and 4cm tiny cystic areas in an organ that normally has 2-3cm cysts where the mass often goes undetected. The way we accomplish this is to do high resolution ultrasound scans with 3D reconstruction and with Doppler blood vessel ultrasound imaging. Because a normal ovarian follicle cyst is clear and has no tumor vessels in it, we distinguish a benign normal ovulation cyst from a cyst that is suspicious and could grow or metastasize. We observe the lining of the cyst where a benign cystic area is smooth outside and inside, while a cancerous cyst has inner wall irregularity, thickening and possibly a serrated outside as well. More importantly, since tumor growth relies on feeding blood vessels we image the  vascular network with the same ultrasound probe that finds the suspicious cystic area. 

TREATMENT WITH IMAGE GUIDANCE
In 1980, my partner and I co-authored the first textbook on ultrasound of the pelvis, including gynecologic tumors. At that point, we could distinguish between a solid area and a benign fluid filled cyst. We were able to detect ovarian cysts (which are normal in the reproductive area). Technology continued to evolve with higher resolution scanning and 3D imaging 20 years ago that is used for scanning the faces of baby in the womb. One could visibly see the fingers and the nose as well. As this technology became more refined quantification of  tumor vessels in the ovary became available about 10 years ago whereby the volumetric imaging of a tumor is able to see the entire 3D outline of a tumor and its malignant blood supply.  This made it possible to find out where the cancer was (and where it wasn't) as well as if and where it was spreading. By simply moving the probe to nearby areas tracking the ovarian pathology metastasis to the liver or lymph nodes allowed staging so some MRI or nuclear scans were avoided. In some cases  bones involvement or lung  fluid from metastatic disease is demonstrable.

Normal blood flow from tumor vessels is distinguished by specific velocity changes. Malignant flow graph is smoother while inflammatory blood vessels have a "spiky" graphic display. More importantly, in addition to seeing the abnormal circulation we measure the aggression by the number of tumor vessels in the area. An elevated number of tumor vessels in the area helps determine the level of treatment. Under continued monitoring, treatment success is measured by the reduction in vessel density.  Diagnostic imaging greatly assists in navigating the selected treatment modality as well as its dosage/intensity. 

THE LATEST: ADVANCEMENT IN EARLY DETECTION OF OVARIAN CANCER
According to the Society for Women's Health Research, "Over 20,000 women will be diagnosed with ovarian cancer this year in the United States and women have a 92% chance of surviving for five years post-diagnosis. However, more than three-fourths of women are not diagnosed until later stages." [1] Abnormal ovaries are often benign simple cysts, however the complex cysts are classifiable with the new ultrasound scoring system as to how suspicious they may be. The same way we detect prostate tumors by routine yearly ultrasound screening in high risk patients, we could save many lives because sometimes the first sign of ovarian cancer is a gland in the neck that pops up, a mass under the arm or jaundice because the liver is filled with metastatic tumor. (visit full feature)

CONTRIBUTORS: 

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration. https://drrobertbard.com/

ROBERTA KLINE, MD (Educational Dir. /Women's Diagnostic Group) is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://robertaklinemd.com/

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SPOTLIGHT: OVATIONS FOR THE CURE OF OVARIAN CANCER

In our continued search for leadership in outreach, advocacy and support for research, the Women's Health Collaborative applauds the committed work of SUSAN PATTERSON of Boston, Mass.  Our editors found her organization, OVATIONS FOR THE CURE OF OVARIAN CANCER at nancyslist.org and proceeded to learn about the origins and the mission behind her crusade. 

Ovarian Cancer continues to be one of the most insidious and challenging cancers to battle. Known as the 'silent disease', organizations like "Ovations for the Cure" understand the importance of continued research in finding answers to someday gather enough clinical data and produce innovative solutions to eliminate ovarian cancer from attacking our global community.

INTERVIEW WITH SUSAN PATTERSON 

We started back in 2007, which at that time, there wasn't much for ovarian cancer.  It wasn't talked about- and you didn't tell anybody you had it. It was a secret. My friend had it... her mother had it before her, but she did not know that because they didn't talk about it. So when she was diagnosed, she had a vision of leaving something behind.  After years of treatment, she finally ran out of options. 

Patty was a talker and she would go into the hospital and she'd talk to everybody- reminding women that they were not alone. They don't have a sisterhood. They don't have a group. They're lone survivors out there and that's sad. So we have made our focus support for the women while they're in treatment- and what that involved was to help them and their whole family. We work with a local company similar to HelloFresh. We make sure they have the proper diet and nutrition. The whole family has meals, transportation, any type of thing that comes up along the way that they need help with. 

The other thing we did was we created what my founder called the sisterhood for every woman nationwide.  We would work with social workers at different hospitals and connect with women that are diagnosed to get a free gift from us.  Right now, it's a teal butterfly bracelet in the hopes that they will see another woman wearing this bracelet during their treatment and can open a conversation. What this also does is when they apply for the treatment, they join our email list and we connect them with other women in their area as well. 

We're in Boston- and our local annual awareness event (in November) is a Learning for Living symposium. We call it a day of hope and healing.  We do it at the Four Seasons Boston for women and their care partners. The morning they hear about  updated medical information from the local doctors at the area hospitals.  Dr. Ursula Matulonis, who is one of the top research doctors at Dana Farber and is on our board of directors.  She chooses the speakers and best topics.  This is followed by a lunch where all the women can connect and share what they heard about today. The other half of it is the non-medical world. In a separate room of the hotel they have some one-on-one time with Reiki and support groups and other nonprofits, which I started last year.  I was searching for other local nonprofits to let the women know there's other people here to help them. So it's all about these women for one day at no cost to anybody. This is all paid for by our sponsors, and the Four Seasons has been wonderful. 

We also work with women and families to create a lot of smaller and local events. We help them create an event to remember her- and we do that year round. We try to have small community events so that the family members can remember and spread the awareness about this disease.  We do videos and we also do a big team fundraising at the Jimmy Fund walk every year to go directly to Ursula Matulonis Ovarian Cancer Research Fund. To date, we've donated over 1.7 million and for a small one person organization, we are pretty darn proud of that. So the focus is always on awareness, education, and research.

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