OC in the ER

Emergency Room Ovarian Cancer Diagnoses

Study: Population-based cohort of 28,204 women (England, 2017–2021). Access Full Study

The Bottom Line

An astonishing 40% (2 in 5) of ovarian cancer patients are diagnosed within 28 days of an emergency room admission. This represents a systemic failure that almost always results in late-stage diagnoses and poor survival rates.

Who is Missing the Diagnostic Window?

The data show emergency presentations aren't random; they split into two clear, vulnerable groups:

• The Disadvantaged Young: Younger women from low socioeconomic backgrounds facing barriers to primary medical care.

• The Frail Elderly: Older women with complex, competing comorbidities that mask vague cancer symptoms.

The Pandemic Spike: Emergency diagnoses peaked sharply in 2020, proving that when routine primary care access shrinks, emergency cancer presentations surge.

What OCA Support Nurses Need to Know

• High-Distress Intake: ER-diagnosed patients skip the gradual preparation period. They hit the oncology system in acute psychological shock with advanced disease. They need immediate, high-intensity supportive care.

• Vigilance for Vulnerable Demographics: Use these two specific patient profiles to trigger higher clinical suspicion when talking to patients with persistent, vague abdominal complaints.

• System Advocacy: Support nurses should push for lower triage thresholds for pelvic ultrasounds and CA-125 tests in emergency departments when treating women with unexplained GI or pelvic symptoms.

Quick Tags:

#Epidemiology #EmergencyPresentation #HealthEquity #EarlyDetection

Falling incidence of ovarian cancer and oophorectomy

Oophorectomy-Corrected Ovarian Cancer Incidence, Survival, and Mortality by Subtype, Race, Ethnicity

https://tinyurl.com/tk4v75pj

Ovarian cancer is declining. This decrease is mostly attributed to hormonal contraception, which means fewer lifetime menstrual cycles. This effect has been noted for the almost 60 years that hormonal contraception has been available and has increased with time as the users aged. As other forms of contraception develop, oral hormonal contraception is now used by 11% of the US population.

Despite this, the incidence of ovarian cancer continues to fall; the reasons are not clear. One suggestion is that removal of ovaries (oophorectomy) for reasons other than cancer may have the effect of reducing ovarian cancer. This study looked at the SEER cancer registry. Almost 160000 cases of ovarian cancer were recorded during the period 2002-2019. The rate of ovarian cancer decreased by about 2% for white women and less, about 1.5% for black women.

The rate of prior oophorectomy for elderly women (aged 70+) remained stable at about 30%. If the population numbers are adjusted to allow for the oophorectomy, no further decrease in ovarian cancer incidence is seen.

The authors note that there has been an increase in fallopian duct cancer, especially for black women and that some of the decrease in ovarian cancer may be due to reclassification. Other factors such as decreased menstrual hormonal therapy and the longer lives of the oral contraception generation may be part of the reason for the decline; it remains unclear as to why this is so.

Long-term PARPi therapy

Long-Term Outcomes in Patients with Recurrent Ovarian Cancer and Exceptional Response to PARP Inhibitors

https://tinyurl.com/y937k685

When PARP inhibitor therapy was first introduced, it was supposed to be maintenance treatment aimed at slowing the progression of ovarian cancer. The measure of success was held to be progression-free survival; cure was not expected with most, if not all, patients with ovarian cancer dying from the disease.

It soon became clear that there was a subgroup of patients whose survival was prolonged beyond the 5-year “cure” marker. This was noted in all the clinical trials with up to 20% of participants in the SOLO2 still alive 5 years later.

This retrospective study was of 320 patients who were part of this group, with a history of exceptional survival. About two-thirds of them had received continual treatment with PARP inhibitors; the others had discontinued the drug either due to carer intervention or due to adverse effects or personal preference. The median treatment course was 75 months; the 10-year progression-free survival was almost 80%.

Survival after cancer for this period may be deemed as a cure. It is of note that those exceptional survivors who terminated the treatment early had no worse outcomes. Why this group is exceptional remains unclear, previous work has suggested that a particular location of the DNA mutation of the BRCA gene may be protective. There was no difference between BRCA1 and 2 germline mutations. No increase in marrow dysfunction or myeloid leukaemia is noted with the incidence being small at less than 2%. For some patients, PARP inhibition may be curative. Interruption of treatment does not appear to be harmful.

Immunotherapy and ovarian cancer

Advances in immunotherapies in ovarian cancer

https://tinyurl.com/5397dpd5

Immunotherapy acts by promoting the activity of cell-mediated immunity to target and kill cancer cells. It is extremely effective for several cancers, such as melanoma, but thus far has been ineffective for ovarian cancer, which is considered to be immunologically "cold".

This editorial review shows why this is so and suggests targets for more effective treatment in the future. Cell-mediated immunity acts by T cells invading the tumour microenvironment (TME). Ovarian cancer cells prevent this from happening, usually by reinforcing the cell membrane with antigen checkpoints that prevent the infiltration of these T cells.

Immunotherapy helps to overcome this protection either by direct checkpoint blockade or by identifying the relevant antigen and using an antibody drug combination to overcome the resistance and access the TME. Manipulation of T cell activity by genetic re-engineering to produce specific antigen receptivity is also used, especially for certain blood cancers (CART cells).

It is hoped that similar treatments will be developed for ovarian cancer. About half of all ovarian cancers show an immune response, with an increased number of lymphocytes visible on pathological examination. This response increases after neoadjuvant chemo, which offers some hope that immunotherapy may be possible.

A recently approved antibody drug combination (elahere), used for platinum-resistant ovarian cancer, shows some promise. The authors suggest that a better understanding of the TME and cellular protection is required before significant progress is possible.

Is endometriosis a significant cancer risk?

Endometriosis and ovarian cancer risk

https://tinyurl.com/36vyrxjf

Endometriosis is a chronic cause of pain for about 10% of women during their reproductive life. The cause remains uncertain; initially thought to result from retrograde menstruation, the implanted cells found throughout the pelvis, which have a similar appearance to the uterine epithelium, may be due to stem cell activation.

Chronic inflammation from endometriosis has been cited as a possible cause for ovarian cancer. This study, looking at all available information using a standard methodology known as the PRISMA guidelines, suggests that the risk is low for most types of ovarian cancer, although there is an increased risk of endometrioid and clear cell cancer, which account for about 10% of the total.

Because ovarian cancer generally has a low incidence, with about 11/1000 women developing the disease during their lifetime, the overall risk increase due to endometriosis at about 1.3 means a small number of 3-4 extra cases. Because of this, the authors suggest that women with endometriosis should be reassured that ovarian cancer is unlikely, and extra surveillance is not indicated.

Insomnia and cancer

‘What has changed?’: Insomnia could explain the rise in early-onset hormonal cancer in women

https://tinyurl.com/4ph4v97e

The incidence of cancer in young people is increasing. Why remains uncertain, with obesity and pollution having been suggested as potential causes. At the recent ASCO meeting, data from a study were disclosed which suggested insomnia may be contributing to this increase.

A retrospective 5-year study of more than 400,000 adults with insomnia looked at cancer incidence and compared the outcomes with a large control group.

Women with insomnia had a significantly greater chance of developing breast, uterine and ovarian cancer. Men with insomnia seem to be more likely to have prostate or testicular cancer, though the evidence is incomplete.

Insomnia is said to affect about 16% of the population; behaviour modification may be protective. Melatonin, often deficient in insomnia, is an oestrogen blocker. Being an insomniac looks like a health hazard.

Fertility saving surgery for borderline ovarian tumours

Recurrence and Malignant Transformation After Borderline Ovarian Tumours: A Systematic Review and Meta-analysis

https://tinyurl.com/yk7et5rw

Borderline ovarian tumours make up 10 to 20% of ovarian masses. They present at an earlier age and rarely progress to invasive cancer. Because of this, surgery for these tumours is often limited to removal of the ovarian mass with preservation of fertility.

This analysis of all the available information looks at the risks of recurrence and malignant change to determine whether limited fertility-saving surgery is harmful.

More than 5000 women were included who underwent surgery for borderline tumours, which included complete clearance for some, with others having less radical surgery, many for preservation of fertility. Recurrence of the tumour is more likely with limited surgical clearance, with as much as a 30% chance in some instances. Those women who had radical surgery had a low risk of recurrence at about 3%.

Progression to invasive cancer is rare, in about 1% of the whole group. The risk increases after recurrence, with up to 20% malignant change after local recurrence. Usually, the cancer is of low grade, with survival rates at around 60%.

The authors suggest that fertility-saving surgery has serious consequences and that informed consent should include the increased risk of recurrence and malignancy.