Newly Diagnosed, Stephanie Wethington, MD
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This document outlines the process from diagnosis to follow-up care for ovarian cancer. It begins with an introduction and disclosure section. It then covers the diagnosis process, including symptoms, imaging, biopsy and surgery. Treatment options like surgery, chemotherapy, targeted therapy and clinical trials are discussed. The roles of the treatment team members are defined. Follow-up care including exams, imaging and survivorship are also summarized. Resources and questions from patients are addressed. Key terminology around histology, grade, stage and tumor markers is explained.
Newly Diagnosed, Stephanie Wethington, MD
- 2. Session Outline • Introductions • Process from diagnosis to follow-up • ‘Doc, what should I be asking you?” • Resources • Questions and answers
- 3. Disclosures No financial disclosures. This is not medical advice.
- 4. Disclosures No financial disclosures. This is not medical advice I am a doctor.
- 5. Disclosures No financial disclosures. This is not medical advice I am a doctor. Stop me if I am using jargon or acronyms Interrupt and ask questions
- 6. Stephanie L. Wethington, MD Raised in Northern Virginia Medical training at Columbia University College of Physicians and Surgeons, Magee Womens Hospital, New York Presbyterian Hospital Gynecologic Oncology Fellowship at Memorial Sloan Kettering Cancer Center Gynecologic Oncologist at Mid Atlantic Gynecologic Oncology and Pelvic Surgery Associates
- 7. What do we mean by Ovarian Cancer? Cancer arising in the ovaries, fallopian tubes or peritoneum
- 8. What is a Gynecologic Oncologist? Completed Ob/Gyn residency Additional 3-4 years of specialized training in the care of women diagnosed with gynecologic cancers Fellowship training includes: Biology & pathology Diagnosis Treatment Surgery Chemotherapy Radiation Survivorship Research
- 9. Members of the treatment team Gynecologic oncologist Medical oncologist Radiation oncologist Palliative care provider Nurse navigator Chemotherapy infusion nurse Social worker “Housestaff” Nutritionist Physical and occupational therapists Acupuncturist Psychiatrist or psychologist Family and friends
- 10. The process: From diagnosis to follow-up
- 11. Diagnosis • Symptoms • Incidental finding • Tumor markers • Imaging • Biopsy • Operation
- 12. What makes you unique?
- 13. Treatment • Operation • Chemotherapy • (Biologic) • (Targeted therapy) • (Radiation)
- 14. Treatment Surgery • Laparotomy (open abdominal incision) • Minimally invasive procedure • Laparoscopy • Robotic assisted laparoscopy • Staging • Where has the cancer spread? • Debulking • How can we remove all the visible tumor?
- 15. Treatment Chemotherapy • Intravenous • In the vein • Peripheral IV • Mediport • Intraperitoneal • In the abdomen
- 16. Treatment What is a cycle? • Recurring group of chemotherapy doses • Example: Dose dense paclitaxel and carboplatin Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1 Cycle#1 Carbo Taxol 2 3 4 5 6 7 8 Taxol 9 10 11 12 13 14 15 Taxol 16 17 18 19 20 21 22 Cycle #2 Carbo Taxol 23 24 25 26 27 28 29 Taxol 30 31
- 17. Treatment • (Biologic) • Avastin • (Immunotherapy) • (Targeted therapy) • (PARP inhibitors) • (Radiation)
- 18. Hot Topic Clinical Trials Geared to specific genomic abnormalities Tumor profiling Foundation One Precision Therapeutics Caris Immunotherapy Adoptive T cell therapy Vaccines PD-1, PD-L1 Pembrolizumab
- 19. Follow-up Components • Symptoms • Physical exam • Tumor markers • Imaging Timeline • Every 3 months • Space out over time
- 20. “Doc, What should I be asking you?” Know yourself
- 21. “Doc, What should I be asking you? Understanding the diagnosis • What type of ovarian cancer do I have? • Histology • Grade • Stage Understanding the treatment plan • Will I have an operation or chemotherapy first? • Why is that sequence recommended? Who is my treatment team?
- 22. Understanding the operation • What procedure did I have? • One ovary or both? • Uterus and cervix? • Lymph nodes? • Bowel? • Other? • Was it a staging procedure or a debulking procedure? “Doc, What should I be asking you?
- 23. “Doc, What should I be asking you? Understanding the chemotherapy plan Which chemotherapy drugs will I receive? Will I receive chemotherapy through the vein (IV) or into the abdomen(IP)? Do I need a mediport? Are these chemotherapies standard of care? Are there other options? Am I eligible for any clinical trials? What are the expected side effects? Are there side effects about which I should call the office urgently? What are your recommendations to decrease side effects? Where will I receive chemotherapy? Will I receive a “chemo calendar”? Who do I call if I have a question about my chemotherapy treatment? How many chemotherapy treatments will I have? How often will I have an appointment with you? How often will I have blood drawn? Will I be able to work during the chemotherapy treatments? Limitations? Do I see my primary care doctor, cardiologist, other specialist while I am receiving chemotherapy?
- 24. “Doc, What should I be asking you? Understanding the follow-up • How often do I need a physical exam? • How often do I need to check tumor markers? • How often do I need to have an imaging study? • What other cancer screening do I need? • Do I need to see my primary care doctor or other specialists? • Is there anything I can do to reduce my risk of recurrence? • Should I schedule an appointment with a genetic counselor?
- 25. • This process is very lonely. Help? • Will I be able to have children after my treatment? • My son is getting married in two months. Will I be able to attend? • I don’t want anyone to know I have been diagnosed with cancer. How do I keep my diagnosis private? • What do I tell my children? • I have been married for 30 years and we have a wonderful intimate relationship? Will this be affected? • I am so tired. What can I do about the fatigue I am feeling? “Doc, What should I be asking you?
- 26. Resources General oncology American Cancer Society, www.cancer.org National Cancer Institute, www.cancer.gov National Comprehensive Cancer Network, www.nccn.org NRG Oncology, www.nrgoncology.org Patient Advocate Foundation, www.patientadvocate.org
- 27. Resources Gynecologic oncology specific o Eyes on the Prize, www.eyesontheprize.org o Foundation for Womens Cancer, www.foundationforwomenscancer.org o Gilda Radner Familial Ovarian Cancer Registry, www.ovariancancer.com o National Ovarian Cancer Coalition, www.ovarian.org o Ovarian Cancer Research Fund Alliance, www.ovariancancer.org o Ovations for the Cure of Cancer, www.ovationsforthecure.org o Society of Gynecologic Oncology, www.sgo.org
- 28. Resources Support Networks Cancer Care, www.cancercare.org Cancer Support Community, www.cancersupportcommunity.org National Coalition for Cancer Survivorship, www.canceradvocacy.org SHARE: Self-help for Women with Breast or Ovarian Cancer, www.sharecancersupport.org
- 29. Resources
- 31. If I could only share one piece of information, it would be…..
- 32. Extra material in case time or questions
- 33. Terminology
- 34. Key Terminology Histology Epithelial Germ cell Sex cord stromal tumor
- 35. Key Terminology Grade How abnormal are the tumor cells under the microscope? • Grade 1 = Well differentiated • Grade 2 = moderately differentiated • Grade 3 = poorly differentiated • Low grade • High grade
- 36. Key Terminology Stage = Spread 0
- 37. Key Terminology Tumor Markers Examples • CA-125 • HE4 • Inhibin • AFP • LDH How are they used? • Monitor response to treatment • Detect recurrence Word of Caution
- 38. Key Terminology Imaging Studies CT (computed tomography) Scan • Series of xray images • Combined by a computer • Intravenous or oral contrast • Structure
- 39. Key Terminology Imaging Studies MRI (Magnetic resonance imaging) • Magnetic field and radio waves • Combined by a computer • Intravenous contrast • Structure
- 40. Key Terminology Imaging Studies PET (positron emission tomography) Scan • Radioactive tracer • Dye collects in areas of the body with high metabolic activity • Metabolism PET CT Fused
- 41. Clinical Trials
- 42. Clinical Trials Goal: Identify better ways to treat ovarian cancer Who leads? • Principal investigator, MD • Research team Who sponsors? • Academic medical centers • Pharmaceutical companies • Nonprofit organizations • NRG oncology • Federal agencies
- 43. Clinical Trials Structure • Phase I • Safety • Dosage • Phase II • Safety • Effectiveness • Phase III • Effectiveness
- 44. Clinical Trials Example questions to ask: • What are the possible interventions I might receive during the trial? • Why do researchers believe the intervention being tested might be effective? Has it been tested before? • Does everyone receive the study drug? • When do I find out which intervention I will receive? • How do the possible risks, side effects, and benefits of this trial compare with those of my current treatment? • What will I have to do? • How long will the study last? • Who will pay for my participation? Reimbursed for other expenses? • What type of long-term follow-up care is part of this trial? • If I benefit from the intervention, will I be allowed to continue receiving it after the trial ends? • Will results of the study be provided to me? • Who will oversee my medical care while I am in the trial?
- 45. Tumor Testing
- 46. Tumor Testing Caris Life Sciences Multiple tumor profiling technologies • IHC, FISH/CISH, Next-Generation Sequencing, PCR
- 47. Tumor Testing Precision Therapeutics Tumor cells are grown in the lab, treated with various chemotherapy drugs, and response measured
- 48. Clinical Trials FoundationOne Sequences more than 200 cancer-related genes