Letitia Linke was young and fit when she first felt a lump in her stomach and went along to her doctor for a check-up. At the time Letitia was 34 years old, and was otherwise feeling quite well after going on a health kick to lose weight and improve her fitness.
At first doctors thought the lump was a hernia and when an MRI scan showed lumps on her abdominal wall, doctors thought she had a severe case of endometriosis. Her other symptoms of lower back and abdominal pain were also consistent with this.
Letitia was referred to a gynaecologist for treatment and during surgery her fallopian tubes were removed and her ovaries were biopsied, which is the usual procedure for a serious case of endometriosis.
Two days later, Letitia’s gynaecologist phoned with shocking news, pathology testing of her tissue samples had confirmed that Letitia had ovarian cancer.
Following the diagnosis, Letitia underwent several operations to remove her uterus and a previously hidden tumour as well as radiotherapy and chemotherapy.
After first line chemotherapy and radiotherapy failed to give Letitia a remission, further pathology was undertaken in the form of “tumour profiling”. This identified that Letitia’s tumour was positive for estrogen and progesterone and resulted in the addition of hormone therapy to her treatment.
Some cancers will respond differently to treatments with certain classes of drugs, depending on the presence or absence of certain mutations (or molecular variants). Testing and treating tumours in this way is known as precision or personalised medicine.
Letitia’s story might sound surprising as ovarian cancer is more common in women over 50, but Letitia is keen to raise awareness that ovarian cancer can affect women of any age, as noted by Ovarian Cancer Australia.
Ovarian cancer tests, diagnosis and treatment
The symptoms of ovarian cancer can mirror those of many other conditions and like Letitia, many women will have minor symptoms that can be put down to another cause, or may have no symptoms at all.
Currently there is no screening test but genetic testing can help women to find out some risk factors. Variations in the BRCA group of genes are associated with an increased risk of breast, ovarian and bowel cancers. A blood test will determine if a woman has a BRCA gene mutation that places her at increased risk. This type of test would usually be offered to women who have breast, ovarian or bowel cancer in the family or if a family member has tested positive for a BRCA mutation.
CA125 tests are also used to monitor treatment and possible reoccurrence for women being treated for ovarian cancer. This test measures the CA125 protein which exists on the surface of ovarian cancer cells, as well as on some normal tissue. The level can help doctors decide if treatment is effective at tackling cancer, or if cancer has returned when a woman is being monitored after successful treatment.
The reason this test cannot be used for screening or diagnosis of ovarian cancer by itself is that the test is not black and white. The presence of CA125 is normal but the level requires careful interpretation and must also be viewed in context. High levels can be caused by factors other than cancer such as menstruation or ovarian cysts. Also, many women with ovarian cancer will not have raised CA125 levels. The only way to confirm a cancer diagnosis is with a biopsy examined by a pathologist.
Because of the difficulties with early diagnosis, many cases of ovarian cancer are first diagnosed when cancer is already in the later stages. This is why the five-year survival rate is around 44 per cent.
“I am now a passionate advocate for the Ovarian Cancer Research Foundation as an early detection test could save many lives. I am lucky to be alive but I have lost more than one friend to ovarian cancer, which can affect women at any age and often goes undetected for a long time,” said Letitia.
As the CEO of Abbott Pathology, Letitia’s mum Madelyn Duckmanton is also passionate about the role of pathology in helping her daughter and other women with cancer; “Pathology is a vital part of Letitia’s ongoing care. It helps her doctors to monitor her so we know as soon as possible if the cancer returns. Cancer is a terrible thing to deal with for any family but we hope that with advances in research, pathology will soon be able to do even more in the fight against ovarian cancer.”
Image: Marie Claire marieclaire.com.au