Ms. Zhang, who is in her 70s, was sent to the hospital because of shortness of breath. The examination found bilateral pleural effusion, and her state of consciousness was not very good. Computed tomography images showed two large tumors in the pelvic cavity and a rather large tumor in the omentum in the abdominal cavity, which was suspected to be ovarian cancer with multiple metastases.
Physician Chen Zhenrui, secretary-general of the Taiwan Women’s Cancer Society, recalled, “Because of the high risk of liver metastases, after discussing with the family, we decided to do chemotherapy first. After several chemotherapy treatments, the pleural effusion in the patient’s chest completely subsided, and the stomach The tumor has also shrunk to the point where surgery can be performed, so that surgery can be arranged to remove the tumor in the abdominal cavity and pelvis.”
The patient also continued to receive chemotherapy after the operation. Dr. Chen Zhenrui said that the tumor metastasized to the liver gradually disappeared with the chemotherapy, and the patient’s condition was also improving day by day.
In addition to chemotherapy, the patient also underwent genetic testing and was found to have a BRCA-1 gene mutation, so he applied to the health insurance for the use of PARP inhibitor oral targeted drugs as maintenance therapy, hoping to maintain a state without recurrence. “It’s really gratifying to see a patient who was once considered terminal cancer and bedridden, has undergone treatment and has undergone tremendous transformation,” said Dr. Chen Zhenrui.
Flatulence, stomach upset, ovarian cancer
The ovary is located in the pelvis, and it is difficult to find abnormality when a tumor forms. Dr. Chen Zhenrui pointed out that as the tumor grows, the common symptoms, including flatulence, poor appetite, weight loss or ascites, are usually in the stomach and intestines. I went to the gastroenterology department in time and was transferred to the obstetrics and gynecology department before being diagnosed with cancer.
A small number of ovarian cancer patients may be manifested by vaginal bleeding. Dr. Chen Zhenrui said that postmenopausal bleeding is generally related to endometrial cancer and cervical cancer. However, in a small number of ovarian cancer patients, the tumor invades the fallopian tubes or uterus, causing vaginal bleeding. .
“Ovarian cancer can grow to be quite large, reaching more than 15-20 cm. When the patient is lying down, he can feel an abnormal lump in the stomach.” Dr. Chen Zhenrui said: “In addition, the cancer cells may pass through the middle of the navel. Patients with severe ovarian cancer can even develop lumps in their navels.”
Multiple treatments to fight ovarian cancer
As long as the physical condition permits, most patients with ovarian cancer are recommended to undergo surgery. According to Dr. Chen Zhenrui, surgery has two advantages. The first is that it can obtain enough tissue for pathological examination. part of ovarian cancer. According to Taiwan’s statistics, more than 50% of the patients belong to the third stage ovarian cancer, that is, there is diffuse cancer cell metastasis on the surface of the intestinal wall and peritoneum. Strong drug resistance, poor prognosis. In addition to surgery, 80 to 90 percent of ovarian cancer patients receive chemotherapy.
With the development of medicine, the treatment of ovarian cancer is gradually moving towards personalized precision medicine. Through genetic testing, it can help patients find suitable drugs. Dr. Chen Zhenrui said that in 2015, three scientists won the Nobel Prize in Chemistry for their discovery of the DNA repair mechanism of cells.
Homologous recombination repair genes are important genes involved in DNA repair in the human body and can help maintain normal and stable cell growth. The abnormality or instability of the gene body leads to an increase in the risk of cancer.
Among them, the homology repair mechanism is most related to BRCA-1, BRCA-2, and PARP. Dr. Chen Zhenrui explained that somatic cells have a double helix repair mechanism, and cancer cells also have a double helix repair mechanism, so we can use drugs that interfere with the repair mechanism of cancer cells to make cancer cells die. Knowing the genetic mutation of cancer cells can help to judge the patient’s response to drugs. Dr. Chen Zhenrui said that according to the current treatment guidelines, it is recommended that some patients with epithelial ovarian cancer should consider genetic testing after surgery.
PARP inhibitor-targeted drugs help prolong survival
Dr. Chen Zhenrui said: “After the patient receives chemotherapy, the cancer cells will be damaged, resulting in DNA breaks. At this time, the repair mechanism in the cancer cells will be activated, and PARP is a repair factor for single-stranded DNA breaks.” If PARP can be inhibited , some cancer cells can not repair the damaged DNA, it can not continue to divide, and gradually die.
“The two most important factors in the double-stranded DNA repair mechanism, one is BRCA-1 and the other is BRCA-2, and PARP is an important factor in repairing single-stranded DNA breaks.” Dr. Chen Zhenrui explained: “When patients have When BRCA is mutated, it means that the body’s ability to repair double-stranded DNA damage is defective. If drugs are used to inhibit PARP, which is responsible for repairing single-stranded DNA breaks, it will increase the chance of DNA double-stranded DNA breaks. Apoptosis by repairing DNA damage.”
According to clinical studies, about 20% of epithelial ovarian cancer patients have BRCA-1 or BRCA-2 gene mutations, and PARP inhibitors have a significant effect on such patients, and studies have also shown that about half of epithelial ovarian cancer patients have homologous recombination repair. Deletion status (HRD), understanding gene mutation status can help to formulate maintenance therapy after chemotherapy. Dr. Chen Zhenrui said: “At present, health insurance has provided some targeted drugs for advanced ovarian cancer as maintenance therapy to help delay the recurrence of the disease.”
Intimate reminder
Ovarian cancer is a kind of cancer that is not easy to detect. More than 50% of patients are diagnosed with ovarian cancer in the middle and late stages. Dr. Chen Zhenrui said that as long as the physical condition permits, it is recommended to undergo surgery to remove the tumor as much as possible. Systemic therapy such as therapy and targeted therapy.
Through personalized precision medicine, the treatment effect of ovarian cancer has been significantly improved. It can be combined with genetic testing to understand the status of one’s own gene mutation, and follow-up with targeted drugs as maintenance therapy to prolong survival!
