Disability and Progress-April 30, 2026-Ovarian Cancer

[00:00:01] Speaker A: KPI.dotorg. [00:00:32] Speaker B: It. This is KFAI 90.3 FM, Minneapolis. And KFAI.org you're listening to Disability and Progress, where we bring you insights into ideas about and discussions on disability topics. I'm Sam Jasmin, the host and producer of this show. Charlene Dahl is my PR research person. She'll be in shortly. We're speaking this Week with Dr. Melissa Geller. Dr. Geller is speaking to us in regards to to ovarian cancer. Dr. Geller, thank you so much for joining me on this show. [00:01:31] Speaker A: Thank you so much for having me. [00:01:34] Speaker B: I want to start out by just getting a brief history about you. Tell me a little about you and really what your job entails now. [00:01:44] Speaker A: Sure. So I am a gynecological oncologist and treating patients and doing research at the University of Minnesota. I've been there since really on faculty since 2005. And I primarily treat patients with recurrent ovarian cancer, advanced stage diseases like endometrial cancer and vulvar cancer primarily. But my main focus has been developing new treatments, especially new immune based therapies for patients with recurrent ovarian cancers. We use something called natural killer cells or NK cel. They are the first line of defense. If you get a sliver in your finger or get an infection, they go to that area and really try to attack the bacteria or the viruses that are there. And so that's where we're trying to better recognize how these cells can destroy cancer. Excellent. [00:02:47] Speaker B: So you get to play in research quite a bit. [00:02:51] Speaker A: I do, I do. I've been very lucky to be able to do both treat patients and also do research at the same time. [00:02:58] Speaker B: Excellent. So we'll get to all those good things in research. I want to start out just by having you give us a layperson's idea on exactly what is ovarian cancer. [00:03:11] Speaker A: Sure. So ovarian cancer is really a kind of a group of cancers that arise, we now think actually from the end of the fallopian tube. And so what we, we now, you know, we are in years ago thought that ovarian cancer actually arose from the ovaries themselves. But we're now getting more data that says the cells, the abnormal cells arise from the fallopian tube and actually land on the ovary, on the outside of the ovary, and ultimately spread throughout the abdomen and pelvis. And so this disease is really characterized by uncontrolled cell growth and unfortunately spreads from the pelvis to the upper abdomen quite readily. And that's part of the problem is the majority of these patients that we see with newly diagnosed ovarian cancer have advanced stage disease because of the way that those cells drop throughout the, the abdomen and pelvis. [00:04:07] Speaker B: How common is ovarian cancer in the [00:04:10] Speaker A: US So last year it was estimated that about over just over 20,000 patients will be diagnosed with, with ovarian cancer. And unfortunately over 12,000 of those women or those patients will die from the disease states. And it's one of these cases that it's about the 11th most common cancer that we see among women. But ovarian cancer is the fifth leading cause of cancer related death. So unfortunately, quite a high mortality rate for this type of cancer and is the deadliest disease that I treat of all gynecological cancers. [00:04:53] Speaker B: Yeah, I think when I was doing some research, it's called the silent disease. [00:04:58] Speaker A: That's what it has been called. So silent, you know, it's, it's been called silence, but it's a little bit misleading I think, because there's been a lot of research that's done and that, that symptoms do occur. Unfortunately for women, they're really subtle. And you know, how many women in, you know, perimenopause menopausal age range, which is the most common age for this cancer to be diagnosed at, at about, if you look at that median age of diagnosis, it says 63. So how many women in that age range don't have a little bit of bloating, change in their bowel habits, their bladder habits? You know, it's very common. But what we're seeing, and based on the data that we, that we have in this disease that really has, you know, these symptoms, when they start occurring can be anywhere from six months to a year prior. Women can experience that bloating, the pelvic or abdominal pain, difficulty eating, as well as this urinary frequency or urgency. And so the challenge is that these symptoms are common and often attributed to less serious conditions, so can really delay the diagnosis. [00:06:10] Speaker B: Are there different types of ovarian cancer? [00:06:13] Speaker A: Yes, and that's really important and key to remember is that they all behave a little bit differently. So the most common type of ovarian cancer is what we call epithelial ovarian cancer. And there's one particular type called high grade serous carcinoma. And unfortunately, this is the most aggressive form of tumors that we see. There are also rarer types like things called germ cell tumors, which can occur in younger women as well as these stromal types of tumors that arise from the hormonal producing cells within the ovary. And so each of these has a little bit of a different biology and a different, slightly different treatment approach. But the most common type that we see is this epithelial ovarian cancer. And these are the ones that that higher mortality rate that we see in ovarian cancer. [00:07:07] Speaker B: So talk a little bit about age risk. What's the biggest or the age groups that this happens in? And I'm sure it's a wider variety. There's probably one that, you know an age risk that it generally happens in. But what do you see and has it changed throughout the years? [00:07:28] Speaker A: Yes, if you look at the ovarian cancer rates are highest in women between the age of 55 and 64 years of age. It's in that prime time of a woman's life or a patient's life, with the median age, as I mentioned before, about 63. The median age of death from this disease is around 70. If you look at that age range, that's the highest percentage of new cases we see within that period of time. Really, we haven't seen that move much. You know, sometimes we see it a little bit, you know, depending on the type. Like I mentioned, that germ cell tumor we can see in younger women up into their, you know, their late teens or, you know, and even younger. But those are specialized types of the cancers, ovarian cancers that are less prevalent. [00:08:20] Speaker B: Dr. Geller, I want to ask about, are there risk factors and what are the biggest ones that happen? [00:08:30] Speaker A: Yes. So what we know, and again, we learn more and more as we study this disease, is really the biggest risk factor is, number one is increasing age, as we discussed a little bit before, and an inherited genetic mutation. And what we're finding out is that there can be other factors, like if you look at personal or family history of both breast and ovarian cancer that are really critical, patients that are at a little bit higher risk if they've never been pregnant or have a history of endometriosis, which is linked to certain subtypes of ovarian cancer, and really essentially anything that increases a lifetime of ovulation. So having, you know, periods at an earlier age and going longer before menopause really slightly increases that risk. But really, the number one important thing is a family history of breast or ovarian cancer. So we now look at patients, anybody who's diagnosed with ovarian cancer, we recommend genetic counseling for those people because then they go through the entire pedigree of their family. They look at, you know, has anybody had breast cancer or ovarian cancer. But what's more important now is we're finding that there are mutations that patients with ovarian cancer have that are not the BRCA mutations or that BRCA 1 and 2, but other different types of mutations that put them at higher risk for developing ovarian cancer. And that's what genetic testing is so important for, is to test for those. [00:10:09] Speaker B: I'm going to stop you there a minute because I want to ask. So it sounds like ovarian cancer can be linked as a higher risk if you've had breast cancer. Correct? [00:10:20] Speaker A: Correct. [00:10:22] Speaker B: But what's the deal with idea that if you have never been pregnant, you have a slightly higher risk? What is that? How does that raise your risk? [00:10:35] Speaker A: We think it has something to do with the ovulation rates and how often those patients are ovulating. We also know that what can be protective is birth control pills, and that's especially the oral contraceptives that can protect a patient. And we often will recommend younger women who we find out, have a breast and ovarian cancer gene mutation patient by putting them on oral contraceptives that may protect them and decrease their risk for developing ovarian cancer. So oftentimes, we will recommend those patients go on oral contraceptive pills to decrease that ovulation, that continuous ovulation where there's repair of that ovary when the egg releases. [00:11:24] Speaker B: So are you saying that the BRCA 1 and 2 are not linked to ovarian cancer? [00:11:33] Speaker A: No, they are. So if you look at the majority of ovarian cancers occur in women after menopause, as we mentioned before. But there are about 15% of patients who carry this BRC1 or 2 mutation, often Ashkenazi, Jewish heritage. They're at a higher risk. So 1 in 40 for carrying these mutations. They can develop ovarian cancer at younger ages, sometimes in their 40s. And so these are the ones? Yes, yes. And so these are the ones that are at higher risk for developing both breast and ovarian cancer. [00:12:10] Speaker B: And with those with that genetic component there, what's the percentage? Did you say a percentage that, like, if they're that young, how much higher is their percentage? [00:12:24] Speaker A: So if they carry the mutation, the BRCA1 or 2 mutation, their lifetime risk is about 40 to 60%. If it's BRCA1 for developing ovarian cancer, BRCA2 mutations carry a little less, so about 10 to 25% risk. And so what's really critical about finding out if you carry one of these genes or these higher Risk genes is that they have important treatment implications, and really, you can do something about it. Now. We actually have a study that's open at the University of Minnesota called the SOROC trial. And this is really looking at can we remove the fallopian tubes in women who have a BRCA1 mutation and decrease or reduce their risk of developing ovarian cancer? And so we're trying to see if prophylactic or preemptively removing their fallopian tubes. If they're done having children at an earlier age and allowing them to keep their ovaries so they still have their hormones, which is so important for women for multiple reasons, can we decrease that risk of ovarian cancer in that population? [00:13:41] Speaker B: So we'll maybe dive in a little more about that later. But I want to ask about the BRCA1 and BRCA2. Is there a difference with those two? Obviously, there must be. Can you explain the difference a little bit? [00:13:56] Speaker A: Sure. So these genes are responsible basically for repairing damaged DNA. And so when they're working properly, they can help prevent cancer. But when they're mutated or they're not working anymore, then DNA damage can accumulate, and that's when it leads to cancer development. Women who have these BRC1 or 2 mutations, they're not able to repair the DNA, and this ultimately leads to cell growth that we see in ovarian cancer. They're just two different genes on two different chromosomes, but they do the same thing. It's just that the BRCA1 mutation has a higher lifetime risk of developing ovarian cancer versus the BRCA2 mutation. [00:14:46] Speaker B: So can a person have both BRCA1 and BRCA2 or is it usually one or the other? [00:14:53] Speaker A: It's usually one or the other. I don't know that I've ever seen somebody who's had both. So it's usually one or the other. [00:15:00] Speaker B: And why is the BRCA one a higher chance of ovarian cancer? [00:15:06] Speaker A: The predisposition and where it acts on within the chromosomes is what puts patients at higher risk. And again, that risk is both for breast and ovarian cancer. So oftentimes, patients who have BRCA mutations. Mutations, unknown mutation, you know, if they're done childbearing, we recommend removal of both their fallopian tubes and ovaries to decrease that risk. And oftentimes these patients will choose to have a prophylactic removal of their breasts. So a mastectomy just to prevent that from occurring. [00:15:43] Speaker B: That's pretty severe. [00:15:45] Speaker A: Yeah, I mean, I think with knowledge, you know, is power and People are able to make these decisions as to how to best manage, you know, and decrease their risk. And you know, I don't know if Angelina Jolie was one, an example of this years ago where she was found to have a BRCA1 mutation. Her mother passed away from ovarian cancer. She knew she had the gene and then proceeded with those surgeries to protect her. [00:16:21] Speaker B: And if one. So let's go back to testing a little bit. If one's going to have genetic testing, does insurance pay for that? [00:16:31] Speaker A: Yes, most insurance companies will pay for this, this testing. And so genetic testing is now really a key part of care for, for women who are diagnosed with ovarian cancer. And it is recommended that all women diagnosed with an ovarian cancer undergo testing regardless of their age or their. And these are recommendations that come from our American College of Obstetrics and Gynecology and other societies. And if patients who don't have cancer but have a strong family history of ovarian, breast or pancreatic or prostate cancer, it also is recommended they be seen by a genetic counselor to help really look at the results of their testing and to guide next steps. These are, these are really critical and is helping to identify patients who may develop ovarian or breast cancer in the future. [00:17:32] Speaker B: All right, so I get it. Once you're diagnosed, you can go through this testing, but what about before you're diagnosed? So it sounds like if you have a family history that you should get diagnosed, that you get genetic testing. If you've had breast cancer, you probably should get genetic testing. Am I correct so far? [00:17:54] Speaker A: It depends really on the age. If you have a history of breast, a young at less than 50 and have breast cancer, usually genetic counseling is recommended for those patients to look at because the younger the development of these types of cancer could say or could suggest that there's a hereditary component to it. [00:18:16] Speaker B: Okay, so then is there anything else that would qualify you for genetic testing before you were diagnosed? Because once it's kind of like the horse has already left the barn. Right? Duh. Yeah, of course you should have genetic testing when that's happened. But it's happened. What could you, you know what I mean? Like maybe you could have had this before and, and saved yourself, I don't know, trouble and maybe live right. [00:18:50] Speaker A: I think really what's important is the degree of relation matters for. So a first degree relative, like a parent, a sibling or a child who has developed these types of cancers really is important. So a first degree relative with an ovarian, a fallopian tube or what we call a primary peritoneal cancer. Those are all related, we call them, we treat them like ovarian cancer. But those are important factors. If there's somebody with an ovarian, a fallopian tube, or primary peritoneal cancer in the first degree, that is enough to recommend testing because they can be linked to those inherited mutations like the BRCA1 or BRCA2 gene for breast cancer. What's really critical is a breast cancer diagnosed before the age of 50 should start triggering that. Or anybody in the family with a history of multiple relatives with breast cancer or somebody who's developed breast cancer, if they're male, in a man that is highly suggestive of hereditary risk. I think it's those patterns that we look at. Clusters of family members who have had ovarian or breast or even pancreatic or prostate cancer. You know, this constellation often points towards a hereditary syndrome involving those genes like BRCA1 or 2. [00:20:20] Speaker B: Are there lifestyle factors that increase or can decrease risk? [00:20:25] Speaker A: You know, so, you know, recommending, really the number one thing, as we mentioned, is the family history and lifestyle. You know, like unlike some cancers, really, we don't think that ovarian cancer has strong lifestyle driven risk factors. I kind of mentioned before the protective factors like having had a pregnancy, breastfeeding for a longer period of time, longer use of oral contraceptives, you know, and again, those are types of things that we think, you know, may be or have been found to be protective against this disease. But really there's not one, you know, lifestyle factor that really has influenced, except for the ones that I just mentioned, in contributing to this development of cancer. [00:21:20] Speaker B: So in birth control, in regards to that, with taking birth control pills, is it the longer time you use it increases risk or being on at all? Because it sounds like some amount could be a protectant, but too long is not. [00:21:38] Speaker A: Well, so from what we know that, you know, using oral contraceptives is one of the strongest protective factors that we know for this disease. And again, we attribute this to that repair mechanism of the ovary and that constant ovulation. So what is known is that women who have used oral contraceptives for five or more years really can reduce their risk of developing ovarian cancer by about 30 to 50%. And that this protection increases with longer use and can persist, we believe, based on literature, for decades after stopping. And so that's why we really recommend to patients who have that higher risk gene, the BRCA1 or 2 mutation, that using these oral contraceptives may decrease their risk or be protective for them. But I think the other important thing is prophylactic removal of the fallopian tubes and ovaries. The recommendation now and by our societies is that if a woman is undergoing a surgery for a different reason or after they're done giving birth and they want to have their, so called, their, their fallopian tubes, their tubes tied, that the fallopian tubes actually be removed. And yeah, and so this has been the recommendation is that if you undergoing an appendectomy or other type of surgery and they happen to be in there and you're done having children, that those fallopian tubes be removed at the time of those surgery. And that statistic is really, we hope, will decrease that risk of ovarian cancer over time. [00:23:19] Speaker B: So if you're removing the fallopian tubes, what might the side effects be [00:23:29] Speaker A: really? You know, so based on the data that we have right now, the current recommendations for these fallopian tube removal, or what we call a salpingectomy, it's really kind of an opportunistic salpingectomy. And we, based on this, there's minimal added surgical risk. It does not induce menopause. The ovaries are left in place. So those are not, not removed. The data is still evolving about how much we can reduce ovarian cancer risk by. And so based on this, in the studies that are ongoing, it does produce permanent sterilization. So obviously you can't have a child after your fallopian tubes are removed, but really the risks are very minimal at doing it the time of another surgery. [00:24:23] Speaker B: Yeah. This is KFAI 90.3 FM, Minneapolis, and KFAI.org you're listening to Disability and Progress. I'm Sam Jasmin. We're speaking with Dr. Geller in regards to ovarian cancer. Dr. Geller, I was wondering, most of the time a. Well, a female should be coming in for a yearly Pap smear or whatever. Their doctor is suggesting how often they should come in for a Pap. Does doing a Pap catch ovarian cancer or any cancers that would lead to ovarian cancer? [00:25:05] Speaker A: Well, right now, based on the data that we have, Pap smears are really screening for cervix cancer. And sometimes Pap smears can pick up adenocarcinomas of the ovaries. So they at times can be shed through that, through the floating tubes, through the uterus and into the cervix. And that can be picked up on a Pap smear. But that's really rare. And so cervix cancers are what we are screening for, primarily in pap smears. [00:25:40] Speaker B: So if you're going to screen for ovarian cancer, what would be the test that you would give that would tell you that a person has it? [00:25:54] Speaker A: This is the tough one about this disease, is there is no good screening test for ovarian cancer. Multiple researchers across the country continue to look for a screening test, and unfortunately, we have not identified one that is sensitive enough or specific enough to identify ovarian cancer at an earlier stage. So, meaning when it's still confined to the ovaries and hasn't spread by the [00:26:23] Speaker B: time you do catch it, it's spread [00:26:26] Speaker A: outside the ovaries the majority of time. When we see patients in my clinic, about 75 to 80% of the time, the tumor has already spread to the upper abdomen. So it's at least what we call a stage three or even a stage four, because those tumors have migrated. Because, again, that goes back to kind of that silent. The silent killer that we discussed before, because we're not identifying these symptoms earlier enough, and there is no screening test. And lacking a test that is both, like I said, sensitive, so it's able to find the disease early and specific, meaning that it's avoiding false positives so that we're not identifying other diseases. This is the problem with this disease. We just do not have a screening test yet. There's a blood test called a CA125, and this is a tumor marker that. That measures a protein that can be elevated in patients with ovarian cancer. This is a blood test. The problem is it can be elevated in multiple other benign conditions. Like, it can be up in women who have fibroids or endometriosis, or even if a patient is having their period, it can be elevated for those reasons. And sometimes, you know, about 50% of the time, the CA125 is not elevated even in patients who have ovarian cancer if it's confined to just the ovaries itself. So stage one. So this is what's difficult in this disease. The other tool we have to use in this is a transvaginal ultrasound. And so ultrasounds can look for ovarian masses, but oftentimes it's after a woman comes and says, I have bloating or I have pain, and then we do an ultrasound, and we can look and see what those ovaries look like, but it's difficult. It can detect cysts, but it can't reliably distinguish a Benign or mass from a cancerous mass or a malignant mass. [00:28:48] Speaker B: So when you talk about bloating, it's bloating constantly, not just after you eat. [00:28:54] Speaker A: Exactly. It's usually, you know, this is what we see is that in patients who have symptoms, oftentimes they're ones that have lasted two weeks or more. You know, so they're ongoing. It's just, it's not intermittent. It's. It's. It's continuous. So I always tell patients, you know, if. If you're having bloating that's going on for more than two weeks or having, you know, changing your bowel habits or bladder habits that lasts more than two weeks, that needs to be investigated. [00:29:24] Speaker B: And the bladder habits would be just constant peeing. [00:29:28] Speaker A: Oh, yeah. Oftentimes urinary, like, urgency, having to go more frequently. Because oftentimes what can happen is these, these masses can sit on the bladder and cause people to have to go more frequently or sometimes can't go. But I think, you know, symptoms that are new or persistent and frequent, meaning more than two to three weeks of duration. This really requires evaluation and to be seen and to tell your physician or your advanced practice provider, you know, what you've been experiencing. [00:30:01] Speaker B: Okay, so, but the problem is, is that the bladder frequency, that can be a lot of other things too, right? [00:30:09] Speaker A: Exactly. [00:30:10] Speaker B: Old bladder, have too many kids bladder. [00:30:13] Speaker A: Right, Right. [00:30:15] Speaker B: So then what happens? You go in and say, hey, I'm peeing all the time, and what do I do? And. And there's stuff that they give you to do. You might go to some kind of physical therapy of such, or pelvic floor therapy, or you might have exercises they give you and it doesn't work. What do you do then? What if you suspect. But as you said, there's no clear thing, but you've had breast cancer, maybe. So then you're worried. You know, it's like, oh, it could be. What do you do? [00:30:52] Speaker A: And I think this is what's so critical is. And why we work so hard and we work with our, you know, our colleagues at Minnesota Ovarian Cancer alliance or MOCA and the Twin Cities to really get the word out about these symptoms and how important they are. And since screening isn't effective, we have to know the symptoms, right? The bloating, the pelvic or abdominal pain, the early satiety, meaning, you know, you eat and you get full right away, these urgency symptoms, you know, that's what we need to educate our. Our colleagues on in family practice and in the internal medicine to Start recognizing these and say, you know what, I'm going to get an ultrasound or I'm going to get a CT scan of the abdomen and pelvis to look to make sure there isn't something going on, that it's not just a urinary tract infection or other causes of these symptoms. So I think being persistent as a patient and an advocate for yourself is really critical in looking for these. And again, not every. If you look at the number of diseases, ovarian cancer is relatively rare. Right. Compared to breast cancer and some of the other diseases, colon cancer that we're seeing. But it deserves a weight. Work up if those are the symptoms that patients are having. [00:32:11] Speaker B: Especially I feel like if you have had some genetic testing done and you have some of those early genetic markers, or if you've had breast cancer, if somebody has just had breast cancer, theoretically. Now the idea is that they do get some kind of genetic testing done. Is that what you're seeing happening now? [00:32:34] Speaker A: Yeah. You know, if they're diagnosed at a younger age and they have a family history, yes. Most patients are getting, you know, if they're less than 50 and developing of breast cancer. And oftentimes it can be dependent on the type of breast cancer that they, that they, that they have. But, you know, again, physicians are, you know, may refer those patients to genetic counseling just based on history and having had a breast cancer. [00:33:06] Speaker B: You started talking a little bit about the study and the new screening tools. Talk a little bit more about that. [00:33:15] Speaker A: Yes. Again, the study that we have ongoing here at the University of Minnesota, as well as this study, is open nationally. It's called so Rock. And basically what this does is it's [00:33:28] Speaker B: a [00:33:31] Speaker A: decision that's made between the gynecological oncologist or the patient's surgeon to compare this removal of the fallopian tubes to reduce the risk of developing ovarian cancer just in BRCA1 carriers. And what the goal is of this trial is to see whether or not we can decrease that risk and still allow these women, you know, who are between the age of 35 and 45 to retain their ovaries. We know more and more data is coming out on the protective effects of hormones that come from the ovaries. So we want to allow these women to hang on to their ovaries for as long as they possibly can or at least up to at least age, you know, 45 in this population. Population. So this trial allows the patient and the provider to have a discussion about the risks and benefits of doing this. And this is A trial that they consent to. To either have their fallopian tubes out right then or to really screen and to keep their ovaries intact, you know, versus taking out fallopian tubes and ovaries. So either you take out the tubes alone or you screen with pelvic ultrasounds and CA125 levels. So I want to stay a little [00:34:50] Speaker B: bit more on this study. It's happening at the U and around nationwide. You said. [00:34:59] Speaker A: Yes. [00:35:00] Speaker B: And how. Right now the idea. Let's talk about the qualifiers to get into the study. So they're looking for people between. And you said 35. 45. [00:35:12] Speaker A: Well, really 35 to 50 who have an inherited BRCA1 mutation. And so what the study is going to determine or to look at is if just removing the fallopian tubes is enough to decrease that risk of ovarian cancer. And so we want to make sure that it's as effective as removing both the fallopian tubes and the ovaries. So, you know, really, we want to do this in patients to examine what factors go into deciding, you know, which surgery to have and the symptoms after the surgery that are caused by a lack of estrogen due to removal of the ovary. And so really, we think, you know, the standard of care is. Is the standard of care for women who with BRCA1 mutation is to remove both the fallopian tubes and the ovaries. What we're trying to do in this trial is to. Is to allow women to hang onto their ovaries longer, and they may, you know, there may be some benefit to them in terms of their bones as well as, you know, cardiac, to help with their heart. And, and so by just removing the fallopian tubes, they'll be able to hold onto their ovaries and still undergo the best screening we have right now, which is not perfect like we talked about before, the transvaginal ultrasounds and the CA125. [00:36:45] Speaker B: So why just the BRCA1 and not the 2? [00:36:50] Speaker A: Yeah, this trial is just focusing on that BRCA1 mutation population because they're at the highest risk of developing ovarian cancer, whereas the. In the BRCA2, it's a lot. It's a lower risk in that population. So this really is going to look at how individuals, their quality of life, basically, if they just, you know, in comparison to those who have their ovaries removed at 35, is the quality of life better if we can just remove the fallopian tubes and allow them to hold onto their ovaries for a Longer period of time. [00:37:28] Speaker B: All right, how do people get into this study? Or can they still. [00:37:33] Speaker A: Yes, they still can. So this is a trial that's being run through the, what's called the NRG Oncology. And we have it open at the University of Minnesota. And so if patients are, you know, have that BRCA1 mutation, they can go to our website for the University of Minnesota Department of Obgyn and look on there under research. And so it's, it's Med umn. Edu OBGYN Research. And they'll be able to look under there under Gynecological Oncology studies. And that trial is listed and so they are able to get information on who to contact for those studies. [00:38:21] Speaker B: Could you give that website one more time? [00:38:24] Speaker A: Sure. It's Med. Umn. Edu OBGYN Research and it'll list all of the research that is being done under the Department of OBGYN in Gynecological Oncology. [00:38:48] Speaker B: So I want to step back for a minute to talk about how, depending on the stage, That could let you know what your prognosis might be. Is that correct? Depending on the stage that it's caught. Can you talk a little bit about the staging and how, how the prognosis of how you, how you live with this can be. [00:39:23] Speaker A: Sure. So as I mentioned, and again, the statistics are hard, right? And because everybody's different and I tell my patients this, that, you know, statistics are what we read about, but every patient is, is an individual. So when we look at this, if you look at the 5 year overall survival or relative survival of patients who are diagnosed with ovarian cancer, so that's all comers, stage one through stage four, five year survival is about 51%. So that means, you know, unfortunately, that's rough. Yeah, exactly. Five year over. Also about 50% of those patients will, will not make it to five years. But if you look at the advanced stage disease, so stage three, stage four patients, their five year overall survival is, you know, anywhere, you know, less than 20 to 30%. And that's what's tough. And these are the advanced, you know, the ones that have disease that has spread to the upper abdomen and has had moved out of the pelvis. And as I mentioned before, those are the majority of the patients we see when you look at stage. The only way we really know a patient's stage of their disease is to undergo surgery. So as a gynecological oncologist, we do both surgery and we treat with chemotherapy. I think the good news is we just returned from our Society of Gynecological Oncology meetings and there's so much new data and so many new clinical trials looking at new drugs for patients with recurrent ovarian cancer. Because the problem with this disease is we can treat it with surgery, we can treat it with chemotherapy in the front setting and we can make that tumor go away. Problem is is the majority of those patients are going to recur from their disease. And when it recurs, this, this tumor cannot be cured. And so we treat it more as a chronic disease and one that patients oftentimes are on chemo or off chemo for the rest of their lives. And based on stage. And as I mentioned, when patients no longer respond to the chemotherapy, that's when we have no further treatment. But there are more and more treatments coming out. Our five year overall survival has improved over time. If you, you look at that and you know, so I have a lot to be hopeful about in this disease. [00:42:02] Speaker B: And I mean it sounds like if you catch it earlier, it's almost an accident, right? You're doing something else for whatever purpose and there's some other idea things that are going on and you oops, you catch it. [00:42:17] Speaker A: And [00:42:19] Speaker B: what about immunotherapy? You hear so much promise with that. Why isn't that effective with this? [00:42:28] Speaker A: Yeah, so that is a really good question. And so unfortunately in this cancer we've done multiple clinical trials with immune based therapies and we have not seen the responses that we've previously seen in other diseases like, like melanoma or kidney cancer. But I will say we just heard data from a new trial called the, it's called the Keynote B96 trial. And this is, was a phase three trial, meaning patients were randomized to two different arms, both of which had treatment. And one of those arms contained an immunotherapy drug in combination with two other types of drugs. And for the first time we've seen a good response rate. So really in those patients who had a marker for an immune drug, it's called PD L1, so this is basically a marker that was upregulated on a tumor cell. In this population, they saw improvement in both progression free survival as well as an overall survival. And so this was really an exciting new trial that's come out showing for the first time a combination therapy in recurrent ovarian cancer that is shown improvement in survival. [00:43:55] Speaker B: So is that treatment or is that given to people now that maybe are having the reoccurrence that. [00:44:05] Speaker A: Yes. So this is just, this data is just kind of Hot off the press. And so patients will, it's in a specific type of platinum, what we call platinum resistant ovarian cancer, meaning that they no longer are responding to our basic drugs called carboplatin and paclitaxel, that they recur within six months of having had those. And so this is really, this is a new opportunity, opportunity for patients to undergo treatment with this, this immune based therapy that, that is going to, you know, hopefully improve our, the amount of time patients can stay, you know, have another recurrence. [00:44:48] Speaker B: Dr. Geller, this was a, this was a fascinating conversation but also a very delicate one. So thank you so much for your time. I wonder if you have any other comments you'd like to leave me with. [00:45:00] Speaker A: You know, the only thing I would say is that, you know, if you have members of your audience diagnosed with ovarian cancer or, you know, may have those symptoms, you know, stay persistent and you know, you be your own best advocate because I think that's really what's critical for women as well as all patients with, you know, who are not feeling well and who go into their physician and you know, be persistent. And I think the, the other important thing is finding referral center that treats a lot of patients because that's also really important. And gynecological oncologists, as I am, we're specially trained in OB GYN and then go further on three to five years of specialized education to become gynecological oncologists. And I think that's critical for treating women who are diagnosed with this disease or patients who are diagnosed with this disease. [00:45:58] Speaker B: And I want to just leave too by putting in my own thought as I have some experience with going in and having difficult things. You can't say enough about bringing someone you trust with you to be your advocate because when you're hearing difficult news, your brain goes to various places and having someone who's as safe, steadfast person who can kind of think things through is just helps immeasurably. So I think that's important too to leave people with, to if you can find somebody who you trust to be, to come with you to hear things. It never hurts to have a second pair of ears. [00:46:45] Speaker A: 100%. Yeah. And you know, it's a lot of information. It comes at patients very quickly. And so to have somebody there to take notes or to just help to digest the information is I think really important for patients just to have that second set of ears, as you mentioned. [00:47:05] Speaker B: Dr. Geller, thank you so much for being on. I really appreciate it. [00:47:10] Speaker A: Of course. Thank you for having me. I enjoyed this interview. [00:47:16] Speaker B: Thank you. You've been listening to Disability and Progress. This is KFAI 90.3 FM, Minneapolis, and KFAI.org this is disability and Progress. The views expressed on this show are not necessarily those of KFAI or its board of directors. My name is Sam. I'm the producer of this show. Charlene Dahl is my PR research person. Aaron is my podcaster. If you want to be on my email list, you can email email me at Disability and Progress, all written [email protected] that's disability and progressamjasmine.com thank you so much for listening. Take care. [00:48:12] Speaker A: KPI.