Ovarian cancer is called the “silent killer of women” – it does not cause symptoms for a long time or they are of little concern. When the woman finally comes to a specialist, it turns out that the cancer is already advanced. From the beginning of 2022, Polish women have access to new drugs. Their use in gynecological oncology is a breakthrough – says prof. dr hab. n. med. Włodzimierz Sawicki, president of the Polish Society of Oncological Gynecology. The expert tells what the therapy looks like? It also explains the situation of patients with endometrial and cervical cancer.
president of the Polish Society of Oncological Gynecology, head of the Department and Clinic of Obstetrics, Women’s Diseases and Oncological Gynecology, Medical University of Warsaw, Mazowiecki Hospital in Bródno, Complex of Obstetrics and Gynecology Departments.
How has the pandemic affected the treatment of gynecological oncological diseases such as ovarian, endometrial and cervical cancer?
Prof. dr hab. n. med. Włodzimierz Sawicki: The pandemic has complicated the lives of doctors and patients as early diagnosis is of utmost importance for the success of cancer treatment. Meanwhile, some hospital wards had to give up their beds for covid patients. Fewer patients also reported to doctors. For this reason, the detection of neoplastic diseases was delayed, which in turn translated into worse results of their treatment, both in outpatient and inpatient care.
What are the latest developments in the treatment of ovarian and endometrial cancer?
From January 1, 2022, Polish patients have access to PARP inhibitors (niraparib) as a maintenance treatment in the first-line treatment of high-grade ovarian cancer. In this way, we achieve the European level. The use of these drugs in gynecological oncology is a breakthrough that has not happened for decades. To date, we have had no maintenance treatment with molecular drugs. We only had immunotherapy, i.e. treatment with monoclonal antibodies. The health benefit for the patients is obvious, it means longer time until disease relapse. Thanks to PARP inhibitors, ovarian cancer becomes a chronic disease that we can control to some extent.
The rest of the text is below the video.
Ovarian cancer is called the “silent killer”. Why?
Because it does not give symptoms for a long time or they are of little concern. And then the patients seek help on their own or from general practitioners. Only after some time they go to a specialist and then it turns out that the disease is already advanced. This necessitates the use of modern treatment and this is what PARP inhibitors provide us with. These are molecular drugs that target the DNA repair mechanisms behind which the neoplastic disease is. PARP inhibitors inhibit tumor growth, delaying its progression. Treatment is personalized. Knowing what genes are mutated, we can tailor treatment to a specific person.
See if you can get cancer. Make a package of oncology tests for women
And what is the situation of endometrial cancer patients in Poland?
It is said that it is a cancer of rich societies because it affects patients with hormonal disorders and overweight. We have a lot in Poland, over 6,5 thousand. illnesses annually. The good news is that endometrial cancer is usually diagnosed at an early stage because it has clear symptoms – bleeding. It most often affects postmenopausal women, and then any bleeding is disturbing and the patient quickly consults a doctor.
The diagnosis is quite simple – uterine biopsy and histopathological examination are enough. In over 60, up to 70 percent. patients are diagnosed with the first stage of their cancer. Unfortunately, some of them have types and varieties that are aggressive and cause quick relapses. Fortunately, the possibility of modern treatment appeared.
What is the treatment of advanced and recurrent endometrial cancers?
The possibility of fast and modern action is possible thanks to immunological treatment, as a result of which the body recognizes and destroys neoplastic cells. It is an antibody that blocks the programmed death receptor (PD-1). Such a drug has already been registered, but is not yet reimbursed in Poland (dostarlimab). It is available only in the form of the so-called emergency access to drug therapies (RDTL). Qualifying for such treatment is related, inter alia, to with the existence of appropriate gene mutations, which are determined on the basis of molecular tests.
How are these mutations identified?
Performs include immunohistochemical tests of the examined tissue. The absence of specific proteins that do not stain from this assay indicates that mutations exist within the genes (MMR / MSI) responsible for the production of these proteins. This method, to some extent, replaces the costly and difficult to obtain commonly available gene sequencing. The work is going in this direction so that histopathological laboratories can recognize more and more types of mutations. This applies not only to gynecological oncology, but also to neoplasms of other systems and organs.
How to protect yourself from getting cervical cancer?
A form of primary prevention is the HPV (human papillomavirus) vaccine. There are about 200 types of this virus, of which about 14 are the most dangerous. for cancer of the cervix, vagina, vulva, nasopharynx, larynx, etc. The vaccine does not contain the live virus, but a part of its protein envelope containing its DNA. We have several types of vaccines, and as of January 2022, one of them covers the two most dangerous types of the virus (16 and 18), accounting for 80% of vaccines. cervical cancer is reimbursed in 50 percent. Immunization protects almost 100%. before you develop cervical cancer, as well as before its recurrence.
Thanks to vaccinations and screening programs, the Scandinavians have almost eliminated the disease. In Poland, five to six women die every day because of it. That is why we are trying to include this vaccine in the calendar of compulsory vaccinations.
The Polish Society of Oncological Gynecology is also fighting for special treatment centers for women with ovarian cancer (Ovarian Cancer Units). Why?
Because there is a need to create three-stage (third stage – the most serious pathologies) ovarian cancer treatment centers with experienced staff and the best diagnostics. This tumor is specific and the trick is to qualify the patient for appropriate treatment.
The role of our society is also education in the field of prevention and making patients and doctors aware of the role of molecular tests, e.g. in ovarian and endometrial cancer. Diagnostics and wise treatment – this is what we need.
Can women from Ukraine receive gynecological care?
We do not have systemic solutions yet, but patients from Ukraine are already sent to our hospitals. Whenever we can, we welcome and heal every person in need. All drug programs available in our hospital treatment arsenal will also be available to these patients.
Will there be HPV vaccinations for refugees?
Everyone will have full rights to use all forms of medical assistance, and thus to diagnosis, treatment and prevention, as is the case with our country’s patients.
Thank you for the conversation.
Strong menstrual pain is not always “so beautiful” or a woman’s hypersensitivity. Endometriosis may be behind such a symptom. What is this disease and how is living with it? Listen to the podcast about endometriosis by Patrycja Furs – Endo-girl.