September is Ovarian Cancer Awareness Month. Ovarian cancer is the seventh most common type of malignant neoplasm in women and the eighth cause of mortality for women (Gaona-Luviano et al, 2020). In women who have died from gynecological cancers, ovarian cancer is the leading cause of death (Arora et al., 2021). This type of cancer can originate from any of the ovary's three main components, including the epithelium, stroma, and germinal cells. Per Gaona-Luviano et al., 2020, “epidemiology of this cancer shows differences between races and countries due to several factors including genetic and economic.” Detection of ovarian cancer is problematic because there is no standardized screening process and most cases of ovarian cancer are found in the advanced stages (Gaona-Luviano et al, 2020).

How is ovarian cancer diagnosed?
Sadly, the existing screening tests have a low predictive value. A gynecological evaluation, transvaginal ultrasound, and tumor marker testing (cancer antigen-125/CA-125 assay) can help with early detection strategies but this has not shown a significant effect on the morbidity or mortality of this cancer (Arora et al., 2021).

How is ovarian cancer treated medically?

Research shows that the standard line of care treatment includes surgery and platinum-based chemotherapy. Additional options including anti-angiogenic bevacizumab and Poly(ADP-ribose) polymerase (PARP) inhibitors have also been used more recently. (Arora et al., 2021)

What are the outcomes of an ovarian cancer diagnosis?
There is a high rate of recurrence after the initial detection treatment. Many of the cases re-occurred and these secondary cases were less curable with increased incidence of treatment failures (Arora et al., 2021).

What are ovarian cancer risk factors?
Some risk factors include advanced age, early menarche, late menopause, family history, nulliparity, obesity, perineal talc use, smoking, endometriosis, and hormone replacement therapy (Arora et al., 2021). Some protective factors include oral contraceptives, bilateral tubal ligation or salpingectomy, breastfeeding, and multiparity (Arora et al., 2021).

Some research shows there may be some health disparities in the diagnoses between Non-Hispanic Black women compared to Non-Hispanic White women. In a study by Washington et al. in 2023 53,367 women were included in the analysis with the profile being 82% Non-Hispanic White, 8.7% Non-Hispanic Black, 5.7% Hispanic, and 2.7% Non-Hispanic Asian/Pacific Islander. They found that the Non-Hispanic Black race was associated with a higher risk of death than Non-Hispanic White race and Non-Hispanic Black women versus Non-Hispanic White women had an increased risk of mortality among those with low and mid socioeconomic status groups.

In response to this potential inequity, the National Cancer Institute has launched 3 studies to look at these patterns to “better understand the causes of racial and ethnic disparities among women with ovarian cancer.” These studies will examine whether the treatments with these patient populations were consistent with standard clinical guidelines and ensure all patients received quality care. Additional studies will look at a “cells-to-society approach” to assess the biology behind these trends. In both cases, the researchers will assess a range of potential factors that can affect disparities, from the molecular makeup of tumors to environmental factors, and comorbidities (NCI, 2024).

What can pelvic health providers do to help?
As pelvic health providers, we can educate ourselves on how best to screen and refer our patients to ensure early diagnosis and medical treatment if we hear anything suspicious. It is difficult to self-advocate in this current medical climate and having a skilled provider guiding the questions to ask and the support to seek is invaluable. If a patient is already into their treatment journey, we can provide the needed rehabilitation support including things like coordination and strengthening of the core and pelvic floor, stretching and positioning to lengthen tight areas, scar mobilization, patient education, and symptom management with the patient for any symptoms that may pop up throughout their course of care.

If you’re unsure that you have these skills in your skill set, please check out the Oncology of the Pelvic Floor Series to gain more knowledge and experience in these areas to better help patients with these diagnoses. Certified Lymphatic Therapists may skip this course and move on to the level Oncology of the Pelvic Floor Level 2A and Level 2B courses.

• Oncology of the Pelvic Floor Level 1, next scheduled for November 2-3, 2024, is the first course in the series and focuses on topics that prepare practitioners to be part of the interdisciplinary oncology team. Topics will include the basics of cancer: terminology, staging, medical treatment, and the sequelae of these medical treatments. These topics include the lymphatic system as well as issues that are commonly seen in a patient who has been diagnosed with cancer such as cardiotoxicity, peripheral neuropathy, and radiation fibrosis.
• Oncology of the Pelvic Floor Level 2A, (not yet scheduled for 2025), builds on information presented in Oncology of the Pelvic Floor Level 1 and focuses on male pelvic cancers (prostate cancer, penile cancer, and testicular cancer), colorectal cancer, and anal cancer including risk factors, diagnosis, and prognosis. Topics discussed include sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life, rehabilitation, and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy. Participants MUST register with a partner, or plan to have a volunteer available to work on during course labs.
• Oncology of the Pelvic Floor Level 2B, next scheduled for December 7-8, 2024, builds on information presented in Oncology of the Pelvic Floor Level 1 and focuses on gynecological and bladder cancers including risk factors, diagnosis, and prognosis. Topics discussed include sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life, rehabilitation, and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy. Participants MUST register with a partner, or plan to have a volunteer available to work on during course labs.

References:

• Arora, T., Mullangi, S., & Lekkala, M. R. (2021). Ovarian cancer.
• Gaona-Luviano, P., Medina-Gaona, L. A., & Magaña-Pérez, K. (2020). Epidemiology of ovarian cancer. Chinese Clinical Oncology, 9(4), 47-47.
• NCI. Ovarian cancer studies aim to reduce racial disparities. Ovarian Cancer Studies Aim to Reduce Racial Disparities - NCI. (2024, June). https://www.cancer.gov/news-events/cancer-currents-blog/2020/ovarian-cancer-racial-disparities-studies#:~:text=Credit:%20iStock,impeded%20research%20in%20this%20area.
• Washington, C. J., Karanth, S. D., Wheeler, M., Aduse-Poku, L., Braithwaite, D., & Akinyemiju, T. F. (2024). Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy. Cancer Causes & Control, 35(3), 487-496.

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.