The Comprehensive Ovarian Cancer Program at UAB Medicine

Additional Info

• Audio File:uab/ua041.mp3
• Doctors:Huh, Warner
• Featured Speaker:Warner Huh, MD
• CME Series:Medical Innovations
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=1958
• Guest Bio:Warner Huh, MD is Professor and Director of the Division of Gynecologic Oncology, his areas of expertise include Gynecologic oncology, cancer vaccine, robotic surgery for gyn/onc, ovarian cancer, endometrial cancer.
  
  Learn more about Warner Huh, MD 
  
  Dr. Huh has the following financial relationships with commercial interests:
  
  Merck - Consulting Fee
  
  Dr. Huh does not intend to discuss the off-label use of a product. No other speakers, planners or content reviewers have any relevant financial relationships to disclose.
  
  There is no commercial support for this activity.
• Transcription:Melanie Cole (Host): The mission of the UAB Medicine comprehensive ovarian cancer program is to improve the lives of women affected by or at risk for ovarian cancer. My guest today is, Dr. Warner Huh, he’s the division director in the division of gynecologic oncology, in the department of OBGYN at UAB Medicine. Welcome to the show, Dr. Huh, tell us a little bit about the UAB comprehensive ovarian cancer program, and how did this come about?
  
  Dr. Warner Huh (Guest): Well, first off, thank you for having me. So, the genesis of the program was based around our realization and understanding that ovarian cancer patients really require multiple resources well beyond just surgery and chemotherapy, but what they really need is really sort of a comprehensive package of care that focuses on multiple aspects that are relevant to their treatment and also on their quality of life.
  
  And I’ll give you an example, some of that might be access to experts that are counselling and testing about 15% are women with ovarian cancer, have a hereditary or high-risk component, and so, it’s important for them to understand whether or not they have a specific gene that may related to their ovarian cancer. That’s important because of novel drug therapy that’s currently available for these women, but not only that, it might affect their future risk of breast cancer, and also, it might affect the future risk of their families. That’s one component. Other components include things like nutritional counselling, expert support of care, counselling, access to alternative therapies, access to clinical trials, but what we essentially have learned is that there needs to be sort of this programmatic approach to caring for these women, well past just basically providing surgery and chemotherapy.
  
  Melanie: And why is that, Dr. Huh? What makes ovarian cancer that much different than, and they’ve called it the silent cancer, and it certainly is a tough one to detect. So, why is this so different than say breast cancer or cervical or any of these other women cancers that would necessitate a program devoted entirely to it?
  
  Dr. Huh: Well, it’s not that… not that so much that it’s different. Matter of fact, what I would argue is, in many ways, the program that we built, I’m hoping will service a future template for other cancers that might benefit from a similar comprehensive program with multiple facets that focus around basically the patient and the family. The reason why I think that ovarian cancers important is that, it’s just from the simple observation that we wind up tapping into multiple resources, that are ultimately really important for the management of women for ovarian cancer. It’s a very difficult disease to treat, and what we know is that, patients require a lot of support, and what we’re trying to do is to try to create an expert program that really revolves around the patient. And so, I think most people who treat ovarian cancer will argue that it requires a certain level that’s expertise. And what we’re trying to do is bring all that expertise under one roof.
  
  Melanie: So, let’s speak about ovarian cancer for a minute, Dr. Huh, what do you want other physicians to know about being able to identify it? To speak to their patients about the risk factors, the hereditary factors involved, the genetics. Since it is so hard to detect, what should other physicians be on the lookout for if there an obstetrician, gynecologist, what should they be helping their patients to understand?
  
  Dr. Huh: Well, to your point earlier. Ovarian cancer has been often labeled or in some says maybe mislabeled as the silent killer. Unfortunately, unlike other malignancies like breast cancer, colon cancer, cervical cancer, there’s no screening tests for ovarian cancer, and so, what we recommend to women, as well as we counsel to their providers is that they need to be aware of symptoms. The patients that have chronic bloating, nausea, vomiting, abdominal pain, difficulty urinating, difficulty using the bathroom. These may all be ultimately signs of ovarian cancer, and what we’re more interested in is sort of chronicity of the symptoms. I think everyone on this, who’s listening to this program realize a lot of things I just mentioned, nausea and vomiting could be caused by a multitude of different things that’s non-specific, but it’s really paying attention to those symptoms and going to doctor, and saying, “Listen, I’ve had multiple weeks of nausea, vomiting, and bloating, and I’m worried about this.” And making sure that they’re properly evaluated. So, it’s really about heightened symptom awareness.
  
  Melanie: So, while there are no screening tools, are there some valuable prognostic tools to aid in diagnosis if you do suspect something?
  
  Dr. Huh: Yeah, I think that in a woman like that who might this chronic symptoms, and OBGYN’s may elect to get an ultrasound of their pelvis, to see if there’s something going on with their ovaries or uterus or perhaps maybe they have increased fluid within their abdomen. Another option would be to check for something called the, CA125, which is commonly used to kind of help guy clinicians in terms of ordering additional testing. Some providers might use…order a CAT scan if they’re really concerned or have a really tightened suspicion of ovarian cancer. So, there are multiple tests that we use, but over and over again, what people recognize, and this has been published in the scientific literature is that referral to a gynecologic oncologist, another word, an oncologist who’s specifically trained to take care of women that have ovarian cancer, both from the surgical perspective, as well as the treatment perspective. That those women actually have much, much better outcomes, overall.
  
  Melanie: So, when we were speaking before about the program, and you were talking about genetics. Tell us what’s going on in the world right now of gene expression and genomics for ovarian cancer. What are you seeing, Dr. Huh?
  
  Dr. Huh: Yeah, this is a really hot area. The area that is of great interest to myself, my division, the ovarian cancer program, as well as the patients. So, the two levels or two types of testing that is done. Right now, we offer pretty much all of our ovarian cancer patients largely, basically, genetic testing or what we call, a gene panel testing, and what we’re looking for are specific mutations. For instance, like the BRCA1 and BRCA2 mutation that put women at considerable risk for developing ovarian cancer and breast cancer, but there actually multiple other genes, 20 plus other genes, that are actually epidemiologically linked to ovarian cancer, that might have great impact. Not only on the management of that individual women, but also an impact on the management of their family, for instance their daughters, and so, what we’re seeing now is what we call cascade testing, where if a woman with ovarian cancer has a genetic mutation, then we’ll talk about with their family members, like for instance, their daughters, their sons. Whether or not they need to be tested, as well, so that we can risk produce their future risk of getting cancer in the future. Now there’s another type of testing that’s done, where we do, what’s known as, next generation sequencing off of their actual tumor, where we try to figure out whether or not they might be candidates for drug therapy in the future, that might actually have a positive impact on their outcome.
  
  So, what are those drugs? That’s really fascinating, and there’s been a lot of attention paid toward it, is from they’re called PARP inhibitors. So, in the United States, there’s three commercially available PARP inhibitors, that are used sort of in different settings for ovarian cancer, but what we know is that women who have, let’s say, a mutation for BRCA1 or 2. That those women actually have a really, very significant positive response to those drugs. So, what we’re doing now, is that we’re trying to understand these genetic mutations much earlier on in the course of their therapies, so that can look at this drug therapy. Not only that, understand what the risk is to the patient and their family as well.
  
  Melanie: Wow, that’s fascinating, Dr. Huh, so in summary, tell other physicians what you’d like them to know about recognizing ovarian cancer, and when you feel it’s very important for them to refer, as you said, to a gynecologic oncologist.
  
  Dr. Huh: Well, one is like you just said, that the scientific evidence clearly indicates that referral of these patients to a gynecologic oncologist or particularly to a Center, that does a relatively high volume of ovarian cancer surgery and treatment, that those are made definitely have a better outcome. And two, to realize that management of ovarian cancer patients, as I said, at the beginning of this interview, is more than just giving chemotherapy and operating. It’s about utilizing multiple resources to really provide, what I call, patient-centric care, that revolves around, not just on cancer outcomes, like survival, but also on quality of life, feeling things to the spirituality, feeling things with how to reduce the risk of their family members getting cancer, and to do that in a truly expert experienced way, that generally just benefits the patient and their families. And I think that, that is the main driver for why we created this program.  
  
  Melanie: Thank you so much, Dr. Huh, for being with us today. It’s really great information and so important for women and for other providers to hear, and a community physician can refer a patient to UAB Medicine by calling the MIST line, at 1800 UAB MIST, that’s 1800 822 6478. You’re listening to UAB Med Cast, for more information on resources available at UAB Medicine, you can go to, UABMedicine.org/Physician, that’s UABMedicine.org/Physician. This is Melanie Cole, thanks so much for listening.
  
  
  
  
• Hosts:Melanie Cole, MS