A New Approach to Undetectable Ovarian Cancer

Amir Jazaeri, MD, of MD Anderson Cancer Center, provides an in-depth perspective on the complex challenges of treating ovarian cancer. He explains that a majority of patients are diagnosed with advanced-stage disease, meaning the cancer has already spread extensively throughout the abdomen and possibly to other parts of the body. Despite this initial widespread nature, a combination of radical surgery and six cycles of platinum-based chemotherapy is often highly effective, leading to a state of remission where patients are considered cancer-free.

Read the full interview with Dr Jazaeri here.

The primary challenge with ovarian cancer is its high rate of recurrence. Jazaeri notes that the cancer "doesn't really come back; it never leaves the body." This is because a small number of microscopic cancer cells remain after treatment, evading detection by conventional methods. The two most common tools for monitoring a patient's remission status—a blood test for the CA 125 tumor marker and radiologic imaging like CT scans—are often not sensitive enough to detect these minuscule amounts of residual disease. This leaves a critical gap in our ability to manage the disease effectively.

For decades, the field has struggled to understand why these persistent cells are so resilient. Jazaeri highlights a fundamental question: What makes this small percentage of cancer cells resistant to treatment? While 99% of the cancer is destroyed by chemotherapy, less than 1% survives. This phenomenon, he explains, is a major limitation in treatment and is the focus of much ongoing research.

To address this challenge, Jazaeri and his team at MD Anderson Cancer Center have taken a pioneering approach. They've developed a more sensitive method for detecting residual disease: a second-look laparoscopy. This minimally invasive surgical procedure involves a detailed examination of the abdominal cavity. During the procedure, surgeons take multiple biopsies from various areas and also perform a peritoneal wash, where sterile saline is introduced, swished around, and then aspirated. This fluid, which may contain floating cancer cells, along with the tissue biopsies, is sent to pathology for microscopic analysis.

This method offers a level of sensitivity that is far superior to both the CA 125 blood test and CT scans, allowing clinicians to identify persistent cancer cells that would otherwise be missed. By uncovering this residual disease, the approach aims to provide a clearer picture of the patient's true remission status and potentially inform more personalized treatment strategies to prevent a full-blown recurrence.