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My journey as a writer began as a child. I wrote poems and short stories which were my way of dealing with various life changing events. I am a member of Rave Reviews Book Club. Follow me on Twitter @KIngallsAuthos www.facebook.com/KarenIngalls, and you can find my books at www.amazon.com. My first book is Outshine: An Ovarian Cancer Memoir which received two awards. All proceeds are donated to gynecologic cancer research. My second book is a novel Novy's Son, about one man's attempt to find love and acceptance from his father. This is an all too common problem in our society. My third book, Davida: Model and Mistress of Augustus Saint-Gaudens is about the love affair between this great American sculptor and his model. ALL ORIGINAL CONTENT COPYRIGHT 2011 THROUGH 2016.

Friday, September 23, 2016


                 What is recent research discovering about 
                             ovarian cancer treatments?
               Here are a variety of articles that you might find       
             informative, and may even answer some questions.

The Lancet study also used CA125, but in a different way. Instead of declaring a certain level abnormal, the researchers developed a mathematical formula that took into account a woman’s age and the degree of change in CA125 over time, and calculated a risk score.
An advocacy group, the Ovarian Cancer National Alliance, issued a statement that called the study promising, but said much more data analysis was needed to determine whether the test would be useful.

Ovarian, Fallopian Tube, and Peritoneal Cancer: Latest Research

Approved by the Cancer.Net Editorial Board, 08/2016
Doctors are working to learn more about ovarian, fallopian tube, and peritoneal cancer. They are looking for ways to prevent them, as well as looking for the best ways to treat them and provide care to people diagnosed with these diseases.
The following areas of research may include new options for patients through clinical trials. As mentioned in the Clinical Trials section, most ovarian cancer trials now include patients with fallopian tube and peritoneal cancers.
Always talk with your doctor about the diagnostic and treatment options best for you.
  • Screening. Screening is used to look for cancer before a person has any signs or symptoms. There are no effective screening methods for these diseases suitable for the general symptom-free population. A screening method that uses serial CA-125 blood tests and pelvic ultrasonography for detecting early-stage ovarian cancer has been completed, and it is not clear whether this approach will produce an improved survival rate. 
    Although some have recommended that women at high risk for ovarian cancer because of their family history or presence of BRCA1 or BRCA2 or other high-risk gene mutation(s) (see Risk Factors) should be screened with CA-125 blood tests and transvaginal ultrasound, this approach has not been shown to improve survival or detect cancers at an earlier and more curable stage.  Therefore, if a high-risk gene mutation exists, the recommendation is to remove both fallopian tubes and ovaries preventively (prophylactically) after the completion of child-bearing, in most women by age 40.
  • Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Some targeted therapy drugs are directed at specific genes that might be found with abnormalities in certain types of epithelial ovarian cancer. 
    Anti-angiogenesis inhibitors. Drugs called anti-angiogenesis inhibitors block the action of a protein called vascular endothelial growth factor (VEGF). These drugs have been shown to increase the cancer’s response to treatment and delay the time it takes for the cancer to return. VEGF promotes angiogenesis, which is the formation of new blood vessels. Because a tumor needs nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Bevacizumab (Avastin), an antibody that binds VEGF and prevents it from being active, has been shown to be effective in ovarian cancer.  FDA approval was given in the United States for its use in combination with selected chemotherapy for patients with platinum resistant recurrence 
    PARP inhibitors. Researchers are evaluating another class of drugs, called PARP inhibitors, for ovarian cancer. These drugs act on DNA repair in cancer cells, making it difficult for them to replicate. The BRCA genes (BRCA1 and BRCA2) are normally involved in DNA repair, and a mutation in these genes interferes with this pathway function. PARP inhibitors make it particularly difficult for cells that otherwise have a BRCA mutation to grow and divide.  
  • The FDA approved the PARP inhibitor olaparib (Lynparza) for recurrent disease in patients who have the inherited BRCA mutation and who have received 3 or more lines of chemotherapy. 
    Many other new targeted treatments are now in clinical trials. Increasingly, doctors are learning about each patient’s individual tumor's biology through direct molecular testing. This information may be useful in matching patients with a clinical trial for a specific targeted therapy. Learn more about the basics of targeted therapy.
  • Immunotherapy. Immunotherapy is usually designed to boost the body’s natural defenses to fight a cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function.
    Researchers are examining whether drugs called checkpoint inhibitors may boost the immune system's ability to destroy cancer cells. Examples of these drugs target PD-1, PD-L1, and CTLA4 and they have been shown to cause shrinkage in other cancer types such as melanoma and some lung cancers, as well as having some activity in patients with ovarian cancer.
    Cancer vaccines are another type of immunotherapy researchers are testing for use against ovarian cancer. Some approaches called “adoptive cell therapy” use killer T cells found as part of the immune system in an individual patient. Researchers grow them in the laboratory and train them to attack certain targets, such as MUC 16 (CA125), that are found on ovarian cancer cells. Doctors then give the T cells back intravenously to the patient.  Clinical trials are opening for ovarian cancer.  Learn more about the basics of immunotherapy.
  • Hormone therapy.  For treatment of recurrent or later-stage ovarian cancer, tamoxifen (Nolvadex, Soltamax), aromatase inhibitors, and enzalutamide (Xtandi), a blocker of the androgen receptor, are being used.
  • Gene therapy. A new area of research is discovering how damaged genes in ovarian cancer cells can be corrected or replaced. Researchers are studying the use of specially designed viruses that carry normal genes into the core of cancer cells and then replace the defective genes with the functional ones.
  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of standard cancer treatments, to improve a patient’s comfort and quality of life.

    Scientists continue to study the genes responsible for familial ovarian cancer. This research is beginning to yield clues about how these genes normally work and how disrupting their action can lead to cancer. 
    Research in this area has already led to better ways to detect high-risk genes and assess a woman's ovarian cancer risk. A better understanding of how genetic and hormonal factors (such as oral contraceptive use) interact may also lead to better ways to prevent ovarian cancer.
    Vintafolide (EC145) is a newer drug that targets the folic acid receptor. This receptor is found on some ovarian cancers. In one study, it helped stop the growth of cancers that had the folic acid receptor.
    Another approach is to develop tumor vaccines that program the immune system to better recognize 

    cancer cells. Also, monoclonal antibodies that specifically recognize and attack ovarian cancer cells are 

    being developed. These antibodies are man-made versions of the antibodies our bodies make to fight

     infection. They can be designed to home in on certain sites on the cancer cell. Farletuzumab is a 

    monoclonal antibody that is directed against the folic acid receptor, which is on the surface of some 

    ovarian cancer cells. It has shown promise in treating ovarian cancer in early studies. Another 

    monoclonal antibody being studied in ovarian cancer is called catumaxomab. It binds to a protein that is 

    in some cancer cells and some immune system cells. When it is administered into the abdominal cavity, it 

    can help treat fluid buildup (ascites) that can occur when cancer is present.

    Is ovarian cancer still possible after a hysterectomy?
Answers from Shannon K. Laughlin-Tommaso, M.D.

Yes, you still have a risk of ovarian cancer or a type of cancer that acts just like it (primary peritoneal cancer) if you've had a hysterectomy.

Your risk depends on the type of hysterectomy you had:

Partial hysterectomy or total hysterectomy. A partial hysterectomy removes your uterus, and a total hysterectomy removes your uterus and your cervix. Both procedures leave your ovaries intact, so you can still develop ovarian cancer.

Total hysterectomy with salpingo-oophorectomy. This procedure removes your cervix and uterus as well as both ovaries and fallopian tubes. This makes ovarian cancer less likely to occur, but it does not remove all risk.

You still have a small risk of what's called primary peritoneal cancer, which may result from ovarian cells that migrated to the peritoneal area during each menstrual cycle before your ovaries were removed. These cells can become cancerous later on. Alternatively, since the peritoneum and ovaries arise from the same tissues during embryonic development, it's possible that cancer could arise from the cells of the peritoneum.

Currently, there are no effective screening tests for ovarian cancer in women with an average risk of the disease. If you're concerned about your risk, discuss your options with your doctor.

Shannon K. Laughlin-Tommaso, M.D.

                                KNOW THE SYMPTOMS
                   IF PERSIST FOR 2 WEEKS, ACT ON THEM

  • Abdominal Bloating
  • Abdominal pain                            
  • Digestive issues
  • Painful intercourse
  • Back pain
  • Change in bowels
  • Change or frequency of urination
  • Unusual vaginal discharges
  • Fatigue

Thursday, September 15, 2016


 Megan Satterwhite of Florida Hospital Foundation interviewed me for the letter below. The Foundation works diligently to raise funds and equally important to raise awareness about ovarian cancer. My humble thanks to her and the Foundation for all they do.
                               LOOKING FOR THE
                            STRONG, SILENT TYPE?
                                 YOU SHOULD BE
YOU SHOULD BE.                  
With vague symptoms and often-late diagnoses, ovarian cancer fits the bill.

I share my story to raise awareness, and I hope you’ll join me in support of
Florida Hospital’s efforts to combat this strong, silent type of cancer.

I’d always been health-conscious. When I started gaining weight, I kicked my
fitness routine into high gear. After going up a size rather than down, I made a
mental note to discuss the issue with my local gynecologist in Minnesota at
my annual appointment. (PAP smears do NOT detect ovarian cancer)

Sitting in the exam room, I was proud of my good health as I answered my
doctor’s questions. My confidence quickly turned to fear when the pelvic exam
began, and I felt an unusual amount of discomfort. “I feel a mass,” my
doctor said, and my eyes welled with tears.

An MRI confirmed a honeydew melon-sized mass outside my uterus. I was
referred to a gynecological oncologist, who determined that I needed a
complete hysterectomy and tumor removal.

A “simple” hysterectomy would take two to three hours, but if the tumor was
malignant, I’d be in surgery longer. When I awoke in recovery six hours later, I
moaned, “Oh, no.” My doctor held my hand and said, “I’m so sorry.”

I was diagnosed with stage IIC ovarian cancer. The mass had invaded my
colon. The outer layer of the lower section of my colon as well as the saline wash of my pelvic cavity were cancerous with a malignant mixed Mullerian tumor. This rare and aggressive sarcoma gave me about a 50 percent chance of long-term survival.

After six rounds of chemotherapy, I got word that my most-recent scan
showed no signs of cancer. Together, my husband, Jim and I cried tears of
relief. Though we’d been “snowbirding” in Florida for a while, we decided
to move there permanently. I began seeing Robert Holloway, M.D., at
Florida Hospital for follow-up care.

My regular exams and blood work were normal for a while, but I had a
recurrence a few years later in 2014. In addition to chemotherapy, Dr. Holloway
prescribed a medication (Avastin) recently approved by the FDA, thanks in part to a
clinical trial at Florida Hospital Cancer Institute. 

Today, I’m cancer-free. I can share my story thanks to progress toward finding a cure. Here in Central Florida, Dr. Holloway is one of the physicians at Florida Hospital
promoting clinical trials related to gynecological cancer. His diligence and
persistence are paying off, and I’m thankful to be in his care.

I believe in Florida Hospital and Dr. Holloway’s work there. All proceeds
from my book, Outshine, An Ovarian Cancer Memoir, are directed toward
his research, and I hope you’ll consider joining me in support of his efforts.
Clinical trials are crucial to the development of new and improved protocols
for cancer patients. Your gift helps bring us one step closer to a cure.

Karen Ingalls
Grateful Patient

(Some editing was done for the purpose of this blog)

Please send your donation to: Florida Hospital Foundation
                                                 550 East Rolling Street, Sixth Floor
                                                 Orlando, FL. 32803

P.S. The Women’s & Girls’ Cancer Alliance lives on