Treating Ovarian Cancer When There Are Genetic Changes

This article is for people who are living with ovarian cancer and their care partners or anyone who wants to learn more about the treatment of ovarian cancer. The goal of this activity is to help people who are living with ovarian cancer with genetic changes talk to and work with their doctor and healthcare team on a treatment plan.

You will learn about:

• What ovarian cancer is

• How genetic changes can increase the risk of ovarian cancer

• How ovarian cancer with genetic changes may be treated

• Questions to ask your doctor and healthcare team about treating ovarian cancer with genetic changes

Certain medicines listed may not be approved by the US Food and Drug Administration (FDA) for ovarian cancer but are recommended by the National Comprehensive Cancer Network (NCCN).

Most ovarian cancers start in the epithelium, which is a layer of tissue that covers your ovaries. This type of ovarian cancer is called epithelial ovarian cancer (EOC).

The ovaries are 2 oval organs of the reproductive system found in people who were assigned female on their birth record. This includes women, transgender men, and some nonbinary people. Ovaries make the eggs used for pregnancy, and they make some hormones your body uses to grow and function.

EOC is also used to describe cancers that start in the epithelium layer of the fallopian tubes (organs near the ovaries) and the peritoneum. The peritoneum is a smooth sheet of tissue that covers organs inside your belly area.

Your body has trillions of cells. Each cell contains DNA, which is made up of genes that tell the cell how to grow and work. A genetic change is a mistake in a gene and is also known as a mutation or variant.

A germline genetic change is passed down from a parent (inherited). All your cells have the same germline genetic changes. Your children can inherit your germline genetic changes.

A somatic genetic change happens when a cell's DNA is damaged from exposure to something harmful or while being copied to make a new cell. All future copies of the cell will have the same somatic change. You can't pass somatic genetic changes to your children.

A genetic change can turn normal ovarian cells into cancer cells. Cancer cells grow out of control, making more and more cancer cells, and eventually form a tumor. As the tumor gets larger, it can damage your ovary and spread into nearby tissues.

As cancer cells copy themselves, they can get more genetic changes. Some changes help cancer cells travel to other places in your body to start new tumors, which is called metastasis. Other changes help cancer cells live longer than normal cells.

DNA damage repair (DDR) genes help fix DNA damage or get rid of cells when DNA damage can't be fixed. But sometimes, germline or somatic genetic changes keep DDR genes from doing their job, which can lead to:

• Homologous recombination deficiency (HRD), which is most commonly caused by changes in the DDR genes BRCA1 and BRCA2. Genetic changes in other DDR genes can also cause HRD.

• Mismatch repair deficiency (MMR-D), which can result from changes in the DDR genes MLH1, MSH2, MSH6, PMS2, or EPCAM. MMR-D due to a germline genetic change is called Lynch syndrome.

Genetic testing in people living with ovarian cancer is important. Germline testing uses a blood or saliva sample. Your doctor may test for germline changes only in the BRCA1 and BRCA2 genes or in a number of genes linked to inherited EOC.

Somatic testing checks a sample of tumor tissue for changes in BRCA1, BRCA2, and other DDR genes. Your doctor may also test your tumor tissue for features (biomarkers) of HRD and MMR-D or for other genetic changes and biomarkers.

Talk to your doctor, healthcare team, or a genetic counselor about your testing options. You may need more genetic testing if your cancer changes.

Genetic test results have important uses in EOC, such as

• Helping to identify your treatment options

• Figuring out how your EOC is likely to behave

• Identifying other family members who might want to consider genetic testing

If your test results aren't clear, your doctor or genetic counselor may recommend more tests.

Types of medicine sometimes used to treat EOC include:

• Chemotherapy (or "chemo")

• Targeted therapy

• Immunotherapy

• Hormone therapy

Each type of medicine attacks cancer cells in its own way. Chemotherapy and hormone therapies can be used to treat EOC with or without genetic changes.

There are several kinds of targeted therapy and immunotherapy medicines, and each one works a little differently. Some only work in EOC with certain genetic changes, while others can be used to treat EOC with or without genetic changes.

Your doctor and healthcare team can work with you on a treatment plan. Your options depend on many things, including what your EOC is like, your genetic test results, your age and overall health, and what you want -- or don't want -- from treatment.

Ask your doctor how each treatment works, how it's given, and how it may affect you. Once you've agreed on a treatment plan, make sure you understand the side effects that could happen with any medicines you're taking, as well as when to report them to your healthcare team and how they're managed.

Questions you can ask your doctor and healthcare team include:

• What genetic changes do I have?

• What treatments are used for EOC with genetic changes, and what are their possible side effects?

• How are the treatments different from each other?

• How might treatment affect my quality of life?

Congratulations!

You have successfully completed the program Treating Ovarian Cancer When There Are Genetic Changes

View Additional Materials on this topic that you may find useful:

Guide to Hereditary Breast and Ovarian Cancer

Ovarian, Fallopian Tube, and Peritoneal Cancer

How Is Ovarian Cancer Treated?

Talking With Your Health Care Team

Questions to Ask Your Doctor About Cancer

Genetic Testing Fact Sheet