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Ovarian cancer

CISS relies strongly in its evaluations below on impartial analyses by the International Cochrane Collaboration and the British Medical Journal’s Clinical Evidence Group – two groups of researchers who specialise in Evidence Based Medicine.

Conventional medicine supports the paradigm that the tumour is the first stage of cancer; therefore, treating and removing the cancer should cure the cancer. Unfortunately statistics show this is rarely the case. Conventional medicine also advocates that treatment should only be used if supported by appropriate clinical trials showing efficacy in terms of a reduction in deaths. In fact evidence based medicine suggests that the only reliable evidence comes from properly run randomised controlled trials. Again, with conventional cancer treatment, there is no evidence from such trials to show that intervention has any effect on deaths.

The following is based on the conventional cancer paradigm, mainly as described by the US National Cancer Institute (NCI) with CISS comments to balance the narrative.

The ovaries and fallopian tubes are part of the female reproductive system. There is one ovary and one fallopian tube on each side of the uterus (the hollow, pear-shaped organ where a fœtus grows). The ovaries store eggs and make female hormones. Eggs pass from the ovaries, through the fallopian tubes, to the uterus. The peritoneum is the tissue that lines the abdomen wall and covers organs in the abdomen. Part of the peritoneum is close to the ovaries and fallopian tubes.

The most common type of ovarian cancer is called ovarian epithelial cancer. It begins in the tissue that covers the ovaries. It is one of the most common gynecologic malignancies and the ninth most frequent cause of cancer death in Australian women, with 50% of all cases occurring in women over 65 years. Sometimes cancer that begins at the end of the fallopian tube near the ovary or in the peritoneum can spread to the ovary. The stages and treatment are the same for ovarian epithelial, fallopian tube, and primary peritoneal cancers.

Another type of ovarian cancer is ovarian germ cell tumour, which is much less common. It begins in the germ (egg) cells in the ovary.

These cancers are often found at advanced stages. This is partly because they may not cause early signs or symptoms and there are no good screening tests for them.

Ovarian low malignant potential tumour (OLMPT) is a type of ovarian disease in which abnormal cells form in the tissue that covers the ovaries. OLMPT rarely becomes cancer.

Risks: Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. (NCI)

The causes of most ovarian tumours are unknown. However, there are claimed to be a few known risks for ovarian cancer. Like all claims about cancer risk they are based on correlation statistics, not proof of cause and effect. As a result claims of this sort are misleading and can raise false fears about risk. In fact in many types of cancer most people diagnosed do not have any of the claimed risks, apart from age. The following are examples of risk based on correlation statistics (CISS)

  • Women who have one first-degree relative (mother, daughter, or sister) with a history of ovarian cancer have an increased risk of ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with a history of ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with a history of ovarian cancer.
  • Some ovarian, fallopian tube, and primary peritoneal cancers are caused by inherited gene mutations (changes). So it is possible to have a genetic disposition.

 

  • The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary ovarian cancer makes up about 5% to 10% of all cases of ovarian cancer. Three hereditary patterns have been identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers.
  • Fallopian tube cancer and peritoneal cancer may also be caused by certain inherited gene mutations. There are tests that can detect mutated genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (NCI)

Claims of increased risk can also wrongly encourage women to accept unproven interventions claimed to reduce the risk. Such claims are misleading and can raise false hopes about reducing risk of death or chance of increasing survival. (CISS)

For example

  • “Some women who have an increased risk of ovarian cancer may choose to have a risk-reducing oophorectomy (the removal of healthy ovaries so that cancer cannot grow in them). In high-risk women, this procedure has been shown to greatly decrease the risk of ovarian cancer.” (NCI)

Evidence from epigenetics suggests rather that genetic abnormalities are widespread among healthy people and are not a cause of cancer. The main role of genes and DNA is human reproduction with very few abnormalities leading to disease. Cancer is more likely to be due to a breakdown in information between cells, and genetic damage can in fact increase after a person has cancer. Research into the observed link between chronic stress and cancers suggest that the mechanism could be via a weakening of the immune system, increase in cell oxidation and a shortening of the cells’ telomeres that determine the cell’s life. (CISS)

Signs and Symptoms: Ovarian, fallopian tube, or peritoneal cancer may not cause early signs or symptoms. When signs or symptoms do appear the cancer is often advanced. Signs and symptoms may include the following:

 

 

These signs and symptoms may also be caused by other conditions and not by ovarian, fallopian tube, or peritoneal cancer.(NCI)

 

Stages

Stage I

In stage I, cancer is found in one or both ovaries or fallopian tubes. Stage I is divided into:

Stage II

In stage II, cancer is found in one or both ovaries or fallopian tubes and has spread into other areas of the pelvis; or primary peritoneal cancer is found within the pelvis. Stage II is divided into:

ENLARGE

Stage III

In stage III, cancer is found in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes. Stage III is divided into:

Stage IV

In stage IV, cancer has spread beyond the abdomen to other parts of the body. Stage IV is divided into:

Stage I ovarian epithelial and fallopian tube cancers are treated as early cancers.

 

Stages II, III, and IV ovarian epithelial, fallopian tube, and primary peritoneal cancers are treated as advanced cancers.

 

Treatment: There are four different kinds of standard treatment for patients with ovarian epithelial cancer.

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy

 

Surgery

 

Most patients have surgery to remove as much of the tumour as possible. Different types of surgery may include:

  • The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy,

(a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or

(b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed.

 

In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.

 

  • Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.

 

  • Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.

 

  • Omentectomy: A surgical procedure to remove the omentum (tissue in the peritoneum that contains blood vessels, nerves, lymph vessels, and lymph nodes).

 

  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the

tissue under a microscope to look for cancer cells. (NCI)

 

Please note: there is little evidence that surgery for cancer has any benefit in increased percentage 5 year survival except in cases where the tumour is in a life threatening position such as obstructing the bowel or pressing on the brain. (The efficacy of surgical treatment of cancer – 20 years later, DJ Benjamin) (CISS)

Radiation therapy

 

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy.

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

 

The way the radiation therapy is given depends on the type and stage of the cancer being treated.

 

Some women receive a treatment called intraperitoneal radiation therapy in which radioactive liquid is put directly in the abdomen through a catheter. (NCI)

 

Please note: radiation has been shown to reduce recurrence with many types of cancer but this rarely results in increased survival. (The efficacy of radiotherapy, DJ Benjamin). (CISS)

Chemotherapy

 

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen the drugs mainly affect cancer cells in those areas (regional chemotherapy).

 

A type of regional chemotherapy used to treat ovarian cancer is intraperitoneal (IP) chemotherapy. In IP chemotherapy, the anticancer drugs are carried directly into the peritoneal cavity (the space that contains the abdominal organs) through a thin tube.

 

Treatment with more than one anticancer drug is called combination chemotherapy.

 

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

 

Research by Morgan et al concludes that chemotherapy in ovarian cancer may give an increase of 8.7% in the 5 year survival rate. This needs to be weighed up against the side effects of the chemotherapy (CISS)

Targeted therapy

 

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

 

Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

 

Bevacizumab is a monoclonal antibody that may be used with chemotherapy to treat ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that has recurred (come back).

 

Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) are targeted therapy drugs that block DNA repair and may cause cancer cells to die. Olaparib is a PARP inhibitor that may be used to treat advanced ovarian cancer caused by mutations (changes) in the BRCA1 and BRCA2 genes. (There is no proof that changes in BRCA genes cause ovarian cancer – CISS)

 

The aim of treatment is to remove the tumour, slow its growth, or relieve symptoms by shrinking the tumour and swelling. However as mentioned above there is little proven survival benefit.

Screening: Like most cancer screening there is controversy about whether ovarian cancer screening provides any benefits or whether it causes more harm than good. In December 2015 there were reports of the results a randomised controlled trial (RCT) that had evaluated the effects of ovarian cancer screening on women who had been offered two types of screening compared to those who had not been offered screening. It was large trial involving 202,638 women in the UK who had been randomised into three groups: 50,640 were offered annual multi-modal screening (MMS) using a cancer marker CA-125; 50,639 were offered annual screening using trans-vaginal ultrasound (USS); and 101,350 were not offered screening. Their health was monitored for 14 years.

One of the trial authors claimed that the lives of about 200 Australian women a year would be saved if such screening were introduced. However the published results do not supports this claim.

First, the whole rationale for screening is to find a lot more tumours earlier so that they can be treated before they become life-threatening. Yet surprisingly while only 22 extra cancers (3.5%) were found in those screened compared to those not screened (652 vs 630) there were 45 fewer deaths from ovarian cancer (302 vs 347) among those offered screening! This immediately suggests that something is not correct in the data.

Although there were slightly fewer deaths among the women offered screening than those not offered screening these differences were not statistically significant.

For the sake of comparison, a similar trial in the US found 21% more ovarian cancers in the screened group, yet they found 18% more deaths among the screened women and 1.1% more deaths from other causes. Again these differences were not statistically significant.

So if the differences in the recently published UK screening trial were not statistically significant, how can the authors claim hundreds of lives would be saved by such screening?

In order to be able to make this questionable claim they modified their data twice by excluding several women in the screened and unscreened groups after randomisation on various grounds claiming that these women should have been ineligible for the trial. Excluding anyone after randomisation is not permitted in RCTs. Comparison is only permissible between the original randomised groups. Otherwise the comparison is between unmatched groups so is meaningless. Yet these trial leaders did this twice!

They first excluded 16 women from both the MMS and USS groups and 60 from the No screening group mainly on the grounds that they had already had an operation on an ovary.

They then found that there was no statistical significance in deaths between the screened and unscreened groups in their primary analysis.

So they then excluded another 63 women whom they assumed must have had ovarian cancer before randomisation from the 338 women found to have ovarian cancer in the MMS group, referred to as ‘prevalent’ cases, and 116 similar prevalent cases from the 630 women with ovarian cancer in the No screening group and then again compared the death rates.

(They made this assumption by comparing the CA-125 level with that measured before randomisation and plotted the increase between the measurement dates. If the CA-125 level was estimated to have reached the cut-off level for the presence of ovarian cancer (35) the women were considered to have had “prevalent” ovarian cancer when randomised. This is based on the unproven assumption that women with this marker level had ovarian cancer.)

They then claimed that “although the mortality reduction was not significant in the primary analysis, we noted a significant reduction with MMS when prevalent cased were excluded”. In other words they fudged the figures in breach of the rules for interpreting results of RCTs.

Despite this, their claim that there was a significant [mortality] reduction was still invalid since the stated reduction of deaths of 20% had a Confidence Interval (CI) of (-2% to 40%). To reach “significance” values cannot have a CI range that includes 0 because this means that zero reduction of deaths is within the probable (95% confidence) range.

So this trial joins the other five screening trials (for breast, bowel, lung and prostate cancer) in showing that most of the trial researchers don’t understand the basic principles of running and interpreting the results of screening trials. (CISS)

The above therapies, including screening and subsequent biopsies all come with risks and side effects which should be discussed in detail by your treating physician.

Before deciding on one of these treatments or interventions you would benefit from asking your physician three questions:

Question 1: What are my treatment options? – These should include doing nothing.

Question 2: What are the possible outcomes of those options? – including benefits and side effects.

Question 3: How likely is each of the outcomes to occur?

If your doctor or other health practitioner cannot answer these questions, or shows that he or she is not comfortable with you asking these questions, it raises the question as to whether they are practising evidence based medicine and you should consider getting another opinion.

These three questions can be expanded.

For a complete comprehensive overview of conventional treatments used for ovarian cancer with up to date information on % effectiveness of each treatment on mortality and morbidity, please follow this link to The Ralph Moss Reports and click on Ovarian cancer.

Alternative Cancer Therapies

 

As mentioned above, conventional medicine supports the paradigm that the tumour is the first stage of cancer; therefore treating and removing the cancer should cure the cancer. Another paradigm believes that cancer is a systemic disease and the tumour is in fact a late stage symptom, element or manifestation of that disease. Therefore treating the disease should be systemic and wholistic (meaning treating the whole body) and should include the following principles:

 

  1. Treatment should cause no harm
  2. Treatment should be wholistic (ie consider the whole person – body, mind, emotions and spirit)
  3. The person with cancer needs to take control of their own health.

 

This latter paradigm is supported by CISS (See Introduction to CISS).

 

Alternative cancer therapies are generally consistent with the above principles. In fact those believed to be most effective in controlling cancer – psychotherapy and immunotherapy – also have strong evidence of benefit from randomised controlled trials.

 

What is important in any cancer treatment is to both understand and believe in your chosen therapy because the placebo effect has been shown to be very strong.

 

There are approximately 200 alternative cancer therapies that have been shown or anecdotally reported to help a person with cancer have reduced morbidity and mortality.

 

There are several alternative cancer therapies claimed to produce benefits with ovarian cancer. Those claimed to have the most benefits in most types of cancer include psychotherapy and immunotherapy.

 

  1. Psychotherapy

 

Although there were no patients with ovarian cancers enrolled in the psychotherapy trials, psychotherapy was found to provide benefits in all types of cancers with solid tumours, so ovarian cancer would not be expected to be an exception.

 

  1. Immunotherapy

 

  • Iscador (mistletoe extract)

 

Many clinical trials have shown benefits of Iscador therapy on people with different types of cancer. One analysis of 22 studies included 12 prospective studies, 5 randomised studies and 10 had a matched-pair design from which the authors identified 41 comparisons of Iscador vs no treatment. All but four showed a positive increased survival.

 

A random effect meta-analysis estimated the overall hazard ratio at HR = 0.59 (CI: 0.53 to 0.66, p < 0.0001). Simple meta-regression yielded a predicted HR = 0.74 (CI: 0.66 to 0.82, p < 0.0001). This means that Iscador was shown to produce about a 26-41% increase survival.

 

Randomised studies showed lower effects than non-randomised studies and matched-pair studies gave significantly better results than others.

 

In one ovarian cancer study 25 women with primary cancers of the ovary (including 20 advanced cases) received treatment with Iscador after surgery. Five-year survival rates with this type of treatment were 100% with stages I and II, 23% in stage III and 0% in stage IV. This group of patients was then compared with women who had received the standard drug Cytoval after surgery.

 

Iscador patients had more advanced disease than the Cytoval group yet they survived on average 16.2 months compared with 5.2 months in the Cytoval group, ie more than 3 times longer. Iscador-treated patients in Stage III (with metastases outside the pelvis) survived 4.2 times longer than the Cytoval patients.

 

The scientists concluded that Iscador is a useful and effective treatment for carcinoma of the ovary, particularly since it usually does not cause serious and undesired side effects.

 

References: Hassauer W et al. What prospects of success does Iscador therapy offer in advanced ovarian cancer? Onkologie 1979; 2: 28-36.

 

Ostermann T, Raak C, Büssing A. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review. BMC Cancer (Dec 18) 2009; 9: 451-.

 

  • Issels Wholebody Therapy

 

Although not based on RCTs, the most successful therapy for late stage cancers including ovarian cancer was Josef Issels’ Whole Body Therapy that focussed on restoring the body’s immune systems.

 

It was estimated in 1970 that a representative sample (252) of Issels’ patients with late stage cancers (of whom 7 had late stage ovarian cancer) showed a 16.6% five-year survival following his treatment. This compared with less than 5% with standard treatment at the time. They also experienced a 15% 15-year survival compared with less than 2% for standard treatment. This long-term surviving group included some of the women with ovarian cancer.

 

References: (Issels, J. Immunotherapy in Progressive Metastatic Cancer – A Fifteen-Year Follow-up. Clinical Trials Journal, August 1970: 357-365 – editorial by Phillips S. Dr Joseph Issels and the Ringberg Klinik. Clinical Trials Journal. August 1970: 355-56.)

 

The above studies, that include RCTs, show that systemic therapies are much more successful than therapies based on the orthodox paradigm.

 

For ovarian cancer, Ralph Moss (Cancer Therapy, The Independent Consumers Guide to Non-Toxic Treatment and Prevention) reports the following alternative therapies have been shown to benefit in addition to Iscador mentioned above:

 

  1. Dimethyl Sulphoxide (DMSO) – This is a solvent derived from wood fibre in trees. It is present in small quantities in the human body. Its medicinal qualities were identified in the 1960s.

One of its many beneficial properties discovered was that it enhances the effect of other chemicals and drugs in the body. In particular it was found to increase the efficacy of many types of chemotherapy. This meant that their dosages could be reduced along with the severe side effects.

 

A variety of standard drugs was tested in samples of 24 malignant ovarian tumours. In each case a 10% solution was used. There were 14 different responses that were better when DMSO was added to the chemotherapy than with the chemotherapy alone.

 

The scientists concluded that “this is strong evidence that 10% DMSO really improves the performance of chemotherapy”. They concluded that DMSO “may be useful in the treatment of certain ovarian cancers…Lower doses of anti-neoplastic agents might be delivered in DMSO producing the same cytotoxic (cell-killing) effect as a full dose of drug without DMSO but with less systemic toxicity.”

 

References: Pommier RF et al. Synergistic cytotoxicity between dimethyl sulfoxide and antineoplastic agents against ovarian cancer in vitro. Am J Obstet Gynecol.(1988); 159: 848-52.

 

Pommier RF et al. Cytotoxicity of dimethyl sulfoxide and antineoplastic combinations against human tumors. Am J Surg. (1988); 155: 672-6.

 

  1. Hydrazine sulphate – This is a common industrial chemical that was used as a component of rocket fuel during World War II. It was first proposed as a cancer treatment in the early 1970s by Joseph Gold MD, of the Syracuse Cancer research Institute, NY.

 

Gold drew on the work of Nobel laureate Otto Warburg, who theorised that cancer derived its energy needs from anaerobic glycolysis (fermenting sugar) rather than respiring in the normal way using oxygen. Gold proposed using chemicals to control cancer’s growth by exploiting this process.

 

Gold suggested that by cutting off a tumour’s supply of new glucose formed in the liver, the drug could starve the tumour and slow down its growth. In would also stop the cancer from depleting the body’s energy pools and put an end to cachexia, the terrible wasting process that often appears in the final stages of the disease. It is this wasting process that often kills the cancer patient and is estimated to cause ~40% of all cancer deaths.

 

A team of 11 scientists at the N.N Petrov Research Institute of Oncology in Leningrad have been working on hydrazine sulphate since the 1970s. The Russians have had the greatest single experience with hydrazine sulphate having treated and evaluated over 740 patients, including ovarian tumours. All patients in this study had already received conventional treatment without effect and were practically in the terminal phase of their disease. This study of the effects of hydrazine sulphate on 740 cancer patients found that 29% experienced at least a stabilisation of the tumour. Of the 6 patients with ovarian cancer 1 showed tumour stabilisation, 2 showed <25% regression (tumour shrinkage) with all three (50%) showing a moderate reduction in symptoms; the other 3 showed continued tumour growth with no reduction of symptoms.

 

References: Filov VA et al. Results Of Clinical Evaluation Of Hydrazine Sulfate. Vopr Onkol 1990;

36 (6): 721-726.

 

  1. Coley’s Toxins

 

These are mixed bacterial vaccines developed by William Coley MD in the 1970s after he observed that many people with cancer went into remission after having an acute infection that caused a fever. They are effective with a wide range of cancers. For example

 

Survival among 896 advanced cancer patients, 523 inoperable, 373 operable:

46% 5-year survival with inoperable tumours

50% 5-year survival for operable, including:

  • ovarian cancer – 67% five year survival

 

These survival figures were well above those achieved with conventional treatments at the time. (CISS)

 

References: Nauts H. Bacteria and cancer – antagonisms and benefits. Cancer Surv. 1989; 8: 713-23.

Prevention

 

If you or someone close to you has just been diagnosed with ovarian cancer it is important that you research and understand your chosen treatment, whether that be conventional, alternative or a mixture of both. For the best results your treatment should include physical, mental, emotional/psychological and spiritual treatments.

 

For more information on some more common evidenced based alternative treatments please go to the Alternative treatment tab. If you don’t know where to begin in your journey to wellness then we suggest you read Where to start.

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