Q&A with Krishnansu S. Tewari, MD, FACOG , FACS
Q: I have just been diagnosed with ovarian cancer. What steps should I take to ensure that I receive the best possible treatment?
A: Perhaps the single most important thing you can do is seek care at a cancer center where providers have experience treating ovarian cancer. These centers, often referred to as “high-volume” centers because they treat many patients with the disease, are staffed with physicians who have extensive experience in treating ovarian cancer and provide the expertise you need.
- High-volume hospitals and high volume surgeons are more likely to practice and adhere to National Comprehensive Cancer Network (NCCN) Ovarian Cancer Treatment Guidelines; improved survival rates have been associated with patients treated according to NCCN guidelines.
- Seeking care with a high-volume provider will also help ensure that you receive an accurate diagnosis, which is incredibly important. In some cases, advanced cancers of the gastrointestinal tract (gastric cancer, colorectal cancer, hepatobiliary cancer, pancreatic cancer) can mimic ovarian cancer, so receiving an accurate diagnosis that will lead to the most appropriate treatment is key.
Q: Are there current advances in treatment or research that I should be aware of as I review my treatment options?
A: Absolutely. New and important advances include weekly dosedense Taxol® (paclitaxel) and intraperitoneal chemotherapy; heated intraperitoneal chemotherapy is also being studied at specialized centers. Be aware that, ideally, chemotherapy should be administered at an NCI-designated comprehensive cancer center. Cancer centers designated by the National Cancer Institute (NCI) are at the forefront of cancer research, so you will have access to the latest clinical trials of novel drugs, including anti-angiogenesis inhibitors and PARP inhibitors.
Q: What steps can I take throughout treatment to help maintain overall health and combat side effects?
A: Some steps you can take include the following.
- Maintain adequate caloric and protein intake. A dietitian who has experience working with cancer patients can help ensure that you are eating the best foods to meet your nutritional needs; inquire at your cancer center if there is a dietitian on staff to assist you, or seek a professional in your community.
- Exercise regularly, according to your ability.
- Maintain regular work hours as much as possible during chemotherapy, as this can help you retain a valuable sense of normalcy and productivity.
- Create a support network of friends and family; also, consider participating in an organized support group to connect with other patients.
- Laugh! The restorative power of laughter cannot be overemphasized; laughing can help you maintain a positive frame of mind, which may just boost your immune system.
Q: What steps can I take to optimize my time with my physician and make sure I am communicating effectively with my care team throughout this journey?
A: Preparing in advance for your appointment can help: write down any questions you want to remember to ask, and consider bringing a close friend or family member to each appointment, even when things are going well, to record the details of your conversation with your doctor.
Krishnansu S. Tewari, MD, is a boardcertified gynecologic oncologist and a professor at the University of California, Irvine. He earned a BS in molecular biology at the University of California, Berkeley, and attended medical school at the University of California, Irvine, where he also completed his OB/GYN residency and his fellowship in gynecologic oncology. Dr. Tewari is currently director of research in gynecologic oncology, co-chair of the cancer center’s Clinical Trials Protocol Monitoring and Review Committee, and principal investigator of the Gynecologic Oncology Group. He is also the director of the gynecologic oncology program at the St. Joseph Hospital Center for Cancer Prevention and Treatment. Dr. Tewari is recognized nationally for his contributions to both robotic oncologic surgery and the conduct of clinical trials in gynecologic malignancies. Dr. Tewari has published more than 70 peer-reviewed papers and numerous book chapters and is on the editorial boards of Gynecologic Oncology and Women magazine.
Symptoms of Ovarian Cancer
From Ovarian Cancer National Alliance
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Urinary frequency or urgency
- Additional symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation, and menstrual irregularities.
(These symptoms are not as useful in identifying ovarian cancer because they are also found as often in women who do not have the disease.)
If you have these symptoms more than 12 times during the course of one month and the symptoms are new or unusual for you, see your doctor, preferably a gynecologist. Experts suggest a combination pelvic/ rectal exam, a CA-125 blood test, and a transvaginal ultrasound.