Miami pediatrician Dr. Elsie Davila, who is battling ovarian cancer, is put at ease by her gynocologic oncologist Dr. Samer Schuman during a post surgery office visit at Sylvester Comprehensive Cancer Center, University of Miami L. Miller School of Medicine. Davila is one of about 20 women so far in South Florida to undergo HIPEC, a new surgical and chemotherapy treatment for ovarian cancer.
She spent decades of her life practicing medicine, so when Miami pediatrician Elsie Davila was diagnosed with ovarian cancer in 2009, she knew every reason to be afraid.
Ovarian cancer is the No. 1 killer among gynecological cancers. Survival, if not discovered early, can be a mere 20 to 30 percent. Making matters worse, the disease is difficult to detect until it spreads to other organs.
“I knew it was bad. I definitely had my concerns,” said Davila, 53, of Doral.
According to American Cancer Society estimates for 2012, about 15,500 American women will likely die from ovarian cancer this year. About 22,280 more women will be diagnosed.
“Compared to other cancers (with prostate at No. 1 followed by breast, lung and colon) the numbers are small but the disease is most deadly,” said Davila’s doctor, Dr. Samar Schuman, an assistant professor of gynecologic oncology at the University of Miami’s Miller School of Medicine.
While statistics are staggering, new hope is on the horizon.
After two years of surgeries and several chemotherapy programs proved ineffective, in April 2012, Davila became one of the first 20 women at the University of Miami Hospital to receive the latest, most promising treatment available for ovarian cancer — hypothermic intraperitoneal chemotherapy.
The hospital is the only medical facility south of Moffit Cancer Center in Tampa to offer the treatment, called HIPEC.
The New England Journal of Medicine in 2006 reported a national study that showed HIPEC can slow the cancer’s progression and increase patient survival rate.
More recent studies from France, Italy, Australia and Spain tout similar results.
University of Miami Hospital began using the procedure in November 2010. Schuman said all patients are faring well but only time will tell how effective HIPEC is for each individual.
“It’s too soon to have hard data yet, but the procedure is proven to be safe and [results] have been encouraging. Theoretically, I am convinced it is a step in the right direction,” Schuman said.
Simply described, HIPEC is a 90-minute wash of the entire peritoneal (abdominal) cavity using an intense solution of chemotherapy heated to about 107 degrees Fahrenheit.
Typically, Schuman said, the accepted standard treatment for the disease is the surgical removal of tumors followed by rounds of intravenous chemotherapy. Additional rounds of chemo, delivered by tubes placed in the abdomen directly at the disease, provide more punch.
Still, ovarian cancer returns in about 75 percent of patients.
Dr. Michel Vulfovich, a chemotology oncology physician at Memorial Cancer Institute at Memorial Regional Hospital in Hollywood, said ovarian cancer can recur a month after treatment.
“It only takes one cell resistant to the therapy for the cancer to start again. The likelihood of cancer in other parts of the body is more than possible — it is probable,” Vulfovich said.
Another problem is that different kinds of ovarian cancers act uniquely from one woman to the next.
“We’ve treated some with very advanced ovarian cancer who were cured and others who came in early who were not. We can have 10 patients with the disease and 10 totally, completely different cases,” Vulfovich said. “We just don’t fully understand the biology of the tumors.”
Many cancer centers, including Memorial, are adding new antibodies Avastin and AMG-479 to treatments to slow the cancer’s growth. Both antibodies are in clinical trials.
With HIPEC, the abdomen is slit open to expose the peritoneal cavity and remove all visual tumors on the ovaries and other organs. Outflow and inflow catheters are inserted and then connected to a pumping machine. The abdomen is then stitched closed to allow intense chemotherapy fluid, heated to about 107 degrees, to circulate through the abdomen.
The abdomen is massaged and shaken to ensure chemo distribution to all surfaces and organs. After 90 minutes, the incision is reopened, the fluid is drained and the abdomen washed with saline.
The procedure takes from five to 12 hours.
Davila didn’t see it coming.
Ovarian cancer is one of the least detectible cancers because vague symptoms such as fatigue, abdominal swelling or discomfort, trouble eating or frequent urination, can indicate common ailments that soon pass. A visit to the gynecologist is urged when symptoms persist for two or more weeks.
“Let me tell you — I had no appetite, my energy was low and my stomach was a little upset but I never thought it was cancer. I didn’t even go to the gynecologist — I went to the proctologist thinking a hemorrhoid had flared up,” Davila said.
An exploratory CT scan discovered tumors and Davila was scheduled for surgery the same day. She had Stage 3 ovarian cancer that had spread to her abdomen.
“HIPEC is not the first choice for fighting ovarian cancer. Going to your gynecologist annually and catching it in the first stage is much better,” Davila said.