A lot of new developments in treatment, eg PARPs and genetic testing, refer to all non-mucinous ovarian cancers, allowing for some mucinous tumours which do not originate in the ovary. Could the panel explain why this type is excluded and what the implications are for the future understanding and treatment of this type of ovarian cancer?
Some types of ovarian cancer behave like bowel tumours and produce mucous - they’re the mucinous tumours. The ones that produce mucous are associated more with bowel type symptoms and so there may be a case for treating them more like bowel cancers than the standard ovary cancers. That’s why you need to know what type your disease is, because they behave differently.
If you’ve got a mucinous tumour, you don’t have a BRCA gene mutation that is relevant to your ovary cancer, so your family doesn’t have a BRCA gene mutation that you need to screen for. Ovary cancer is not one disease, it’s lots of different diseases.
Mucinous tumours are more commonly treated with surgery, rather than chemotherapy, because we know from evidence that they’re not very chemotherapy responsive. You have to tailor your treatment according to the histology.
Mucinous tumours are a different subset of cancer and maybe that is why it hasn’t been included in the majority of the trials - but I think as evidence matures and as the new medications like the PARP inhibitors come along, they have started to test them in BRCA negative tumour types, including the mucinous. I think the data are not there yet, but they will be.