Clock is ticking for ovarian cancer

If a woman is diagnosed with early stage ovarian cancer, her chance of survival is high. But early detection tests don’t exist, yet. Our researchers are on the cusp of calling time for ovarian cancer.

Clock is ticking for ovarian cancer
Photo by National Cancer Institute / Unsplash

by Carmen Swadling at the University of Newcastle

If a woman is diagnosed with early stage ovarian cancer, her chance of survival is high. But early detection tests don’t exist, yet. Our researchers are on the cusp of calling time for ovarian cancer.

It only took three dances. After that, Dubbo farmer Brian Schloeffel knew he would marry Nola Giddings.

“Well, I suppose I was lucky – I was one of those blokes who was in love at first sight,” 78-year-old Brian says.

“I was in fifth year and she was in third year. And she grew rather beautifully, very quickly.”

But Brian had to work hard for young Nola’s attention.

Young Brian and Nola at their wedding

As Vice-Captain of Dubbo High School, in central west NSW, he and the prefects were tasked with getting the school’s 950 students to class on time, hurrying them along as they dawdled.

“So, we're out there saying ‘get going’, you know,” Brian recalls.

“And the first time I met her after that I said, ‘would you like to go out?’ She said, ‘No, I don't like you, you’re too bossy’.”

A fortnight later the pair shared three dances at Rawsonville Hall.

“Afterwards, I said to the boys I would marry her. But at that stage, she still couldn't stand a bar of me.   About 12 months on I think she gave up, the poor girl, because she knew I wasn't going to,” he relays with a cheeky laugh.

Brian and Nola were married 49 years, a milestone reached just two weeks before ovarian cancer claimed the love of his life.  Nola was 69.

“God wouldn't put breath into a better lady,” he says as his voice begins to strain.

Brian’s eyes exude a deep love for his Nola, but so too, a deep pain as they begin to glisten with tears.

“I loved her dearly. I still love her.”

Trauma tests love and commitment

Life sent a cruel test early in Brian and Nola’s marriage, that would either make them or break them. A farm accident claimed the life of their firstborn, a daughter.

“We were lucky enough to get through it with total commitment. She dragged me on, and we were blessed with the three boys,” Brian said.

Outnumbered by her boys, Nola took no prisoners.

“I always joked,” Brian says, “there were four men and one woman and we always lost every argument,” he chuckles.

The strength Nola had for her family was just as evident in her love for her local community.

Easily labelled the perfect wife, mother and friend to all who knew her, Nola served in Red Cross, Women in Agriculture and was a Country Women’s Association (CWA) member of her local Wongarbon branch for more than four decades.

Video

Clock is ticking for ovarian cancer

VIDEO: Penny Harnett.

The devastating diagnosis

In 2017 Nola began experiencing abdominal pain and bloating, a loss of appetite and was constantly exhausted, more so than usual.

She suspected something was wrong. But like many women, Nola was told by a doctor it could be indigestion or a number of other minor ailments.  An ultrasound failed to confirm any medical issue, however months later Nola was still feeling unwell - and she deteriorated - rapidly.

Following a two week stay in Sydney for Brian to undergo a double knee replacement, the couple started to make their way home. It was a Sunday.

“By Wednesday she was critically ill. I think she knew she was gone but she never said anything.  As soon as we got to the private hospital, they did a CAT scan and there it was,” Brian said.

It was Stage 4 ovarian cancer.

Nola spent 26 days in ICU as her family rallied around her.

"We were all shattered by the news.  We found out later that Nola had pleaded for a CAT scan and was given an ultrasound," Brian said.

“You’re blown away by the prognosis. And the fact that we didn't know a damn thing about it, and here it was – going to take the life of my angel, my rock.”

Nola had to decide whether to have treatment, or as Brian explains, ‘leave her cue in the rack’.

“I am bull-headed, so I said we’ll go on, you know, because the end result, you could never, ever consider. Nola said, ‘right here we go’.”

Ovarian cancer has deservedly earned a reputation as a ruthless, silent killer. It is the deadliest gynaecological cancer – with no early detection test available, yet.

It claims the life of one woman in Australia every eight hours – more than 1000 women a year.

The State of the Nation Audit, commissioned by the Ovarian Cancer Research Foundation (OCRF) in 2020, estimates the development of a reliable early detection test for ovarian cancer could potentially save 1.3 million lives globally over the next decade.

While advances in surgery, chemotherapy and radiation therapy over the past 20 years have led to improved outcomes, overall, the five-year survival rate is only 40 per cent, compared with 90 per cent for breast cancer and 67 per cent for colorectal cancer.

Ten months after her diagnosis, Nola passed away.

It’s left the Schloeffel family, Brian and sons Brett, Andrew and Craig, “completely busted”.

Brian and Nola Schloeffel wedding party
Younger Brian Schloeffel kissing wife Nola
Older Brian kissing Nola on cheek at award ceremony
Brian and Nola Schloeffel with sons Brett, Andrew and Craig
Nola and Brian Schloeffel fire fighting award
Brian Schloeffel and his sons Brett, Andrew and Craig have used their local media to spread awareness of ovarian cancer and the need for an early detection test.
Brian Schloeffel and his sons Brett, Andrew and Craig have used their local media to spread awareness of ovarian cancer and the need for an early detection test.

Desperate to make a difference, they’ve been on a mission to help spread awareness about ovarian cancer through their local media and via community groups such as the CWA.

It led them to Professor Pradeep Tanwar.

After discovering an online article on his research into gynaecological diseases, they reached out to Pradeep.

“By chance, we had one of these big CWA meetings in Dubbo coming up. So, my son Brett rings Pradeep, and said ‘would you like to come out?’ And that he did.”

Born from incredible loss, it was the beginning of a special friendship.

Dubbo farmer Brian Schloeffel and Professor Pradeep Tanwar
Dubbo farmer Brian Schloeffel and Professor Pradeep Tanwar.

Global push to bolster women’s gynaecological health

Women's reproductive health and gynaecological diseases are an understudied area.

Professor Tanwar leads a 35-strong team of researchers in the University of Newcastle’s Global Centre for Gynaecological Diseases, which is dedicated to improving the health of women through innovative research that informs better healthcare. It focuses on five streams: ovarian cancer, endometrial cancer, endometriosis, vulvovaginal diseases and fibroids.

Poor understanding of ovarian cancer’s pathobiology, the lack of an early detection test and significant chemoresistance of the late-stage of the disease are some of the key reasons for poor outcomes, which are much worse for women in regional and rural areas, compared to metropolitan centres.

“Brian found me online and wanted to have a chat with me. He was quite specific – he was looking for someone who works in this area, but also quite driven to make a difference for early detection,” Pradeep said.

Professor Pradeep Tanwar

The driving factor why ovarian cancer needs an early detection test is that 75 per cent of patients are diagnosed when nothing can be done.

“And ‘nothing’ means you can improve survival, you can enhance survival, but the disease has usually spread too far. The majority of patients will develop chemo resistance, and ultimately, you will have a very bleak outcome for those patients."

Ovarian cancer is often assumed to be cancer of ovary, but Pradeep says that's not entirely true.

“For example, high-grade serous ovarian cancer, which is the most common subtype, was previously thought to originate in the ovaries but actually arises from precursor lesions that begin in the fallopian tubes - and then it spreads like wildfire, invading adjoining vital organs, causing a lot of vague symptoms,” Pradeep explains.

“Women can experience bloating, weight loss, abdominal pain and cramps, along with stomach and gut problems and issues with the bladder, exacerbating back pain.  It can also affect the cervix and vaginal epithelium, causing pain, bleeding and cramps during sex.”

The problem is – many of these symptoms can be attributed to a menstrual cycle.

If there’s a silver lining, it’s that research has shown for the 25 per cent of women who are ‘fortunate’ to be diagnosed early, they can be cured with current treatment approaches.

It’s the holy grail Pradeep and his team have made significant inroads in reaching.

Over the past six years, and with significant philanthropic and industry support of the centre, they have discovered and patented a blood-based biomarker test targeted at the detection and risk categorisation of early-stage ovarian cancer. The team has validated the ultrasensitive test in 500 women with 90 per cent accuracy.

"Without a diagnostic test for ovarian cancer, how can you make an early intervention with treatment that will be effective at that early stage?"

“An ultrasound will not pick it up. By the time a woman reaches a specialist, and they have a CAT scan - which will catch it, it's often too late,” Pradeep explains.

But more than an early detection test, the team is also aiming to create a triaging tool to support general practitioners. It will mean women who present with a cluster of vague symptoms can have ovarian cancer ruled out, or, if they test positive for the ovarian cancer biomarker, can be quickly referred to a CAT scan, which can confirm a positive diagnosis and expedite their treatment.

“It takes four to 11 years from the early ovarian cancer stage to become a full-grown disease,” Pradeep says. “That means if you have an opportunity to stop it early, you’ve got plenty of time.

“That's what bothered Brian. If Nola had been diagnosed earlier, they would be living a normal life but instead his life has been turned upside.”

On the healthcare frontline

Gynaecological oncologist Dr Rachel O’Sullivan knows too well the impact an ovarian cancer diagnosis can have on a family.

“They're usually someone's mum, they're someone's grandmother. And so often, they're the core of the family. So, it can be a huge shock and a huge disruption knowing that mum or grandma has cancer.”

Rachel is Director of the Hunter New England Centre for Gynaecological Cancers, which provides coordinated and individualised care for women undergoing investigations and treatment for gynaecological cancers.

“It's a great job, but it's certainly very tough at times,” Rachel says.

“Usually, we're in the position where we can offer some form of treatment – a way forward. It's very unusual we would say we can't do anything, but certainly, we have some hard conversations and some days it hits you more than others.”

Gynaecological oncologist Dr Rachel O'Sullivan
Director of the Hunter New England Centre for Gynaecological Cancers Dr Rachel O'Sullivan.

The treatment for ovarian cancer involves an operation to remove as much of any visible cancer as possible. This surgery is called cytoreductive or radical debulking surgery.

Surgery routinely involves the removal of the uterus and fallopian tubes and ovaries, the omentum and peritoneal disease (the peritoneum lines the abdominal cavity and covers the organs). Less commonly, surgery may involve removal of parts of the bowel, bladder or liver, or removal of the spleen.

As surgery alone will not remove all the cancer cells, women also undergo chemotherapy in an attempt to cure their cancer. They either have three cycles of chemotherapy before their surgery, followed by the remaining three cycles (neoadjuvant chemotherapy), or six cycles of chemotherapy after their surgery.

“The earlier you detect a cancer, the better the prognosis, the better the survival.”

Rachel says an early detection test would be a game changer. As would more individualised or targeted therapy.

In support of the end game, Rachel is on board as a valued clinical partner with the University’s Global Centre for Gynaecological Diseases, which fosters close collaboration between researchers from the University, Hunter New England Health, Hunter Medical Research Institute, John Hunter Hospital, Calvary Mater Hospital and Lingard Private Hospital.

All eyes on the prize

The centre is the first of its kind in the world to mobilise leading researchers and clinicians, industry partners, philanthropic organisations and community organisations to advance translational research in gynaecological diseases.

The strong emphasis on collaboration is deliberate.

By bringing together world-leading gynaecological researchers, PhD students, early career researchers, clinical and professional staff – who are involved from patient care to discovery research – it is hoped the centre will provide outcomes that revolutionise health care for millions of women.

The five-year objective is to launch the ovarian cancer early detection tool for community use.

And Pradeep believes it is achievable.

He acknowledges his confidence in reaching this goal would not exist without the significant ongoing support from a number of anonymous donors and industry bodies.

To date, the centre has received more than $23m in funding from the National Health and Medical Research Council, the Australian Research Council, Cancer Council NSW, the Ovarian Cancer Research Foundation, the Australian Government, industry partners and philanthropic donors.

“I'm proud of my team and the research we do,” Pradeep says, as he reflects on the time when he was a team of one, with only $500 left in his research fund.

“I feel very grateful there are so many people who are interested in supporting our work.

“And I feel like the best is yet to come because we are getting closer to our goal.”

Director of the University's Global Centre for Gynaecological Diseases, Professor Pradeep Tanwar and team member Ms Isabella Moore.
Director of the University's Global Centre for Gynaecological Diseases, Professor Pradeep Tanwar and team member Ms Isabella Moore.
Expertise from all corners of the globe including France, India, Bangladesh, Malaysia, Singapore, Nigeria, Australia, Ethiopia and Sweden bring different perspectives to the Centre. Himself originally from India, Pradeep says diversity helps develop and deliver better outcomes. “Our motivation is common, but it has different languages.”
Expertise from all corners of the globe including France, India, Bangladesh, Malaysia, Singapore, Nigeria, Australia, Ethiopia and Sweden bring different perspectives to the Centre. Himself originally from India, Pradeep says diversity helps develop and deliver better outcomes. “Our motivation is common, but it has different languages.”
With the backing of significant philanthropic and industry support, Pradeep and his team have discovered and patented a blood-based biomarker test targeted at the detection of early-stage ovarian cancer.
With the backing of significant philanthropic and industry support, Pradeep and his team have discovered and patented a blood-based biomarker test targeted at the detection of early-stage ovarian cancer.
Professor Pradeep Tanwar and Senior Research Assistant Florence Bartlett
Professor Pradeep Tanwar and Senior Research Assistant Florence Bartlett
Professor Pradeep Tanwar spoke to more than 600 Country Women's Association members about ovarian cancer at their 2023 State Conference in Bathurst.
Professor Pradeep Tanwar spoke to more than 600 Country Women's Association members about ovarian cancer at their 2023 State Conference in Bathurst.

CWA - Chicks With Attitude

Eager to learn more about the potentially life-changing work of Pradeep’s team, Brian and his son Brett called in to visit him at the University’s Callaghan campus in Newcastle.

“So, we’re wandering through these massive buildings of the University of Newcastle. We thought, we'll get 10 minutes. Two hours later - the whole box and dice!

“We said, if this bloke is good enough to show us his time, then we'll do whatever we can to help.  And the one unit that can help us is the CWA. It’s not Country Women, it’s ‘Chicks with Attitude’,” Brian says.

In May this year, Pradeep entered the Bathurst Memorial Entertainment Centre to the murmuring of 600 CWA ladies mingling.  It was their 2023 State Conference, drawing members from all corners of NSW from Cobar to Coonamble, Coffs Harbour to Cowra.

Later taking to the stage, Pradeep shared startling facts and figures to a captive audience to raise awareness of ovarian cancer and explained how his research team was working hard to improve outcomes, particularly in regional areas.

“We don't need to accept that we lose 1000 women in Australia every year from ovarian cancer, who are dying because healthcare is unable to protect them.

“Only a few years ago, testicular cancer used to be a death sentence. Now, 96 per cent of people with testicular cancer will survive.

"If we can go to the moon, if we can communicate between different continents, then improving the outcomes for 1000 fellow Australians is not a tough ask."

The conference was another chance for Brian and Pradeep to catch up, their warm friendship unmistakeable as Brian planted more seeds about how they could raise awareness of the ‘silent killer’ in rural and regional areas.

In recognition of the devastation the ‘silent killer’ causes women and their families, the CWA State branch’s current three-year medical research project is supporting ovarian cancer as its cause. For the second year in a row, CWA NSW made a donation to Pradeep and his team, this time for $36,500, to help continue their important work.

Born from incredible loss, Brian Schloeffel and Professor Pradeep Tanwar have built a friendship dedicated to lessening the impact of ovarian cancer.

Days are numbered for ovarian cancer

When Brian lost his Nola in 2017, he decided to channel his grief into something that would have a positive impact.

“I was the richest man on Earth. I adore my wife, I’m still madly in love with her. By helping other people, she's not gone,” Brian says.

Pradeep dreams of a world where his wife and two young daughters know ovarian cancer can be detected early and women can be cured.

“We want to be able to save women’s lives. It’s people like Brian who inspire us to keep going.”