September is Ovarian Cancer Awareness Month. Ovarian cancer is the seventh most common type of malignant neoplasm in women and the eighth cause of mortality for women (Gaona-Luviano et al, 2020). In women who have died from gynecological cancers, ovarian cancer is the leading cause of death (Arora et al., 2021). This type of cancer can originate from any of the ovary's three main components, including the epithelium, stroma, and germinal cells. Per Gaona-Luviano et al., 2020, “epidemiology of this cancer shows differences between races and countries due to several factors including genetic and economic.” Detection of ovarian cancer is problematic because there is no standardized screening process and most cases of ovarian cancer are found in the advanced stages (Gaona-Luviano et al, 2020).

How is ovarian cancer diagnosed?
Sadly, the existing screening tests have a low predictive value. A gynecological evaluation, transvaginal ultrasound, and tumor marker testing (cancer antigen-125/CA-125 assay) can help with early detection strategies but this has not shown a significant effect on the morbidity or mortality of this cancer (Arora et al., 2021).

How is ovarian cancer treated medically?

Research shows that the standard line of care treatment includes surgery and platinum-based chemotherapy. Additional options including anti-angiogenic bevacizumab and Poly(ADP-ribose) polymerase (PARP) inhibitors have also been used more recently. (Arora et al., 2021)

What are the outcomes of an ovarian cancer diagnosis?
There is a high rate of recurrence after the initial detection treatment. Many of the cases re-occurred and these secondary cases were less curable with increased incidence of treatment failures (Arora et al., 2021).

What are ovarian cancer risk factors?
Some risk factors include advanced age, early menarche, late menopause, family history, nulliparity, obesity, perineal talc use, smoking, endometriosis, and hormone replacement therapy (Arora et al., 2021). Some protective factors include oral contraceptives, bilateral tubal ligation or salpingectomy, breastfeeding, and multiparity (Arora et al., 2021).

Some research shows there may be some health disparities in the diagnoses between Non-Hispanic Black women compared to Non-Hispanic White women. In a study by Washington et al. in 2023 53,367 women were included in the analysis with the profile being 82% Non-Hispanic White, 8.7% Non-Hispanic Black, 5.7% Hispanic, and 2.7% Non-Hispanic Asian/Pacific Islander. They found that the Non-Hispanic Black race was associated with a higher risk of death than Non-Hispanic White race and Non-Hispanic Black women versus Non-Hispanic White women had an increased risk of mortality among those with low and mid socioeconomic status groups.

In response to this potential inequity, the National Cancer Institute has launched 3 studies to look at these patterns to “better understand the causes of racial and ethnic disparities among women with ovarian cancer.” These studies will examine whether the treatments with these patient populations were consistent with standard clinical guidelines and ensure all patients received quality care. Additional studies will look at a “cells-to-society approach” to assess the biology behind these trends. In both cases, the researchers will assess a range of potential factors that can affect disparities, from the molecular makeup of tumors to environmental factors, and comorbidities (NCI, 2024).

What can pelvic health providers do to help?
As pelvic health providers, we can educate ourselves on how best to screen and refer our patients to ensure early diagnosis and medical treatment if we hear anything suspicious. It is difficult to self-advocate in this current medical climate and having a skilled provider guiding the questions to ask and the support to seek is invaluable. If a patient is already into their treatment journey, we can provide the needed rehabilitation support including things like coordination and strengthening of the core and pelvic floor, stretching and positioning to lengthen tight areas, scar mobilization, patient education, and symptom management with the patient for any symptoms that may pop up throughout their course of care.

If you’re unsure that you have these skills in your skill set, please check out the Oncology of the Pelvic Floor Series to gain more knowledge and experience in these areas to better help patients with these diagnoses. Certified Lymphatic Therapists may skip this course and move on to the level Oncology of the Pelvic Floor Level 2A and Level 2B courses.

• Oncology of the Pelvic Floor Level 1, next scheduled for November 2-3, 2024, is the first course in the series and focuses on topics that prepare practitioners to be part of the interdisciplinary oncology team. Topics will include the basics of cancer: terminology, staging, medical treatment, and the sequelae of these medical treatments. These topics include the lymphatic system as well as issues that are commonly seen in a patient who has been diagnosed with cancer such as cardiotoxicity, peripheral neuropathy, and radiation fibrosis.
• Oncology of the Pelvic Floor Level 2A, (not yet scheduled for 2025), builds on information presented in Oncology of the Pelvic Floor Level 1 and focuses on male pelvic cancers (prostate cancer, penile cancer, and testicular cancer), colorectal cancer, and anal cancer including risk factors, diagnosis, and prognosis. Topics discussed include sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life, rehabilitation, and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy. Participants MUST register with a partner, or plan to have a volunteer available to work on during course labs.
• Oncology of the Pelvic Floor Level 2B, next scheduled for December 7-8, 2024, builds on information presented in Oncology of the Pelvic Floor Level 1 and focuses on gynecological and bladder cancers including risk factors, diagnosis, and prognosis. Topics discussed include sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life, rehabilitation, and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy. Participants MUST register with a partner, or plan to have a volunteer available to work on during course labs.

References:

• Arora, T., Mullangi, S., & Lekkala, M. R. (2021). Ovarian cancer.
• Gaona-Luviano, P., Medina-Gaona, L. A., & Magaña-Pérez, K. (2020). Epidemiology of ovarian cancer. Chinese Clinical Oncology, 9(4), 47-47.
• NCI. Ovarian cancer studies aim to reduce racial disparities. Ovarian Cancer Studies Aim to Reduce Racial Disparities - NCI. (2024, June). https://www.cancer.gov/news-events/cancer-currents-blog/2020/ovarian-cancer-racial-disparities-studies#:~:text=Credit:%20iStock,impeded%20research%20in%20this%20area.
• Washington, C. J., Karanth, S. D., Wheeler, M., Aduse-Poku, L., Braithwaite, D., & Akinyemiju, T. F. (2024). Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy. Cancer Causes & Control, 35(3), 487-496.

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

Allison Ariail, PT, DPT, CLT-LAANA, BCB-PMD is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides and Nicole Dugan among others.

March is Colorectal Cancer Awareness Month. Did you know that the incidence rate of colorectal cancers is increasing? According to the International Agency for Research on Cancer, 1.9 million new cases of colorectal cancer were identified worldwide in 2020. This number is expected to grow even more. It is predicted that by 2040 the number of new cases of colorectal cancer will rise to 3.2 million new cases a year, and 1.6 million annual deaths worldwide. Additionally, did you know due to the fact that the incidence rate is increasing and it is being diagnosed in younger individuals, the age for screening for colorectal cancer has lowered to 45? At age 45 individuals should begin regular screening for colorectal cancer either via stool-based testing or visual-based screening via a colonoscopy. If someone has risk factors they may need to begin screening at a younger age. 

Colorectal cancer can often be preventable through modifiable risk factors. Changing some of these risk factors, alongside the detection and removal of precancerous lesions can lower someone's risks.  However, if a diagnosis is made, treatment can help to prolong the life of the patient. The treatment can include various surgeries, chemotherapy, and radiation. All of these treatments can cause changes to a patient's body. A rehab professional that has knowledge about both the body and how the medical treatment of cancer causes changes, can make all the difference in the world for that patient returning to activities that they enjoy and love after treatment.

There are not many opportunities for rehab professionals to learn about these changes and how we can help these patients. However, Herman & Wallace has a series focused on helping oncology patients. In this series, techniques are learned that can help colorectal cancer patients recover from their diagnosis and the medical treatment they go through. The oncology series is online and offered several times a year. You can attend the upcoming oncology courses on: Oncology of the Pelvic Floor Level 1 scheduled for July 8-9 and December 2-3, Level 2A scheduled for May 20--21, and Level 2B scheduled for December 9-10.

Reference:

Morgan E, Arnold M, Gini A, et al.  Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN.  Colon. 2023; 72(2).

*Certified Lymphatic Therapists may skip Oncology of the Pelvic Floor Level 1 and move on to the Level 2A and Level 2B courses.*

Oncology of the Pelvic Floor Level 1 - no partner needed for registration
Price: $550.00          Experience Level: Beginner          Contact Hours: 17.5 hours

Oncology of the Pelvic Floor Level 2A - partner needed for registration
Price: $495.00          Experience Level: Intermediate          Contact Hours: 17.25 hours

This course was designed to build on the information that was presented in Oncology of the Pelvic Floor Level 1.

Information will be provided focusing on male pelvic cancers, colorectal cancer, and anal cancer including risk factors, diagnosis, and prognosis. The participant will also understand the sequelae of the medical treatment of cancer and how this can impact a patient's body and quality of life. Other topics include rehabilitation and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy.

Course Dates: May 20--21

Oncology of the Pelvic Floor Level 2B - partner needed for registration
Price: $600.00          Experience Level: Intermediate          Contact Hours: 19.25 hours

This course was designed to build on the information that was presented in Oncology of the Pelvic Floor Level 1.

Information will be provided focusing on gynecological and bladder cancers including risk factors, diagnosis, and prognosis. The participant will also understand the sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life. Other topics include rehabilitation and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy.

Course Dates: December 9-10

Allison Ariail is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Practitioners who took the main Pelvic Floor course still weren’t sure how to handle oncology tissues, what they could do, or how to treat these patients. Thus the oncology series was created to provide additional instruction for treating pelvic cancer patients.

Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides, Nicole Dugan, Tina Allen, Jennafer Vande Vegte, and Megan Pribyl.

The Oncology Series is comprised of three different courses, with the first course, Oncology of the Pelvic Floor Level 1, designed as an overview of the oncology world. Allison explains that the reason level 1 is an introduction is that “this is because the oncology medical world is so different from what a lot of rehab professionals are used to.”

Oncology of the Pelvic Floor Level 2A addresses colorectal cancers, anal cancers, and cancers that affect male genitalia. New information about how to treat prostate cancers is also discussed. The third course, Oncology of the Pelvic Floor Level 2B, is being launched this year in 2022 and covers gynecological cancers and bladder cancers. The tentative launch will be in November 2022.

There are a lot of labs in all of these courses that are specific to the side effects that these patients have after going through radiation and other surgical treatments. Oncology patients can have a range of problems from radiation fibrosis, range of motion issues, and weakness. While these patients may be seeing a certified lymphatic therapist, that CLT is not going to have time to address these additional issues. Allison Ariail explains, “that is where this knowledge from these courses comes in. Not just as a supplement for that patient, but as a completely different treatment, where that patient really needs to see both therapists. One for lymphedema and one for radiation fibrosis, or weakness, or other side effects, that can affect their quality of life.”

Certified Lymphatic Therapists can skip OPF1 or dive in at OPF2A or OPF2B as long as they have taken the main Pelvic Floor Level 1 course prior.

Oncology of the Pelvic Floor Series 2022 Schedule

Oncology of the Pelvic Floor Level 1

• January 29-30
• July 16-17
• December 3-4

Oncology of the Pelvic Floor Level 2A

• April 2-3
• August 20-21

Oncology of the Pelvic Floor Level 2B

• TBD – course launch is tentatively scheduled for November 2022
• If you are interested in attending this course, please contact us!