Jianyu Rao, MD, professor and chief of Cytopathology, University of California, Los Angeles, discusses testing for somatic and germline mutations in patients with ovarian cancer.

Rao says that when a patient is diagnosed with ovarian cancer, clinicians often follow a set of algorithms to help approach genetic testing. For example, a group from Johns Hopkins Medicine has developed an algorithm to simultaneously analyze proteins and genes together with the hope of improving early detection. This technique is still relatively new, and physicians are still waiting for evidence as to whether it is clinically useful in this population.

He adds that with a better understanding of BRCA genes, pathologists can move forward with developing noninvasive approaches to treatment. Testing for mismatch repair deficiency is another recommendation for treatment. There are ways pathologists can improve early detection of ovarian cancer as well, Rao concludes.

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Dr. Rao on Testing for Somatic and Germline Mutations

Jianyu Rao, MD, professor and chief of Cytopathology, University of California, Los Angeles, discusses the histogenesis of endometrial cancer.

There is some overlap in the histogenesis of endometrial cancer and ovarian cancer, says Rao. Cervical cancer, however, has a completely different histogenesis that is often related to an HPV infection, says Rao. Endometrial cancer is typically classified by 2 categories—tumors that are associated with high levels of estrogen, and tumors that are associated with low levels of estrogen.

Endometrial cancers can be classified as type 1 endometrial tumors or type 2 serous cancers. That distinction is often made by histology. Testing for mismatch repair deficiency and microsatellite instability is now recommended to help improve classification and treatment. Pembrolizumab (Keytruda) is the first agent to be FDA-approved based only on histology.

Ovarian cancer is identified by estrogen, but the other gynecologic cancers are more related to the genetic changes of the particular gene in question, states Rao.

Dr. Rao on the Histogenesis of Endometrial Cancer

Jianyu Rao, MD, professor and chief of Cytopathology, University of California, Los Angeles, discusses improving methods of early detection of ovarian cancer.

In discussions regarding the relationship between genes and histology, physicians and pathologists are trying to determine if there is a way to improve early detection approaches, says Rao. One thing that Rao believes that there must be a better understanding of not only the BRCA genes, but other genes that may be involved in more sporadic cancers. Then, physicians can develop and refine non-invasive approaches like liquid biopsies.

The Hopkins group developed an algorithm to simultaneously analyze proteins and genes together with the hope of improving early detection. However, Rao notes that physicians and pathologists are still waiting to see if it will be clinically useful or not.

Jianyu Rao, MD

Articles

Dr. Rao on Testing for Somatic and Germline Mutations

Dr. Rao on the Histogenesis of Endometrial Cancer

Dr. Rao on Improving Methods of Early Detection of Ovarian Cancer