Biomarker Testing for Ovarian Cancer: Evelyn’s Journey

Biomarker testing looks for genetic changes, proteins, or tumor characteristics that give doctors clues about how cancer behaves. These results help guide personalized treatment options.

Common biomarkers include CA-125 (a blood protein used to monitor response), BRCA1/2 mutations (hereditary risk factors and treatment indicators), and HRD (homologous recombination deficiency), which helps determine eligibility for PARP inhibitors.

No. Biomarker testing works alongside traditional treatments like surgery and chemotherapy. The results may guide whether targeted therapies, such as PARP inhibitors, should be added to your care plan.

It is best to discuss biomarker testing at the time of diagnosis or soon after surgery. The results can help shape your treatment journey from the beginning.

Yes. While access may vary, most oncologists can order these tests, and many insurance providers cover them. Always ask your care team about testing options.

Welcome to Teal Talk, an ovarian cancer podcast from the National Ovarian Cancer Coalition. Hear experts, survivors, and advocates share knowledge and inspiration for every step of your journey, subscribe and follow us on social media at NOCC National.

Jennifer McClendon: Today we are talking about biomarker testing, a valuable piece of information that may not only help explain why your cancer has formed, but also provide key information to how your cancer behaves so we can treat it better, and that’s the power of biomarker testing.

Evelyn: So I’m Jennifer McClendon, and this is Teal Talk. Evelyn, we are so glad to have you with us today to share your experience with biomarker testing and how it played a role in your treatment. Thank you. Happy to share my story. 

Jennifer McClendon: So tell us a little bit about yourself and when you were diagnosed with ovarian cancer? 

Evelyn: I’m a mom and a wife. I have two children. My son is 21 and my daughter is [00:01:00] 15. I was diagnosed October 17th, 2022. At the time I had a lot of things going on because my son, we were getting him ready to go away to school we were getting ready to go to Europe for a month that summer,

Evelyn: and during the long trip, there were times where the kids would say oh, you’re like slow, right? But I’m thinking, yeah, I have a. Bag. I have a backpack on. I’m hot, I’m a little bit slower. when I look back, I was significantly slower.

Evelyn: Like, they were surprised at how long it was taking me to make it up certain things or, ’cause I’m a, fast walker. It just, there was definitely a difference.

Evelyn: And then also with eating, my food felt like it was like just below my bus line. But part of our trip, we met family on a cruise.

Evelyn: I thought it was cruise eating because I don’t eat like that. You know, we were eating [00:02:00] at all hours. Your routine is completely thrown out the window. And when we came back in August, my focus was. I’m gonna detox, I gotta get back to my normal routine.

Evelyn: But I did start feeling some differences in my bowel movement. More effort there, which isn’t normal. A lot of friends were coming back from vacations and getting ready for September and we were discussing that and she was saying maybe we should see her. A gi and I was like, yeah, I should, but of course you talk about it. And so it was, that was early September I started to see my weight gain increase and it was more apron weight and when I would look up things, because I was 51 at the time, I chalked it up to that’s the prime age for menopausal. Symptoms to occur.. So I’m like, here we go. The body’s changing. It’s menopause time. This is normal. I’m gonna, try and get ahead of it. So I had that mindset.

Evelyn: My belly looked [00:03:00] maybe five months pregnant labeled this my Meno baby. And I remember speaking to my sister-in-law and I was like, this sucks. Menopause is terrible. You just wait. Everything was related to menopause.

Evelyn: And she said, maybe you should see a gynecologist, right? Because putting those together. So I was like, you know what? I should, so I get my appointment. Gynecologist feels a mass, and my ovary, she sends me for an ultrasound. I get an ultrasound.

Evelyn: They confirm there’s a six centimeter mass. Then oncologist conversations start happening. But that weekend was my parents’ weekend to see my son and I was like it’s not gonna change. So we went. I was very uncomfortable, very painful. I couldn’t make it to any of the events.

Evelyn: I ended up bringing myself to the ER on Monday morning when we returned. I was diagnosed with high grade C. Stage four. The stage was the sucker punch from then [00:04:00] on I had to focus on okay, what are we gonna do? 

Jennifer McClendon: Wow, Evelyn, that is just such a testament to, how the symptoms can just be so common and associated with so many things that we have as women, especially going through, perimenopause or menopause how did that, or did that affect you in any way in terms of like.

Jennifer McClendon: Gosh, I wish I would’ve caught this sooner or thought about this sooner. 

Evelyn: You’re always gonna do that, right? You’re always gonna do that in any situation, everyone hates this.

Evelyn: I hate this phrase, but hindsight is 2020. You have this knowledge and wish you saw clues to bring you to this point. I mean, if we could do that, everyone would get ahead but that’s not how life works. So I’ve come to accept that I love telling my story to my girlfriends, my sister, it is so easy, and it’s not that you’re making an excuse, you also don’t wanna be an alarmist. So you’re finding the right balance and so for me, the fatigue, [00:05:00] I was traveling. I didn’t feel like the fatigue was continuing, but then again, I wasn’t doing the same type of activity, so I couldn’t measure that.

Evelyn: That measuring stick was God. The food only happened on the cruise. That was the only time, and I can even remember where we were on that boat when I said it to my sister-in-law that I never knew what it felt to, to feel that kind of fullness. 

Evelyn: It never happened again.

Evelyn: And then I thought it’s gotta be because of that eating. The change in my silhouette I’ve seen my aunts and friends moms and older women their bodies have changed like that. So I’m like I guess it’s my turn.

Evelyn: I’m gonna have to figure out how to get around that. But when the weight gain was more front it really looked like a pregnant belly and that was my ascites. And it was firm too. It wasn’t like I could like press into it. It was firm. And so that was where it was like, okay, something’s going on.

Evelyn: Extended [00:06:00] belly. because first it started like rounds, like normal, right? Like a tire, then it started coming forward. That’s when. I started talking about GI because the shape was very, very different.

Evelyn: It was very much front focused. By that time, the ascites is developing. I mean, of course then it’s progressing quite rapidly and what I’ve learned is. That’s why you have many late stage diagnoses because the signs are so vague and minimal and you could relate it to something else.&lt;/span></p></p>

Evelyn:</b>style=”font-weigh

t: 400;”> And I had gone to the doctor. I had gone in May, I didn’t know until I was diagnosed that there’s no screening. I felt really foolish because I am a health coach. And I would think I would know this, but they said there’s no screening for this. Pap smears are for cervical cancer.

Evelyn: I thought that when I went to the gynecologist, the full run of tests, including the pap smear was like everything in your reproductive area you’re getting screened [00:07:00] for. Right after my gynecological appointment, I always would get my mammogram. Like I always did. All the things so you think you’re checking off the boxes and then all of a sudden your body tells you otherwise. The listening and recognizing the signs is really everything.

Evelyn: My only wish is that I was more informed that I heard something like this conversation that I paid attention and sought. To get further testing done. And, hopefully this conversation helps a lot of people. 

Jennifer McClendon: And I love what you said, you can’t be an alarmist about it. You just have to take the information and do the best you can. What was it like for you to hear that you were diagnosed with not only ovarian cancer, but an advanced stage of the cancer. 

Evelyn: I definitely knew something was really wrong. I knew I had a mass, and then this change in the pain that I was feeling when I got to the er, I was like, okay, this is definitely something.

Evelyn: Nothing crazy. I thought, okay, stage one or two, when [00:08:00] the doctor said four, that’s when my husband Jerry and I, he was standing to my right.

Evelyn: That’s when we squeezed our hands. It was unexpected.

Evelyn: So I always say that when I heard it, I went into work mode. I became a strategist. I basically look at it like a entrepreneur and an athlete. It was first from an entrepreneurial standpoint,

Evelyn: I didn’t take any medication I only had water, so I’m ready for surgery. And they’re like, no, it doesn’t work like that. Then I was like, okay, let’s go. I’m like, chemo. And then they explained they have to do all the pathology, 

Evelyn: I was like, how long does that take? I took out my phone, had a calendar. I was like. I want chemo. That was October 17th. I was like, is it realistic for me to have chemo starting the week of October 31st? they’re like, yes. I was like, so I’m gonna start calling to get an oncologist.

Evelyn: I was already talking to my friends, who’s the best [00:09:00] oncologist, all this stuff. And I got my chair on November 2nd, started chemo first, athlete wise, I started researching, asked the doctor, what do you recommend? What are good resources?

Evelyn: she said, don’t look at stats. She gave me Credible organizations to read. I started diving into it. I allowed myself to have my emotional expression. But that happened when I was alone, like once my husband left to be with my daughter who was 12. ‘Cause I was diagnosed late afternoon, around four o’clock. So he went home. we have to tell the kids. So we were gonna do it by Zoom. in the hospital by myself I had my emotion, you know, I was able to like release and figure out like, okay, now how am I gonna, how to manage this?

Evelyn: For me, the other things were tactical, so I needed to, figure out like what was gonna be like, my toolbox of coping emotionally.

Evelyn: To understand the experience of Chemo and [00:10:00] treatment I didn’t know anything. I was very green to it all. So I was like, I need to catch up. I need to educate myself because I need to be part of what’s going to happen.

Evelyn: So I went into full planning strategy mode.

Evelyn: It’s ongoing. Some of the terminology is difficult I have to read it. Several times. And I think I’m an intelligent person and I’ll read it. I’m like, wait, I thought I got it the first time.

Evelyn: Let me read it again. I have great respect for all the specialists because they get it. But for me to be in that room and you’re gonna tell me what might be the course of action. I need to understand I may not know everything, but I need to know enough from a concept perspective.

Evelyn: what is the goal Why is this medication being given to me? Just the why I need. I need to have a decent grasp of it.

Jennifer McClendon: I don’t know if at that time when you were diagnosed if biomarker testing was a word they were using, or if they were speaking in general terms about testing your tumor. I wanted to ask what tests they did, what you found out. So in [00:11:00] this case, of those who were listening who may not know what we’re talking about, basically, you know, a biomarker, I think of it as like a clue. So something that gives clues to your doctor about how your cancer’s behaving.

Jennifer McClendon: hopefully we can know more about how to treat or manage it. it’s just a clue, right? physicians have looked at, many biomarkers for years, but it hasn’t been until recently, that we’ve been able to, use them, more effectively to really help select what do we do with this cancer?

Jennifer McClendon: How is it working, how do we need to treat it based on these tests? So at what point, did you know at what point biomarker testing came into the picture for you? Yeah. And how did you find out those results? What were the results? 

Evelyn: the term biomarker was not used. 

Evelyn: It was a blood test. I learned about biomarker the term later. And I understand there’s biomarkers for various different cancers.

Evelyn: So they did tell me that when they did the blood test and for ovarian cancer, it’s ca 1 25, first time I ever heard that.</p>

Evelyn:yle=”font-weight: 400;”&gt; And my oncologist would tell me, you [00:12:00]</span&gt; get a little bit obsessed with the CA 1 25 number because it’s a number, it’s something you can track and look at. And. It’s a data point that you can see, right? So mm-hmm.

Evelyn:> every time I would have chemo. What’s my ca 1 25, right? And then after chemo, what’s my C one? Everything was, what’s my CA 1 25.</span></span>

<b&gt;Evelyn:<span style=”font-weight: 400;”> So I did have that, but it took a while to get the results. from the tumor testing. Funny enough though, when I look back, I didn’t know the results of the tumor testing, even though my surgery was January. I didn’t know until April, like mid-April.

Jennifer McClendon: Okay. </p>

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velyn: The results. That’s when that conversation started about and I know you’re gonna explain ’cause I can’t say the whole word that I’m HRD positive.

Evelyn: Okay. Wait, I’m gonna try homogenous. Oh, what’s the r? I can’t remember the R, but deficient. Oh my gosh. Okay. You’ll say homologous. 

Jennifer McClendon: Homologous. 

Jennifer McClendon: Homologous combination. RE combination. So [00:13:00] HRD, that is from the tumor testing. What they found that your tumor was expressing HRD?

Evelyn: Correct. Yeah. And then that put me. in the category of okay, you qualify for a PARP inhibitor. and then that continued to another conversation. 

Jennifer McClendon: So you finished your first course of those first four chemos around May-ish? Yes. 

Evelyn: Then they did the surgery after the fourth. in January. And then I didn’t know anything about, what could happen after chemo for a few months until April, I finished treatment in May.

Evelyn: started on a PARP inhibitor in June. 

Jennifer McClendon: Got it. 

Evelyn: I went 70% of my treatment journey, not knowing I could do anything beyond surgery and chemo.

Jennifer McClendon: And it is a process you gotta go step by step put the puzzle pieces together sometimes you wish you could put the whole puzzle together at the beginning, but sometimes it’s. Doesn’t work that way.

Jennifer McClendon: Okay. So you had the tumor testing and what you’re talking about Is a clue. when they. [00:14:00] Took your tumor and tested it, they found that a clue called HRD. like you said, it stands for homologous recombination deficiency.

Jennifer McClendon: so knowing you had this HRD was a clue to how your cancer’s working, how it’s behaving, and how can we treat it. So kind of imagine like. We’re gonna talk about HRD, but imagine your DNA is like a giant document filled with sentences, right?

Jennifer McClendon: Like a Word document. normally your DNA has a powerful spell check so that if it messes up, it can fix itself really quickly. spell check as homologous recombination. the HR is the spell check. that finds and fixes mistakes in your DNA 

Jennifer McClendon: if your DNA spell check isn’t working, in medical terms, you’ll hear deficiency. So we call that homologous recombination deficiency. that basically means that your cancer spell check is broken. And so those mistakes keep piling up.

Jennifer McClendon: cancer cells can’t fix themselves. The DNA is damaged and they cannot fix themselves, which is good because We want them to die. [00:15:00] if they have errors, they die.

Jennifer McClendon: And so we’ll talk about more why that’s important here in a moment. that’s how I think about it. 

Evelyn: I remember when they said HRD positive, but then the full. Term is had deficiency in it. deficiency doesn’t sound good, right?

Jennifer McClendon: Yes. you would think deficient means a bad thing, but in this case it’s a good thing. It means your cancer cells your DNA is going to die.

Jennifer McClendon: you hear deficiency, you think it’s bad, but then you hear HRD positive.

Jennifer McClendon: You think that’s a good thing? Yeah. we don’t want our DNA to repair itself. that’s when PARP inhibitors come in

Jennifer McClendon: So we bring in that PARP inhibitor to help it not. Fix itself. we basically want it to die. Yes okay. So once you knew that you were HRD positive. How did that affect your treatment plan? 

Evelyn: I tolerated chemo well, surgery went well. it was a success. I had my unremarkable result on my final scan, so that was [00:16:00] May. And leading up to this, that final scan, we were talking about a PARP inhibitor for two years.

Evelyn: I ended up taking Lynparza my first chemo ended early in May. So June 1st I started my first dose of Lynparza. I was worried like, okay, I did well with chemo.

Evelyn: That doesn’t mean anything. ’cause now I’m introducing another medication to my body. I had a lot of worries. I knew about the side effects. they’re gonna explain the side effects. So I was worried. I did pretty well with chemo, Am I gonna do well again on this? I had the full dose, which meant 2 pills in the morning and two at night. the oncologist said, only the cancer cells, your healthy cells, they remain intact, like they’re not touched. So I would always have this visual of like, I all my healthy cells zapping the cancer cells and like [00:17:00] this the PARP inhibitor was like that extra punch, bonus hit. Yes. So like a video game. So I am very, very thankful that that test existed so that I could find out. And what my oncologist told me was that, okay, some of the most common side effects might be digestive, 

Evelyn: Various digestive. Symptoms and she did say there was gonna be some joint pain. And I, and then she did say that if you experience these, it depends on the severity, right? that she would wanna give it about two months.

Evelyn: sometimes within two to three months, symptoms might level out and plateau. So don’t throw in the towel right away, like, you know. Sure. Dig your heels in. Mm-hmm. Get through it.

Evelyn: I understood it made sense to me. when I started, I didn’t have digestive issues, but I had a lot of [00:18:00] joint pain where I would get outta bed and I felt so creaky while I felt that when I got outta bed, if I went for a drive to the store, 

Evelyn: sitting for a while getting up I couldn’t even straighten up right away. it was like as if I was sitting on the floor Crisscross applesauce for like hours. That’s how I got up from being in the car for a bit. 

Jennifer McClendon: Yeah. 

Evelyn: It would resolve itself once I moved, but as soon as I stopped moving, I’d be sitting on the couch for a bit. I would get up the same. that was probably the worst This went away after a while, but this was weird.

Evelyn: I had a metallic taste. 

Jennifer McClendon: Oh, 

Evelyn: And then it went away after a while, I can’t remember how long it lingered. It was for a couple of months. trying to put lemon in my water and not drink out of stainless steel.

Evelyn: I would drink out of Yetis a lot. And then fatigue. The fatigue was hard to power through. you hear like, okay, if you exercise that’s how you can [00:19:00] combat fatigue. Exercising made me feel better ’cause I got the endorphins 

Evelyn: And I liked, if I went for a walk it was nice ’cause I’m outside and it lifted me. But I don’t know if it was temporary, if it was helping or not, or if it was just psychologically it was helping me. I’m fortunate ’cause those were the only symptoms I experienced and they were manageable.

Evelyn: I never changed my dose. I just remained cognizant of any changes? I stayed on the full dose. for Two years. I finished this past June.

Jennifer McClendon: finding out that, after your chemo and after your surgery, finding out that you did have this HRD biomarker opened up that option for 

Jennifer McClendon: That PARP inhibitor for you, which was that last piece of the puzzle. So thank you for sharing Your experience and how you tolerated that. That’s very insightful.

Jennifer McClendon: So for those who might have a new diagnosis of ovarian cancer, what would you say to them about all of the information that you were able to gain specifically about your tumor testing and what those results could mean for them? 

Evelyn: I would [00:20:00] say, if I’m thinking about someone who’s newly diagnosed, if I was gonna give them like advice is that this is a lot.

Evelyn: you hear that term, you hear it a lot in business, like drinking from the fire hose, 

Jennifer McClendon: Yes. 

Evelyn: Like if you’re onboarding to a new job or something you have to take things one step at a time.

Evelyn: someone newly diagnosed listening to this podcast is amazing because obviously that type of person is a seeker. you have that curiosity and you’re trying to figure things out so that you can be a part of the conversation. You’re not being spoken to.

Evelyn: You are part of your care. while I didn’t know what HRDU necessarily was, I felt I did a good job learning as I went, still feeling part of the conversation. it’s important [00:21:00] to educate yourself about different options, and be willing to ask the questions and be okay with asking the questions several times. I kind of think of it, it’s like we’re an opponent of cancer, right? You have to be willing to understand your opponent, right? 

Evelyn: I can move this way if they move that way Exactly. That is important. And then the trust of your team. if you’re not with someone who’s gonna understand your way of thinking and your approach, then maybe you wanna have a different conversation with someone else. 

Evelyn: at the start, you have to create support and think of it like I am the CEO of me.

Evelyn: And you’ll see all these pieces willfall into place. everyone is different, when I was diagnosed with stage four, you hear about stage four and it’s like, oh, it’s a final stage. I remember speaking to another survivor. If you can find those people. It’s amazing. You have a [00:22:00] completely different conversation with them. You will not have that conversation with a girlfriend, your closest friend, your closest sibling.

Evelyn: You will not have a conversation like that except for someone who’s gone through it. what I learned was everyone’s approach is different, but one woman, was amazing. She’s like, stage, who cares about the stage?

Evelyn: You’re going to face it the same way no matter what. your mindset. It’s gonna be the same. just put it in a category. allow things to come at you and be okay with not understanding, but know that if you have the team, you have the right mindset, you’re gonna figure out what it is they’re trying to explain and understand what’s gonna be right for you. just don’t let it overwhelm you. Right? 

Jennifer McClendon: How are you 

Evelyn: I had always been doing three month scans. they extended it to six months. December is my next one and it’s hard.

Evelyn: I always try and say, it’s just information. I need so that I [00:23:00] know.

Evelyn: What’s next? 

Jennifer McClendon: training strategy, correct? 

Evelyn: I just try and stay calm. I’ve been leaning on coping mechanisms, like meditation, breath work, journaling, talking. 

Evelyn: it’s a different shift when you’re done with treatment I had something going on and I had these bookmarks.

Evelyn: And then when you’re done, it’s like you’ve graduated and it’s like. where are my check-ins? And there, it’s so far away the six month, and so that’s a little bit hard. So I’m at that point where I’m trying to acclimate into, sometimes I say like, gen pop. it’s hard sometimes, but, I try and rely on what I learned from the start.

Evelyn: But overall I’m very thankful that I was able to find additional treatment. I am thankful that, there was medicine to find out more about my tumor type so that , it can be more precise. 

Jennifer McClendon: Thank you for sharing your story with us.Your experience, thank you, is such apowerful reminder [00:24:00] of how this information can guide treatment and decisions 

Jennifer McClendon: Thank you again so much, Evelyn. We appreciate this. 

Evelyn: Thank you. 

LAG (2): Thanks for listening to this episode of Teal Talk. We’d love your feedback. Take our quick survey linked in the description or drop a comment with your questions and topic suggestions. For more information about the National Ovarian Cancer Coalition and our mission, visit ovarian.org. Until next time, stay informed.

LAG (2): Stay empowered, and take care.