Ovarian cancer remains one of the most difficult cancers to treat successfully.
Many women do not realize they have the disease until it has already spread beyond the ovaries into the abdomen. By the time symptoms become obvious, treatment is often far more challenging.
One common problem in advanced ovarian cancer is a condition called ascites. Ascites happens when large amounts of fluid collect inside the belly. This fluid buildup can make the abdomen swell and may cause pain, breathing problems, nausea, poor appetite, and difficulty moving comfortably.
Doctors have traditionally treated ascites mainly as a symptom. Patients often undergo procedures to drain the fluid so they can breathe more easily and feel less pressure. However, researchers at Duke University School of Medicine now believe the fluid itself may actively help cancer survive and spread.
Their new study, published in Nature Communications, found that ascites may protect ovarian cancer cells from destruction. The researchers also discovered that a decades-old cholesterol drug may interfere with this protection.
The study does not prove the drug can treat ovarian cancer. However, it suggests that weakening the cancer’s surrounding environment may make existing treatments work better in the future.
The research team was led by Dr. Jen-Tsan Chi at the Duke Cancer Institute.
According to the scientists, nearly 90% of patients with advanced ovarian cancer develop ascites. While the fluid clearly causes discomfort, the new findings suggest it may also play a much more dangerous role biologically.
Cancer cells that spread through the abdomen often separate from the original tumor and float freely inside the abdominal cavity. Normally, these loose cancer cells are vulnerable because they are exposed to stressful conditions that can kill them.
One important form of cell death is called ferroptosis. Scientists describe ferroptosis as a kind of internal rusting process inside cells. It happens when iron reacts with fats inside the cell membrane, causing the membrane to break apart and the cell to die.
Many free-floating metastatic cancer cells are naturally sensitive to ferroptosis. Researchers believed this weakness could help limit cancer spread.
But the Duke team discovered that ascites appears to protect ovarian cancer cells from this deadly process.
To study the effect, the researchers collected real ascites fluid from ovarian cancer patients and used it in laboratory experiments. They exposed cancer cells to substances that normally trigger ferroptosis and watched how the cells reacted.
The results were striking. Cancer cells surrounded by ascites survived much better than expected. Even tiny amounts of the fluid offered strong protection.
The researchers found that the fluid changes how cancer cells store fats and regulate iron. These changes block ferroptosis and allow cancer cells to survive while traveling through the abdomen.
Interestingly, the protection seemed very selective. Ascites mainly blocked ferroptosis but did not strongly protect cancer cells from other common forms of cell death such as apoptosis or necrosis.
This suggested that something very specific inside the fluid was responsible.
The scientists then separated ascites into different components, including proteins, fats, and small molecules. By removing each component one at a time, they discovered that lipids, or fats, were the key factor protecting the cancer cells.
Once the lipids were removed, the protective effect disappeared.
This discovery led the researchers to test drugs that affect fat metabolism. One medication attracted special attention: bezafibrate, an older cholesterol-lowering drug used for many years to reduce triglyceride levels.
The scientists found that bezafibrate removed much of the protection provided by ascites and restored sensitivity to ferroptosis. However, the drug worked only when ascites was present.
Importantly, bezafibrate did not directly kill cancer cells on its own, nor did it stop tumor growth in mouse experiments. Instead, the drug appeared to weaken the cancer-supporting environment around the cells.
The researchers believe this may represent a new strategy for cancer treatment. Rather than attacking tumors directly, future therapies may also target the biological environment that helps cancer spread and survive.
The findings may also apply to other cancers. Tumors such as pancreatic cancer and colorectal cancer can also spread within the abdominal cavity, where similar fluid environments may exist.
The study highlights how complicated cancer biology can be. Tumors are not isolated masses of cells. They interact constantly with surrounding fluids, fats, immune cells, and nearby tissues. Understanding these interactions may help researchers discover new treatment approaches.
If you care about cancer, please read studies that artificial sweeteners are linked to higher cancer risk, and how drinking milk affects risks of heart disease and cancer.
For more health information, please see recent studies about the best time to take vitamins to prevent heart disease, and results showing vitamin D supplements strongly reduces cancer death.
Source: Duke University School of Medicine.
