What is ovarian cancer?
Cancer is a disease in which certain cells of the body grow without control. Women have two ovaries located at both sides of the pelvis, laterally to the uterus. The main function of the ovaries is to produce and release the ovum to allow conception, together with the production of female hormones (mainly estrogen and progesterone).
It is a tumor that grows very fast; this is the reason why it is diagnosed in advanced stages, when the disease is extended by the abdominal and pelvic cavity, in almost 80% of the cases.
Can ovarian cancer be detected early?
To date, there are no reliable tests to detect ovarian cancer in early stages, before the onset of the patient’s symptoms.
It is important to remember that cytology is not useful for the early detection of ovarian cancer. Its function is to detect pre-malignant lesions of the uterine cervix or cervical cancer at very early stages.
At this time, there are multiple studies that are being carried out in order to discover new molecules in blood that may be useful for the early diagnosis of this disease. This is of vital importance since the effectiveness of the treatments increases significantly when ovarian cancer is detected in early stages, with the disease limited at the ovarian site.
What are the risk factors for the development of ovarian cancer?
Ovarian cancer usually presents around 60 years of age, and represents the 4th most common cause of cancer-related death among women.
While it is difficult to find a specific cause of ovarian cancer. These are some of the main factors that could increase the risk:
- Age: around 55-60 years
- One or more relatives of first degree (mother, sister, daughter) or second degree (grandmother, aunt) affected, both on the maternal and paternal side.
- Having cancer of the uterus, breast, colon-rectum.
- Eastern European Hebrew ancestry (Ashkenazi).
- Not having been a mother (nulliparity)
- Hereditary predisposition: approximately 15-20% of ovarian tumors are hereditary. This means that they are transmitted from one generation to another by specific genetic mutations. The most common cause of hereditary ovarian cancer is the mutation of the BRCA1 and 2 genes.
The fact of having any of the risk factors mentioned above does not mean that the woman will have an ovarian cancer in the future; this only means that it is necessary to discuss this with her gynecologist.
What do I have to do to prevent ovarian cancer?
While there are no specific ways to prevent ovarian cancer, some of the following measures may help reduce the risk:
- Take oral contraceptives for more than five years.
- Perform a tubal ligation, removal of both ovaries or hysterectomy.
- Have children
What are the symptoms of ovarian cancer?
Women with ovarian cancer limited to the ovaries, are usually asymptomatic and they are diagnosed with a routine ultrasound or a physical examination. However, ovarian cancer usually causes symptoms in women with advanced stages of the disease. These symptoms are nonspecific and include:
- Vaginal bleeding: particularly during menopause
- Pain or pressure in the region of the pelvis or abdomen
- Back pain
- Swelling, which is the sensation of distension or “full stomach”
- Sensation of satiety with few or minimal amounts of food
- Changes in the rhythm of bowel movement (diarrhea or constipation) or in the rhythm of urination (burning sensation, increased frequency and decreased amount of urine)
These symptoms are nonspecific, which means that they can also be caused by diseases other than ovarian cancer. However, it is very important that women know that any change in relation to the aforementioned symptoms should alert them to consult a doctor.
What procedures can help diagnose ovarian cancer?
- Pelvic exam: This may alert to the presence of an ovarian cyst or deeper nodules in the pelvis.
- Ca 125: determined by a blood test. The value of this marker is frequently elevated in women with ovarian cancer in advanced stages. However, when the disease is limited to the ovary, the value of the tumor marker may be normal. Therefore, it is important to take into account other clinical factors as well. In addition, Ca 125 is increased in other types of tumors (uterus and gastrointestinal tract) or even under physiological conditions such as menstruation, pregnancy or stress.
- Diagnosis of extension of the disease
- Gynecological ultrasound: differentiates the characteristics of ovarian cyst in relation to size, presence of solid areas, or papillae.
- Computed axial tomography: performed routinely prior to any oncological treatment to determine the extension of the disease outside the affected organ: lymph nodes, abdominal organs or the thoracic cavity. It is usually done with oral and intravenous contrast.
- Colonoscopy, gastroscopy: these are optional methods and are used in selected cases.
- PET-CT: a method that combines CT with the measurement of a substance similar to glucose that is previously injected into the body. As the tumor cells are able to capture high amounts of glucose, suspicious lesions can be seen in this study.
- Surgery: it is the obligatory step to make the final diagnosis of ovarian cancer. However, there are exceptions in which an ultrasound-guided biopsy of an intra-abdominal lesion can be performed to reach the diagnosis and decide the final treatment.
What is the treatment of ovarian cancer?
The initial treatment of ovarian cancer is the most important factor in determining the patient’s survival expectations. The surgical team must be adequately trained to perform the surgical treatment that the patient requires.
The final decision of the best treatment for a particular case is based on the following factors:
- The tumor stage
- The extent of the disease
- Your wishes for future fertility
- Your global health status
- Your preferences
Surgical treatment usually represents the first therapeutic step.
Surgical staging for ovarian tumors in early stages includes the following surgical procedures:
- Hysterectomy: removal of the uterus, including the cervix.
- Bilateral adnexectomy: this procedure accompanies the previously described and consists of the removal of both ovaries and tubes (uterine annexes).
- Omentectomy: removal of a fatty tissue attached to the large intestine.
- Pelvic and para-aortic lymphadenectomy: removal of the lymph nodes around the main arteries and veins of the abdomen and pelvis.
- Appendectomy: extirpation of the appendix in selected cases of ovarian cancer (mucinous histological variant)
- Multiple peritoneal biopsies: removal of small fragments (3-4 cm) in several regions (8-10) of the peritoneum. The latter is a thin sheet of tissue that lines the intra-abdominal organs and the abdominal wall.
We are committed to the development of innovative surgical techniques for the treatment of gynecological cancer, including cervical tumors. In this sense, laparoscopic mini-invasive surgery represents the best example of technological development to ensure the best surgical results with faster and safer patient recovery. We perform these procedures in almost 100% of patients by using a laparoscopic mini-invasive approach.
Surgical cytoreduction for ovarian tumors in advanced stages
After surgery, pathologists will carefully review the material sent to obtain a final diagnosis and determine the true extent of the disease. Then, all the best postoperative therapeutic options are considered based on factors that include:
- The intra-operative findings
- The final histological result
- The general conditions of each patient
- The preferences of the patient and their relatives
The decision can be simply observation and follow-up, or it can include chemotherapy according to each case.
Chemotherapy: is currently administered intravenously but, according to the results of recent studies, it is very likely that it will be administered orally in the coming years. Currently, almost 90% of patients diagnosed with ovarian cancer will need chemotherapy before or after surgery.
To date, the standard treatment consists in the administration of 6 cycles of intravenous carboplatin and paclitaxel. Each cycle is separated from 3 – 4 weeks.
Follow-up and surveillance:
The oncological follow-up period begins after the initial cancer treatment. Its main objective is to detect early possible recurrence of the disease.
Beyond adopting the most effective follow-up rules, we also pay special attention and interest in maintaining and increasing the quality of life of our patients and achieving a rapid and effective re-insertion in everyday life as before the diagnosis of their cancer.