What is ovarian cancer?
This type of cancer is the most aggressive tumor of the female reproductive system and the sixth cause of death due to cancer in woman. Ovarian cancer occurs when cells that line the ovaries, fallopian tubes, or the peritoneum near the ovaries grow out of control. The aggressiveness of this cancer is given by the fact that we do not have test to diagnose it early.
What are the symptoms of ovarian cancer?
One of the main problems of this type of cancer is the lack of clear symptoms that cause the patient to arrange a quick visit to the specialist. They symptoms of this type of cancer can be confused with the symptoms of menopause, especially in women in their menopausal stage, that is why the diagnosis is given when the cancer is already at an advanced stage.
Despite this, there is a series of signs which is important to pay attention to it. Here we list them:
- Most frequent symptoms: abdominal swelling, pelvic and abdominal pain frequently, feeling full and swollen, loss of appetite.
- Occasional symptoms: frequent urination, constipation or diarrhea, back pain, fatigue, loss or sudden weight gain, nausea and vomiting, bleeding and disturbances of the cycle.
Given the lack of specificity of the symptoms, it is recommended to consult a medical specialist in case of suffering one or some of these signs, during a prolonged period, to perform an exploration and detect possible problems.
Main risks factor for ovarian cancer
The main risks factors are:
- Family history: it is important to know the medical history of their direct relatives.
- Genetics: between 10 and 15% of cases occur due to a genetic mutation in the BRCA1 or BRCA2 genes.
- Having other hereditary conditions, such as colorectal cancer without hereditary polyposis (CCSPH, also called Lynch syndrome).
- Age: the risk of developing ovarian cancer increases after 50 years. Approximately, 50% of women diagnosed have an age above 63 years.
- Weight: women with obesity are more likely to develop this type of cancer.
- Endometriosis: there is a link between this disease and the increased risk of having ovarian cancer.
- Ethnic origin: It has been noted that women of Ashkenazi Jewish origin are more likely to develop cancer.
- Reproductive history: women who have never had children or who are sterile for no apparent reason, have a higher risk.
What tests are needed to diagnose ovarian cancer?
In addition to pelvic examination and cytology performed during periodic gynecological examinations, additional tests are prescribed to find the diagnosis:
- Blood test: if there is a suspicion of ovarian pathology, blood markers such as CA 125 should be requested.
- Transvaginal ultrasound: it is an ultrasound technique that allows diagnosing pathologies of gynecological origin and allows seeing tumors in the ovaries.
- CT and / or abdominal and pelvic MRI: it allows to assess if the cancer has spread to other organs or if it has spread inside the abdominal cavity. In some cases, it also allows a directed biopsy to determine the type of tumor. To assess if there is involvement of other organs and detect the presence of peritoneal implants.
- Laparoscopy: consists of a non-aggressive surgical intervention, under general anesthesia in which a camera is inserted inside the abdomen. This test allows to assess the extent of the disease and the taking of biopsies.
- PET / CT to assess whether the disease has spread outside the abdominal cavity.
Are there different types of ovarian cancer?
Yes, there are different types of ovarian tumors, depending on the place of origin of the tumor cells:
- Ovarian epithelial tumors: are those that originate on the outer surface of the ovaries. These can be benign, of little malignancy or malignant.
- Germ cell tumors originate from the cells that produce the ovules.
- Stromal tumors arise from the cells of the structural tissue that produce the female hormones estrogen and progesterone.
Malignant epithelial tumors are the most frequent and represent 85-90% of all ovarian cancers. Among them the most common is the serous. The other main types are mucinous, endometrioid and clear cell.
What are the main treatments for ovarian cancer?
Before the diagnosis, the most important thing is to go to a gynecologist expert in ovarian cancer. The prognosis of the patient with ovarian cancer will depend to a great extent on the treatment applied.
Here are the main treatments for ovarian cancer:
- Surgery: It is the most important treatment for this type of cancer. The main thing of the surgery is to remove all the tumor that is macroscopically visible. The surgery consists of the removal of the ovaries and fallopian tubes (salpingo-ooferectomy), of the uterus (hysterectomy), and of the omentum, in addition to the aortic and pelvic lymph nodes (lymphadenectomy). Also, all visible implants in the rest of the abdomen should be removed. This surgery is called cytoreductive surgery and in some cases involves the removal of other organs such as the large intestine, small intestine or spleen.
- Cytoreductive surgery and application of intraperitoneal hyperthermic chemotherapy (HIPEC): in this case, when cytoreductive surgery is finished, chemotherapy is applied directly in the abdomen. It has been proved that this treatment increases survival in certain cases. If you want to know more about this treatment, click here.
- Chemotherapy: is a cancer treatment in which drugs are used to destroy cancer cells and / or stop the formation of new malignant cells. In ovarian cancer, chemotherapy can be administered intravenously or intraperitoneally, depending on each case, but always complementing the surgery (before, during or after it). Nowadays, new drugs (PARP inhibitors) have appeared that, applied after cytoreductive surgery, increase the disease-free period and are much better tolerated than conventional chemotherapy.
The importance of putting yourself in the hands of expert surgeons
Surgery represents more than 70% of the success of the treatment, so it is key to be in the hands of expert surgeons and multidisciplinary teams. The only prognostic factor that can be modified is the quality of the surgery (the patient will live more time if it is well operated from the beginning), hence the importance of referring the patient to a gynecologist expert in ovarian cancer. If you need professional advice, you can contact the gynecological cancer surgery unit of Quénet Torrent Institute, where an expert committee will analyze the case.