Cancer of a malignant type, ovarian cancer is a neoplasm that arises from the uncontrolled proliferation of a cell of the epithelium that covers the surface of the ovaries.
In oncology, malignant tumors that originate from the abnormal proliferation of an epithelial cell are called "carcinomas".
What are the Ovaries: a brief review
Two and located on the sides of the uterus, the ovaries (in the singular ovary, but also ovary or ovary) are the female gonads.
They cover two fundamental functions for reproduction:
- They secrete the female sex hormones estrogen and progesterone;
- They produce and bring to maturity the egg cell (also called oocyte or oocyte).
Did you know that ...
The ovaries are the female equivalent of the testicles in men; the latter, in fact, secrete male sex hormones (testosterone) and spermatozoa.
For further information: Ovaries: Anatomy and Function , is the second most common subtype of ovarian cancer.Other forms of ovarian cancer
Ovarian cancer is one of the three main types of ovarian cancer; the other two types - which are very rare neoplastic forms - are germ cell tumor of the ovary and stromal tumor of the ovary.
For further information: Ovarian cancer: the various types, symptoms and treatment of DNA that alter the mechanisms of cell growth and division.
In spite of the numerous researches on the subject, doctors have not yet identified the precise causes of the genetic mutations that induce ovarian cancer; however, they noted a correlation between this neoplasm and factors such as:
- Over 50 years of age;
- High number of ovulations (in other words, early onset of menstruation and / or a late onset of menopause);
- Overweight and obesity;
- Postmenopausal hormone replacement therapies;
- Past history of breast or bowel cancer;
- Family history of ovarian cancer
- Inheritance for ovarian and breast cancer linked to mutations in the BRCA1 or BRCA2 genes;
- Smoke.
To learn more about the risk factors of ovarian cancer, we recommend reading: Causes and Risk Factors of Ovarian Cancer.
Other risk factors for ovarian cancer:
- Radiotherapy in the abdominal area;
- Exposure to asbestos;
- Peutz-Jeghers syndrome;
- Familial adenomatous polyposis associated with mutations in MUTYH.
Ovarian Carcinoma Epidemiology
As anticipated, ovarian cancer is the most common type of ovarian cancer: 90% of ovarian cancer is in fact a form of ovarian cancer.
Ovarian cancer: the situation in Italy
In Italy, ovarian cancer affects approximately 5,000 women each year (source: Italian Cancer Registry Association); moreover, it represents 25-30% of all cancers affecting the female genital system and occupies the ninth position among the most common cancers among women.
Did you know that ...
According to a statistic from the Italian Cancer Registry Association, in 2017, about 40,000 women were affected by a form of ovarian cancer.
Ovarian Carcinoma: Incidence and Age
Ovarian cancer mainly affects women who have passed the menopause: most of the diagnoses concern people between the ages of 60 and 64.
Estimates at an international level report that in women over the age of 50 - the age in which the incidence of cancer begins to rise significantly - is 33 per 100,000.
Ovarian Carcinoma and Population
Epidemiological studies suggest that Caucasian women are more at risk of ovarian cancer than African and Hispanic women.
or responsible for barely noticeable symptoms. This feature complicates its early diagnosis, which would be essential for an effective treatment of the neoplasm.As the disease progresses, the manifestations that distinguish it become more and more evident.
Before analyzing in detail the symptoms of ovarian cancer, it should be noted that the lack of specificity of the most common symptoms also complicates the recognition of the aforementioned neoplasm: these, in fact, are very reminiscent of the disorders that arise from very common pathologies and conditions, such as irritable bowel syndrome (IBS), premenstrual syndrome and ovarian cysts.
Ovarian Carcinoma: Symptoms
Typical symptoms of ovarian cancer are:
- Persistent abdominal swelling
- Persistent pelvic and abdominal pain;
- Loss of appetite, feeling of fullness in the stomach even after a light meal and nausea.
Ovarian Carcinoma: Other Symptoms
Other symptoms that can be observed in the presence of ovarian cancer are:
- Back pain;
- Need to urinate frequently and urgently
- Pain during sexual intercourse (dyspareunia);
- Constipation and diarrhea;
- Ascites (accumulation of fluid in the abdominal area, precisely inside the peritoneal cavity).
These manifestations should cause concern when combined with the most common symptoms of the neoplasm and if they are the protagonists of a continuous worsening.
Complications of Ovarian Carcinoma: Metastases
When the diagnosis is late, ovarian cancer has time to infiltrate neighboring tissues and organs (intestine and spleen); moreover, it manages to reach nearby (abdominal) and distant lymph nodes, and spread its malignant cells in the blood, triggering the phenomenon of metastases.
Metastases due to ovarian cancer can affect various organs and tissues of the body: first of all, the pelvic bones and vertebrae; then, the lungs, liver and brain follow.
The spread of metastases to various parts of the body is indicative of a serious health condition, usually fatal for the patient.
and a gynecological physical examination; after which, it continues with a specific blood test for the tumor marker CA-125 and with diagnostic imaging (ultrasound of the pelvic organs in the first place, possibly followed by a CT scan and / or magnetic resonance); finally, the investigations end with a biopsy, which is essential to confirm any suspicion.It should be noted that, also depending on the results of the aforementioned investigations, the diagnostician could prescribe a chest X-ray, a laparoscopy or a diagnostic laparotomy and liver function tests.
Important!
The earlier the diagnosis of ovarian cancer is, the more likely the therapy is to succeed.
Ovarian Carcinoma and Biopsy
The biopsy is the examination that allows us to establish whether the suspicious mass identified during the previous investigations is ovarian cancer or not.
In fact, it is the investigation necessary to obtain a diagnostic confirmation of what until then was only a "hypothesis."
The biopsy involves two procedural steps:
- The sampling, through a special needle introduced at the abdominal level, of a portion of suspicious ovarian tissue.
- Laboratory tests on the collected tissue sample. These investigations make it possible to establish whether it is actually a tumor and, if it is, to establish its stage and degree.
It should be noted that biopsy, in particular the sampling phase, is not applicable in all women; for these patients, the alternative is laparotomy or laparoscopy.
Stages of Ovarian Carcinoma
The staging of a malignant tumor includes all the information, collected during the biopsy, concerning the size of the tumor mass, its infiltrating power and its metastasizing capacity.
According to the classic staging system, there are 4 stages of ovarian cancer, identified with the numbers 1 to 4:
- Stage 1. Non-metastatic ovarian cancers, confined by extension to one or both ovaries, are stage 1.
- Stage 2. Non-metastatic ovarian carcinomas, also developed outside the ovary (s), but still inside the pelvic area, are stage 2; organs and tissues affected by the tumor can be the fallopian tubes, the uterus, the bladder or the rectum.
- Stage 3. Non-metastatic ovarian cancers, which have developed outside the pelvic area, up to the abdominal cavity or to the nearest lymph nodes, are stage 3.
- Stage 4. Ovarian carcinomas that have spread metastases in organs and tissues of the body distant from the original site, for example in the lungs or liver, are stage 4.
Please note: the above is a simplified version of the classic staging system; in fact, there are also substages.
Ovarian cancer: other tests
In the presence of suspected ovarian cancer, tests such as CT, MRI, chest X-ray and diagnostic laparoscopy and laparotomy are aimed at clarifying whether the tumor has affected other organs and whether and where it has spread metastases.
; therefore, radiotherapy and targeted therapy follow.
Ovarian Carcinoma: Surgery
Surgical therapy for ovarian cancer consists in the removal of the tumor mass from the site of origin and where it has possibly spread; very often, the removal procedure performed at the site of origin involves the removal of the entire ovary.
The success of surgery is strictly dependent on the extent of the tumor mass: the smaller and less extensive the ovarian cancer is, the more likely it is that the surgery will allow the tumor to be eradicated.
Surgery for Stage 1 Ovarian Cancer
Surgery for stage 1 ovarian cancer varies depending on whether the cancer affects one or both ovaries:
- If only one ovary is involved, it is limited to the removal of that organ and the related fallopian tube;
- If both ovaries are involved, it extends to both diseased organs, both fallopian tubes, and sometimes even the uterus.
The choice of whether or not to preserve the uterus depends on the age of the patient (in a patient of childbearing age, the preservation of the uterus would allow for a possible pregnancy) and on some characteristics of the tumor (there are ovarian tumors of stage 1 more aggressive than others).
Surgery for Stage 2, 3 and 4 Ovarian Cancer
In women with stage 2, 3 or 4 ovarian cancer, surgery involves the removal of both ovaries, both fallopian tubes, the uterus and all those portions of tissue and intra- and extra-pelvic organs. on which the neoplasm has spread; it should be noted that, for stage 4 ovarian carcinomas, the removal work could also involve metastases.
Ovarian Carcinoma: Chemotherapy
Chemotherapy consists in the administration of drugs (the so-called chemotherapy) capable of killing all rapidly growing cells, including cancer cells.
In the presence of ovarian cancer, chemotherapy can:
- Follow up with surgery, in an attempt to eliminate residual cancer cells and to reduce the risk of relapse (adjuvant chemotherapy);
Adjuvant chemotherapy is used in the treatment of stage 2, stage 3 ovarian cancers and, only if they are particularly aggressive, stage 1 cancers. - Before surgery, to facilitate the subsequent removal operation (neoadjuvant chemotherapy).
Neoadjuvant chemotherapy is used in the treatment of stage 4 carcinomas and, only if they are in an uncomfortable position, stage 3 carcinomas. - To represent the only treatment applicable, in the event that the conditions for carrying out the surgical removal do not exist.
Chemotherapy as a palliative treatment is generally used in advanced stage 4 carcinomas or in relapses.
The most commonly used chemotherapy drugs in the treatment of ovarian cancer are carboplatin and paclitaxel.
Chemotherapy has several side effects, which the attending physician carefully exposes to the patient before starting treatment.
Ovarian Carcinoma and Relapses: What to Do
If the combination surgery-chemotherapy does not involve the elimination of all the tumor cells of ovarian cancer, the latter can recur after some time; when this happens, it is referred to as a relapse.
Treatment of a relapse of ovarian cancer involves a new course of chemotherapy and, sometimes, the implementation of targeted therapy.
scientifically reliable that allows to identify ovarian cancer early.Therefore, doctors invite women with a family history or with a "heredity for ovarian cancers and women who have passed the menopause to undergo, at least once a year, a gynecological examination and an" ultrasound of the pelvic organs ( better if transvaginal).
Ovarian cancer: how to reduce the risk?
To reduce and control the risk of ovarian cancer, experts advise women to:
- Follow a healthy lifestyle (balanced diet, weight control, regular exercise, do not smoke, etc.);
- Consider using birth control pills in those fertility years when you don't want to have children yet;
- Carrying out at least one pregnancy in life and breastfeeding.
