Ovarian cancer is also known as ovarian cancer, ovarian cancer, ovarian cancer or ovarian cancer.
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 , epithelial cancer of the ovary is the most common type of ovarian cancer: it is observed, in fact, in at least 90% of ovarian cancer cases.For further information: Ovarian Carcinoma: What is it?
Germinal Tumor of the Ovary
The germ cell tumor of the ovary is the neoplasm that arises from the uncontrolled proliferation of one of the cells destined to become an oocyte (germ cell).
A rare variant (about 5%) which mainly affects young adult women (around 30 years of age), the germ cell tumor of the ovary can be malignant or benign.
Stromal Tumor of the Ovary
Stromal tumor of the ovary is the neoplasm that arises from the uncontrolled proliferation of one of the cells of the stroma or of the sexual cords of the ovary, ie the ovarian tissues used to support germ cells and endocrine activity.
Rare variant (about 5%), the stromal tumor of the ovary can be malignant or benign.
Secondary Ovarian Cancer
The ovaries can also be the site of tumor metastases; in these situations, the resulting neoplasm is a secondary tumor of the ovary with obviously malignant characteristics.
The cancers that most often produce metastases in the ovaries are breast cancer, colon cancer and stomach cancer.
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:
- Old age. Numerous epidemiological studies have shown that the risk of developing ovarian cancer begins to be relevant from the age of 50 and reaches its peak between the ages of 75 and 79.
- High number of ovulations (in other words, early onset of menstruation combined with a late onset of menopause). It seems that the ovulation process causes a micro-damage to the DNA of the cells of the ovary and the fallopian tubes, which, if repeated excessively over time, is responsible for neoplastic phenomena.
This evidence would explain why factors that block ovulation, such as pregnancy, breastfeeding or use of the contraceptive pill, have a protective effect against ovarian cancer. - Overweight and obesity. The excess of adipose tissue favors the onset of ovarian cancer.
- Postmenopausal hormone replacement therapies. Research has shown that hormone replacement therapies used to control symptoms of menopause moderately increase the risk of ovarian cancer (and more significantly that of breast cancer).
In this regard, an Anglo-Saxon study is reported, from which it emerged that, in the United Kingdom, 4 out of 100 cases of ovarian cancer is related to post-menopausal hormone replacement therapies. - Past history of other malignancies. Women who developed breast cancer at a relatively young age and those who got estrogen receptor-negative breast cancer have a higher risk of ovarian cancer.
An increased risk is also observed in women who have suffered from bowel cancer in the past. - Endometriosis.
- Family history of ovarian cancer. Clinical research has shown that women with a sister, mother or grandmother with ovarian cancer are more at risk of ovarian cancer.
- Inheritance for ovarian or breast cancer linked to mutations in the BRCA1 or BRCA2 genes.
- Smoke. Scientific studies have shown that smoking increases the risk of developing a particular subtype of epithelial cancer of the ovaries, known as mucinous cancer of the ovary (or mucinous adenocarcinoma of the ovary).
- Radiotherapy in the abdominal area. According to some evidence, radiotherapy in the abdominal area performed, for example, to treat another neoplasm would increase, albeit slightly, the risk of developing ovarian cancer.
- Exposure to asbestos.
Epidemiology of Ovarian Cancer
Ovarian cancer: the situation in Italy
According to a 2017 estimate drawn up by the Italian Association of Medical Oncology (Aiom) and the Italian Cancer Registry Association (Airtum), in Italy, ovarian cancer affects 5,200 women every year.
Other statistical data in this regard add that ovarian cancer covers 30% of all cancers affecting the female genital system and occupies the ninth position among the most common cancers in the female population.
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 Cancer: Incidence and Age
Ovarian cancer is a cancer whose incidence increases with age; menopause represents an important watershed, beyond which cancer gradually becomes more frequent; most of the diagnoses of ovarian cancer concern women aged 60 and 64 years old.
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 Cancer 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 symptomatology of ovarian cancer, it should be noted that the recognition of the aforementioned neoplasm is also complicated by the lack of specificity of the most common symptoms: these, in fact, closely resemble the disorders produced by very common pathologies and conditions. such as irritable bowel syndrome (IBS), premenstrual syndrome and ovarian cysts.
Ovarian Cancer: Symptoms
Doctors and experts agree that the most frequent symptoms of ovarian cancer are:
- Persistent abdominal swelling. Persistence is important; a swelling that comes and goes, in fact, is not typical of ovarian cancer.
- Persistent pelvic and abdominal pain. Again, persistence is a feature to consider.
- Loss of appetite, feeling of fullness in the stomach even after a light meal and nausea.
Ovarian Cancer: Other Symptoms
Other symptoms that can be observed in the presence of an ovarian tumor 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 are of concern when combined with the more common symptoms of ovarian cancer and when subject to continual worsening.
Ovarian Cancer: Initial Symptoms
When it is not asymptomatic, ovarian cancer tends to begin with the symptoms that most characterize it, namely: persistent abdominal swelling and pain, loss of appetite, stomach fullness and nausea.
Ovarian cancer: when to see a doctor?
If a woman, especially if she is over 50 years old, continuously and persistently feels the most characteristic manifestations of ovarian cancer, she should contact her doctor immediately, for a deeper understanding of the situation.
Complications of Ovarian Cancer: Metastases
If diagnosis and treatment are late, malignant forms of ovarian cancer can infiltrate neighboring tissues and organs (intestine and spleen); moreover, they can reach nearby (abdominal) and distant lymph nodes, and spread their malignant cells in the blood, triggering the phenomenon of metastases.
Metastases resulting from malignant ovarian cancer (metastatic ovarian cancer) can affect various organs and tissues in 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 conclude 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.
Physical examination
The gynecological physical examination involves the collection and evaluation of symptoms; this investigation also includes a pelvic examination.
Anamnesis
During the medical history, the doctor - who is always a gynecologist - investigates the patient's general state of health, her age, her habits, her family history and her working activity, with the aim of understanding if there are any relationships with the present symptomatology.
The medical history establishes whether the patient is in a risk situation and whether it is justified to think about the presence of a tumor of the ovaries.
Measurement of CA-125 levels
CA-125 protein is a tumor marker for ovarian cancer.
Therefore, the finding, through a blood test, of elevated blood levels of this protein could be indicative of ovarian cancer.
However, it should be pointed out that:
- Some ovarian cancers never accompany or accompany only a more advanced stage at high levels of CA-125;
- The increase in blood levels of CA-125 may also be due to other conditions, including endometriosis, pelvic inflammatory disease and tuberculosis.
In light of the first and last information, the search for the tumor marker CA-125 is a useful diagnostic test, but not sufficient to draw definitive conclusions about the present condition.
Pelvic ultrasound
Pelvic ultrasound is used in the diagnosis of ovarian cancer, because it is able to identify any suspicious masses affecting the ovaries.
There are two types of pelvic ultrasound for ovarian cancer research:
- The transabdominal pelvic ultrasound, which involves the application of the probe on the external abdominal-pelvic wall, and
- Transvaginal pelvic ultrasound, which involves inserting the probe into the vagina and observing the ovaries from the inside.
Of the two variants briefly described, the first is more practical, not at all invasive, but not very comprehensive; the second, on the other hand, is more invasive, more annoying, but definitely more precise and specific.
Did you know that ...
Pelvic ultrasound makes it possible to exclude that the suspected symptoms are due to endometriosis.
Biopsy
The biopsy is the examination that allows to establish whether the suspicious mass identified in the course of the previous investigations is or is not a tumor of the ovaries.
In fact, it is the "investigation that is needed to have 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 Cancer
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 numbers from 1 to 4:
- Stage 1. Non-metastatic ovarian tumors, confined, by extension, to one or both ovaries, are stage 1.
- Stage 2. Non-metastatic ovarian tumors, also developed outside the ovary or ovaries, but always 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 tumors are stage 3, which have developed outside the pelvic area, up to the abdominal cavity or to the nearest lymph nodes.
- Stage 4. Ovarian tumors 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 or suspected ovarian cancer, tests such as CT scan, MRI, chest X-ray and diagnostic laparoscopy and laparotomy are intended to clarify whether the neoplasm has affected other organs and if and where it has spread metastases. .
; therefore, radiotherapy and targeted therapy follow.Ovarian Cancer: Surgery
Surgical treatment 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 tumor is, the more likely it is that the surgery will allow the tumor to be eradicated.
Here is an overview of the possible surgical interventions adopted based on the stage of ovarian cancer.
Stage 1 Ovarian Cancer Surgery
If ovarian cancer affects only one ovary, surgery may be limited to the removal of the diseased ovary and related fallopian tube.
If, on the other hand, ovarian cancer affects both ovaries, the removal procedure is extended to both diseased organs, both fallopian tubes and, sometimes, also to 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 stages I more aggressive than others).
Stage 2 Ovarian Cancer Surgery
For most women with stage 2 ovarian cancer, surgery involves removing both ovaries, both fallopian tubes, and the uterus.
If the tumor has also affected other pelvic organs (eg intestine), surgery may also include the removal of part of these organs.
Stage 3 Ovarian Cancer Surgery
In women with stage 3 ovarian cancer, surgery involves the removal of both ovaries, both fallopian tubes, the uterus and all those portions of tissue and organs on which the tumor has spread.
Stage 4 Ovarian Cancer Surgery
For stage 4 ovarian cancers, surgery definitely involves the removal of both ovaries, both fallopian tubes and the uterus.
To this are added the elimination of the tissues on which the neoplasm has spread and possibly the removal of metastases.
It should be noted that, very often, before surgery, doctors carry out a course of chemotherapy, so as to reduce the size of the tumor masses and make their subsequent removal easier.
Ovarian Cancer: Chemotherapy
Chemotherapy consists in the administration of drugs (the so-called chemotherapy) capable of killing all rapidly growing cells, including cancer cells.
If you have ovarian cancer, chemotherapy can:
- Follow up with surgery, in an attempt to eliminate residual cancer cells and to reduce relapse (adjuvant chemotherapy);
- To precede surgery, to facilitate the subsequent removal operation (neoadjuvant chemotherapy);
- To represent the only treatment applicable, in the event that the conditions for carrying out surgical removal do not exist (in this case, chemotherapy assumes the role of palliative care).
The most commonly used chemotherapy drugs in the treatment of ovarian cancer are carboplatin and paclitaxel.
Important!
Chemotherapy has several side effects, which the attending physician carefully exposes to the patient before starting treatment.
Chemotherapy for Stage 1 Ovarian Cancer
In women with stage 1 ovarian cancer, chemotherapy is used after surgery only in the presence of particularly aggressive neoplastic forms; when the neoplasm is confined to only one ovary it is often not needed.
Chemotherapy for Stage 2 and 3 Ovarian Cancer
Typically, in women with stage 2 or 3 ovarian cancer, chemotherapy follows surgery, with the intent of eliminating tumor residues that the surgeon has not been able to eliminate.
It should be noted, however, that when the tumor occupies particularly uncomfortable sites, neoadjuvant chemotherapy is also required.
Chemotherapy for Stage 4 Ovarian Cancer
As a rule, in women with stage 4 ovarian cancer, doctors use chemotherapy before surgery, because they are faced with very complex tumors that need to be removed surgically.
Ovarian Cancer and Relapses: What to Do
If the combination surgery-chemotherapy does not involve the elimination of all the tumor cells of an ovarian neoplasm, the latter can recur after some time; when this happens, it is referred to as a relapse.
Treatment of ovarian cancer recurrence involves a new course of chemotherapy and, sometimes, the implementation of targeted therapy.
scientifically reliable that allows to know in advance the predisposition of a woman to ovarian cancer.Therefore, doctors invite women with a family history and women who have passed the menopause to undergo, at least once a year, a gynecological examination and an ultrasound of the pelvic organs (preferably 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, then eat in a healthy and balanced way, keep body weight under control, exercise regularly, do not smoke, etc.
- Consider using birth control pills in the fertility years when you don't want to have children yet.
- Carrying out at least one pregnancy in life and breastfeeding.
