Worryingly, ovarian cancer affects relatively young women. Its occurrence increases significantly after the age of 40, although it appears in very young women, even before the age of 20.
Unlike many other malignancies, ovarian cancer does not take many years to develop - it can develop quickly, even in a few months.
Symptoms of ovarian cancer
In the early stages, when the size of the tumor does not exceed 7 cm, it is completely asymptomatic. It is believed that it gives symptoms only when it reaches about 11-15 cm.
In young women, before reaching the age of 30, the tumor can cause cycle disorders, premature puberty or hirsutism. However, these are the symptoms that in the first reflex lead to looking for hormonal disorders, not cancer.
When the tumor is already large, it begins to give very uncharacteristic symptoms, mainly related to the digestive system. Typically, the woman then goes to the internist and reports:
- a feeling of fullness in the belly
- lower abdominal pain
- increasing the circumference of the abdomen
- general weakness
- loss of appetite
- bad mood
- bladder pressure
- pain when urinating
- feeling of pressure in the lower abdomen
- vaginal bleeding
- ascites (the most common reason for which women with ovarian cancer consult a specialist)
Unfortunately, most of these symptoms appear as a result of a large tumor that has already invaded the organs adjacent to the ovary in the abdomen. Metastasis of ovarian cancer occurs most often in the intestine, liver, spleen and, via the lymphatic route, in the lymph nodes.
Ovarian cancer diagnosis
A patient who reports to an internist with symptoms related to the digestive system should undergo a thorough diagnosis and then be referred to a gynecologist for consultation. An internist may order basic tests for a woman:
- Abdominal ultrasound
It is best for a woman to come to the gynecologist's consultation with the results of the above tests. The gynecologist will often be able to detect the presence of a tumor in the ovary in a basic two-handed gynecological examination. In the course of further diagnostics, the doctor may order:
- Transvaginal ultrasound
- Abdominal ultrasound (if not done before)
- tumor markers Ca-125, HE-4, CEA or CA 19-9
- CT of the pelvis and abdomen
- Chest x-ray
- The determination of beta HCG and alphafetoprotein is used in the diagnosis and detection of possible cancer recurrence
The ROMA test is used to determine the risk of cancer. This abbreviation comes from the English name Risk of OvarianMalignancyAlgorithm. The result of this test indicates the probability that the detected lesion is malignant and is an indication for the doctor to make further decisions regarding the diagnosis of the tumor.
The ROMA test is not performed on patients under the age of 18, patients undergoing chemotherapy or women who have already been treated for cancer. The ROMA test takes into account the statistically estimated risk of developing a malignant ovarian tumor and the concentration of two tumor markers1 (Ca-125 and HE-4). The result is given in percentage. The probability determined in the ROMA test is one of the prognostic factors of ovarian cancer.
However, studies of the concentration of tumor markers do not provide 100% certainty - for example, the Ca-125 marker may be elevated not only in malignant ovarian tumors, but also in endometriosis, uterine fibroids or pelvic inflammatory conditions.
Therefore, in the ROMA test, the HE-4 marker is also taken into account - its elevated level indicates a malignant neoplastic process in the ovary. Importantly, it is detectable even in the first and second stages of the disease, while the concentration of Ca-125 may not be elevated yet. HE-4 is also a useful marker at the stage of monitoring the progress of treatment and possible recurrences of the disease.
Treatment of ovarian cancer
The most important part of the treatment is surgical treatment using the laparoscopic technique or with the support of a robotic technique. It consists in removing the maximum amount of the tumor from all affected organs (so-called cytoreduction). The more thoroughly all cancer cells are removed during surgical treatment, the better. Unfortunately, it is often necessary to simultaneously remove fragments of affected organs, e.g. intestines.
The next stage of treatment is chemotherapy, usually administered in 6 cycles at 3-4 week intervals. Ovarian cancer is highly sensitive to chemotherapy, especially when all or most of the cancer cells have been removed during surgery. Currently, the "gold standard", i.e. the procedure considered to be the most effective in ovarian cancer chemotherapy, is the simultaneous administration of carboplatin and paclitaxel.
The difficulty in treatment is that in some cases the cancer unfortunately recurs. In such a situation, it is possible to further treat the disease, which extends the woman's life, but it is rather impossible to cure her completely.
For ovarian cancer, radiotherapy is usually used as a palliative or symptomatic treatment.
Causes of ovarian cancer
At the moment, there are no clearly defined causes of cancer. It is suspected that it may have a genetic basis. However, risk factors have been identified that increase the likelihood of developing this cancer. These are:
- family history of ovarian cancer (BRCA1 or BRCA2 gene mutation carrier)
- previous breast cancer
- a family history of hereditary non-polypoid colorectal cancer or Lynch syndrome
- anovulatory cycles that require stimulation of ovulation
- late motherhood (over 35)
- hormonal disorders - hyperestrogenism
- puncturing the surface of the ovary when collecting oocytes
- perimenopausal age
- low socioeconomic status
- a high-fat diet
The risk of developing this cancer decreases in women who have had children, breastfed or used hormonal contraception.
Ovarian cancer - prognosis and complications
The possibilities of cure are best when the disease is detected in stages I and II. Detection of cancer in stages III and IV, i.e. when it is detected most often, significantly worsens the prognosis and the chance of 5-year survival is up to 30-50%. The prognosis is also more unfavorable when the tumor is located on both sides or has already metastasized (ovarian cancers very quickly spread to the peritoneum and spread throughout the abdominal cavity).
Statistically, every year for every 3,000 women who find out they have ovarian cancer, 2,000 will fail the treatment.
What metastasis does ovarian cancer give
Ovarian cancer in a relatively short time metastasizes to the abdominal cavity and chest, and even further, to the liver, lungs or bones, wreaking havoc in the woman's body, impairing organ functions and, consequently, causing bone pain, hemoptysis or reduced respiratory efficiency.
Ovarian cancer prevention
In the case of ovarian cancer, there are no regular tests that can help diagnose the disease at an early stage. An important element of prophylaxis are regular visits to the gynecologist - women over 40 should come for a visit at least every year, and younger women every 1-3 years.
There is also no way to prevent ovarian cancer, because there are no clearly defined causes of its formation. However, by eliminating risk factors, you can reduce the risk of its occurrence. The best way is:
- change to a low-fat diet
- having a child before the age of 35
- giving up smoking
- reducing body weight and maintaining it at an appropriate level
- breastfeeding children
- long-term use of hormonal contraception (especially for women with a positive family history)
- prophylactic oophorectomy (especially in women with a family history of ovarian cancer and those with confirmed genetic mutations).
It is important to collect a detailed history of the occurrence of reproductive cancers among women in the closest degree of kinship (mother, grandmother, sister).
The presented medical information should not be treated as guidelines for medical conduct in relation to each patient. The medical procedure, including the scope and frequency of diagnostic tests and/or therapeutic procedures, is decided by the doctor individually, in accordance with medical indications, which he determines after getting acquainted with the patient's condition. The doctor makes the decision in consultation with the patient. If the patient wants to perform tests not covered by medical indications, the patient has the option of paying for them.
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