Ovarian cancer is one of the most common gynecological tumors. With more than 3,600 cases a year in Spain, according to data it is the fifth most frequent tumor in women, along with breast, colon, uterus, and lung cancers.
It is a disease that is characterized by “diagnosing in most cases, in advanced stages, that is, when the tumor is no longer located in the ovary but is affecting other organs of the abdominopelvic cavity. This is due to the fact that the disease is asymptomatic in the initial phase, that there is currently no early diagnosis (screening), and that its progression capacity is high”, explains Dr. María Bordés Infantes, Coordinator of Oncological Gynecology of the Public Hospitals managed by Quirónsalud in Madrid.
It is a silent disease, that is, it does not give symptoms, but even so there are a series of specific signs such as Weight loss and appetite. Feeling tired. Abdominal distension, that is, the patient feels bloated despite taking very little food. Constipation and difficulty urinating. Abdominal pain. And shortness of breath or difficulty breathing when she is lying down.
Are there risk factors? As explained by Dr. María Bordés, the main risk factors that can affect the appearance of the tumor are the following:
– Age. This type of tumor is more frequent once the barrier of 50 years has been overcome, once menopause or postmenopause has begun.
– Early menarche. Women who began their hormonal development at an early age, that is, had menstruation before the age of 12, are more likely to develop this cancer.
– Late menopause. There also appears to be an associated risk of ovarian cancer in menopausal women over the age of 52.
– Family background. “ Those people with a history of first or second-degree relatives with ovarian cancer have a higher risk of presenting this disease. There are several genetic mutations that are associated with hereditary familial ovarian cancer, the most frequent being BRCA 1 and 2”, says the doctor.
– Nulliparity. Not having had children is another reason why this type of tumor can be diagnosed.
– Endometriosis. This disease of the uterus is associated with minimal increased risk of developing a certain type of ovarian cancer.
– Other factors. Like tobacco, being overweight or sedentary life.
With more than 3,600 cases a year in Spain, it is the fifth most frequent tumor in women
“There are several factors that prevent the risk of ovarian cancer and they are very important. Mothers who opt for breastfeeding have a 30% lower risk of having ovarian cancer. Use oral contraceptives. Have your ovaries and fallopian tubes removed once you no longer want to have any more children. It is the most effective measure to reduce ovarian cancer, however, it does not exempt you from developing another similar cancer such as peritoneal cancer. The ligation of the fallopian tubes is also another measure that has been shown to reduce the risk of cancer”, adds Dr. Bordés.
DIAGNOSIS AND TREATMENT
“The initial assessment is through the physical examination of these patients. When a woman is sent to the consultation or to the emergency room with the aforementioned symptoms, she already has to set off the alarm, that it is possible that we have a woman with an ovarian mass in front of us to rule out malignancy ”.
In addition, other tests are required, such as a gynecological ultrasound, to visualize ovarian masses that may meet ultrasound criteria for malignancy, and a blood test to determine the specific tumor markers, although there are more specific markers than others depending on the type of tumor, the most used They are: Ca 125, Ca 19.9 and HE4.
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“Thirdly, we have to carry out an extension study, to see how the disease is and what phase we are in. For this, an MRI is performed, which studies very well the disease located in the pelvis, and a computerized axial tomography (CAT), which rules out distant disease from other organs”.
Other imaging tests with higher resolution such as PET CT and biopsies are also used to determine the extent of the disease in order to carry out an adequate and personalized treatment.
What are the main treatments? The three basic pillars for the treatment of ovarian cancer are surgery, chemotherapy, and immunotherapy. “Whenever possible due to the extent of the disease, surgery should be performed that involves resecting all the visible tumors in the abdominopelvic cavity. Different types of operations can be done, hysterectomy (resection of the uterus), bilateral adnexectomy (both ovaries and fallopian tubes), pelvic and para-aortic lymphadenectomy (remove all lymph nodes in the regions surrounding the ovaries and in the great vessels). If the disease is advanced and affects other organs, the disease must be resected until there is no visible tumor with primary cytoreduction”.
To increase patient survival, chemotherapy treatment must always be performed, except in very early stages. Thanks to research, more personalized treatments are carried out every day and directed at certain target points, which allows cancer cells to be “attacked” from several fronts.
RISK OF RELAPSE
Despite continuous advances in science, unfortunately, there is still a risk of relapse. “This is due to the aggressiveness of the disease, and above all, because we do not have an early diagnosis as in other entities, such as breast and cervical cancer, which allows us to diagnose our patients in very early and curable stages.
