Ovarian cancer can develop in a few months, i.e. between one visit to the gynecologist. Moreover, there are no screening tests that are performed for this in all patients. And ovarian cancer symptoms can be confused with other ailments. With which? Dr. Dominika Trojnarska, MD, a gynecologist from the Superior Medical Center explains.
- There is no simple screening diagnosis for ovarian cancer
- To detect it, it is necessary to undergo regular ultrasound examinations. However, it also does not give 100 percent. certainty that the cancer will not develop
- Cancer grows very quickly. So it’s worth knowing what its main symptoms are
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Agnieszka Mazur-Puchała, Medonet: Doctor, have you ever had a patient who developed ovarian cancer and she realized it too late?
Dominika Trojnarska, MD, PhD, gynecologist from Superior Medical Center: Unfortunately, such patients happen relatively often. The main problem with ovarian cancer is that symptoms come on late. At the same time, we do not have any screening methods that would allow its detection at a very early stage. Usually, the patients who come to me with ovarian cancer are women whose gynecologist on a routine ultrasound examination saw a tumor on the ovary that met the criteria for a malignant tumor.
It also happens that women come to me with more unusual symptoms, such as an increase in the circumference of the abdomen, sometimes weight loss or ascites, which is the fluid in the abdominal cavity that is produced by an ovarian tumor. Ascites is detected by an ultrasound examination performed not only by a gynecologist, but also, for example, by a family doctor.
Can we detect every ovarian cancer with ultrasound?
Yes and no. It may happen that the patient already has symptoms in the form of ascites and gynecological examination turns out that she does have some change on the ovary, but it is not a large tumor, several centimeters long, but even smaller. The problem is that even an ultrasound scan is not reliable in this case. Having an ultrasound routinely helps us to recognize ovarian cancer earlier. Unfortunately, this cancer can grow very quickly and it may happen that it will appear between visits to the doctor.
Even if we check ourselves regularly?
When I was still in residence, a patient came to see me. About 50 years old, very neat, regularly going to the gynecologist’s check-ups. Six months earlier, she had been to the doctor, had an ultrasound and no changes were visible. And six months later, the examination showed a tumor and ascites. The patient asked if the doctor had missed anything then. It was about my friend who is a good specialist. There was no way it was a mistake. The cancer simply developed rapidly. This unfortunately happens.
So ovarian cancer does not have specific symptoms, and we do not have a screening diagnosis. What can we confuse it with?
There are many diseases that can cause ascites – for example cirrhosis of the liver. When it comes to gynecological diseases, the same symptoms are also manifested by cancer of the fallopian tubes or cancer of the peritoneum. These are other cancers that are difficult to spot. Moreover, it is only from the pathologist’s information that we learn what kind of cancer we are dealing with, as long as we do not determine during the operation which organ it originates from.
Other ovarian tumors are simple, hemorrhagic or endometrial cysts. Ovarian cancer can also be mistaken for a dermoid. The difference is that cancer in the case of malignant changes leads to exhaustion of the body in the long run – the patient is losing weight and feeling tired. There are no such symptoms with benign tumors.
And such inconspicuous symptoms? I read that women confused ovarian cancer with, for example, flatulence …
As this tumor grows in the abdomen and produces fluid, some patients have difficulty passing stools, for example. They are mainly constipation. Pain may also sometimes occur, but in ovarian cancer it appears relatively late. The earliest change we can detect is a tumor on the ovary. Therefore, whenever we see one, we refer the patient for diagnostic tests – we determine tumor markers in the blood. In the case of ovarian cancer, Ca125 and HE4 antigens are tested, on the basis of which the ROMA index is calculated. This way, taking into account the patient’s age, it is possible to check how high the risk of ovarian cancer is.
- The editorial office recommends: Are you worried that you are at risk of cancer? Perform a study of tumor markers for women
Unfortunately, not everything is simple here either. The most common form of ovarian cancer is serous cancer and we learn the most about it through indicators. Other ovarian cancer subtypes are not as specific as possible, although rates will continue to be elevated.
As part of prophylaxis and diagnostics, it is worth performing a genetic test of the most common mutations associated with ovarian and breast cancer. This examination is available in a shipping version, which is completely safe and convenient.
So, tumor markers alone are not a solution either?
There has been, and is still going on, a lot of research to determine how we might detect ovarian cancer early. But it has been proven that neither ultrasound nor the collection of screening markers statistically increases the detection of ovarian cancer and does not extend the life of patients who develop ovarian cancer.
Especially since even a correct result does not guarantee that there is not a single cancer cell that will rapidly develop ovarian cancer.
Thanks to Paulina Młynarska, there is talk of prophylactic mastectomy in Poland again. Is conservative surgery a good idea for ovarian cancer?
This is prophylaxis for women with a confirmed mutation in the BRCA1 BRCA2 genes, and it is also not a screening test. I would not advise women without specific indications, e.g. a positive family interview, to do tests for mutations of these genes. Even if someone has the mutation, it doesn’t mean they will definitely get sick.
- See also: Paulina Młynarska has undergone prophylactic mastectomy. Up to 300 people qualify for it. Polish women
In turn, prophylaxis in positive women, especially if they have already completed procreation, is recommended. The cell from which ovarian cancer originates is located in the distal part of the fallopian tube, which is where the hyphae are. In women who have the uterus removed, it is excised together with the fallopian tubes. Prophylactic removal of the fallopian tubes is said to reduce the risk of ovarian cancer.
How fast does ovarian cancer develop?
It’s hard to say unequivocally. I don’t want to talk about weeks, but it may indeed be months during which the cancer will develop. Usually, the large ovarian tumors we see in a patient are largely benign tumors – they have time to grow. Malignant ovarian neoplasm grows relatively quickly, but because it is so aggressive, it quickly metastasizes and causes symptoms such as ascites.
Women go to a gynecologist with ovarian cancer when it is at least to some extent advanced. Is there any chance of a full recovery at this stage?
Ovarian cancer is specific in that it respects the peritoneal boundaries. It metastasizes quickly, but within the abdominal cavity. There may be liver or bowel loops metastases, but they are superficial. They stem from the fact that the cancer cells are in the fluid that collects in the abdominal cavity. And this one circulates due to body or bowel movements. At this stage, ovarian cancer has no distant metastasis.
Even with advanced cancer, if the patient’s general condition allows it, a major operation is performed, during which the abdomen opens from the pubic symphysis to the xiphoid process of the sternum. Then the uterus, ovaries and the peritoneum are removed. You can also remove superficial liver or intestinal metastases. The clinical trials conducted so far show that such an operation has a positive effect on the patient’s health – the aim is to remove the tumor sites whose border is 1 cm. If there are no larger tumors in the body after surgery, then that’s fine. And even better when macroscopically you can no longer see them at all.
Of course, there are extreme cases where, after opening the patient, so many neoplastic areas can be seen that it is only possible to take a clipping, close the abdomen and apply chemotherapy.
Regular cytology is essential for cervical cancer. We can detect breast cancer by self-examination or ultrasound. There is no such simple remedy with ovarian cancer. So what should we do to increase our chance of early cancer detection?
Unfortunately, we have to undergo regular gynecological checks once a year. In case of abdominal pain, an increase in its circumference or a decrease in body weight, the patient should see a doctor as soon as possible. And that’s all we can do, unfortunately. Of the gynecological neoplasms, ovarian cancer is the worst. We do not have anything specific that could be caught in preventive diagnostics. It’s a vicious circle.
Also read:
- What do Polish women die most often?
- They know they are dying. How do I talk to cancer patients?
- WHO: Breast cancer is the most commonly diagnosed cancer in the world. Not lung cancer anymore
- Poland: more and more malignant tumors