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Ovarian cancer awareness during the COVID-19 pandemic, which has already claimed many thousands of victims, is of particular importance. – The epidemic is dangerous not only because the virus can kill, but also because fighting it has a very significant impact on the functioning of healthcare. Unfortunately, neoplastic diseases cannot wait for a diagnosis or treatment. This also applies to ovarian cancer, which is 75% cases is diagnosed in the advanced stage, with metastases – emphasizes prof. dr. hab. Jan Kotarski, president of the Polish Society of Oncological Gynecology.
- Almost 4 of women in Poland are diagnosed with ovarian cancer every year
- Ovarian cancer accounts for only about 4,6 percent. cancer incidence among women in Poland, the mortality rate is nearly 6 percent. of all female cancer deaths. Late diagnosis and thus poor prognosis are a problem all over the world, but in Poland the mortality from ovarian cancer is several percent higher than the European Union average
- Often, ovarian cancer does not give any alarming symptoms for a long time, it “does not hurt” for a long time, only to suddenly attack sharply. Its cells can easily detach from the original tumor and move around the abdomen. They attack other organs, such as the intestines, liver, and stomach. Some symptoms appear only in the advanced stage of the disease, but they are often equated with gastric ailments.
- As ovarian cancer is most often detected in the advanced stage with metastases to other organs, treatment should be started as soon as possible. Unfortunately, the COVID-19 pandemic certainly delays both diagnosis and treatment initiation in many cases
Ovarian cancer in the world and in Poland
Every year around the world, ovarian cancer is detected in about 300. women. About 180 patients with this cancer die. The World Ovarian Cancer Coalition – an international organization that has been working to increase knowledge about ovarian cancer and progress in the diagnosis and treatment of this cancer since 2016, estimates that by 2040 the number of cases will increase by approx. 47%. and will exceed 430 patients annually.
In 1990, 2404 women contracted ovarian cancer in Poland, 10 years later – 3157, and in 2010 – 3587. The number of ovarian cancer cases in our country in 2017 reached 3775. The threat is growing all over the world. In the European Union countries, about 45 thousand people suffer from illness each year. women. In Germany there are approx. 7 thousand, in Great Britain almost 6,5 thousand, in Italy and France approx. 5 thousand each.
Thanks to the progress of medicine, more and more precise surgical techniques and new drugs, the chances of extending the life of patients are increasing, but the progress in this area still does not meet the expectations of neither doctors nor patients.
Ovarian cancer tragic statistics
Today, it is difficult to predict the long-term effects of the COVID-19 pandemic, and how many people will go to a specialist who will diagnose cancer too late. How many patients will start cancer therapy too late, and how many will not receive the care they would have had without the involvement of the entire healthcare system in fighting the pandemic.
Unfortunately, although ovarian cancer accounts for only about 4,6 percent. cancer incidence among women in Poland, the mortality rate is close to 6 percent. of all female cancer deaths. Late diagnosis and hence poor prognosis are a worldwide problem, however in Poland, the mortality rate due to ovarian cancer is several percent higher than the average in the European Union.
More than half of the cases of ovarian cancer occur in women aged 50–70 years, but it is sporadic even in young girls, and approx. 15% it occurs in women before the age of 50. Women with a genetically determined risk of this cancer are particularly at risk.
Hidden symptoms – ovarian cancer diagnosis difficult
The high mortality rate from ovarian cancer is due to its insidious development. This cancer does not show any obvious symptoms, and there is no possibility of screeningas is the case with, for example, cervical cancer or breast cancer.
Cancer cells grow in the ovaries, in the tissues surrounding them, or in the fallopian tubes. Sometimes the neoplastic process begins in the lining of the abdominal cavity, i.e. in the peritoneum. Often, ovarian cancer does not give any alarming symptoms for a long time, it “does not hurt” for a long time, only to suddenly attack sharply. Its cells can easily detach from the original tumor and move around the abdomen. They attack other organs, such as the intestines, liver, and stomach. Some symptoms appear only in the advanced stage of the disease, but they are often equated with gastric ailments. This includes flatulence, diarrhea, a feeling of fullness, belching or finally ascites. Symptoms characteristic for diseases of the reproductive organ, such as unusual bleeding, pressure in the pelvis appear less frequently and also do not necessarily suggest this disease immediately.
There are no simple diagnostic methods or testing to detect early stage ovarian cancer. Transvaginal ultrasound may be helpful, as it shows some changes in the ovaries, but most often they are harmless cysts. Currently, the assessment of tumor markers Ca-125 and HE-4, performed together with the ultrasound examination, is used in diagnostics. However, in the initial stages of this cancer, the Ca-125 level may not be abnormal, and elevated levels may not be indicative of the disease or the disease at all. The HE-4 marker is more sensitive in ovarian cancer, but also does not give a clear assessment in the primary stage of its development.
Ovarian cancer and genes
We know more and more about the relationship between genes and the development of neoplastic diseases. However, the risk factors for developing ovarian cancer are not fully understood. Pregnancy and breastfeeding, i.e. longer, physiological breaks in ovulation, and the use of hormonal contraception can protect against it..
However, some cases have a genetic background – mutations in the BRCA1 and BRCA2 genes (also responsible for genetically determined breast cancer) and hereditary predispositions associated with other genes. Experts estimate that 1 in 300 women have these mutations in Poland. They increase the risk of ovarian cancer by approx. 40% and breast cancer by approx. 70%. So if there have been cases of these tumors in the closest family, the woman has a right to be afraid of them. However, mutations in the BRCA1 and BRCA2 genes can be detected in a relatively readily available genetic test
The genetic basis is from 15 percent. up to 24 percent ovarian cancer cases in Poland. The detection of genetic mutations is important not only in the diagnostic process, but also influences the prognosis and the choice of the most effective therapy possible. Sometimes, the result of a prophylactic examination, prior to the onset of the disease, indicating the occurrence of mutations in the BRCA1 and BRCA2 genes, prompts healthy women to preventive removal of the ovaries and uterus or to prophylactic mastectomy. These procedures in women with confirmed genetic mutations are reimbursed in Poland, and in the case of ovarian cancer – recommended after the implementation of maternity plans and menopause.
Treatment of ovarian cancer despite the pandemic
As ovarian cancer is most often detected in the advanced stage with metastases to other organs, treatment should be started as soon as possible. Unfortunately, the COVID-19 pandemic certainly delays both diagnosis and treatment initiation in many cases. It is not without reason that doctors are sounding the alarm that the victims of the pandemic will soon become mainly patients suffering from diseases other than COVID-19.
– Based on the information available so far, it seems that the benefits of oncological treatment significantly outweigh the risk of dying from COVID-19. Treatment of ovarian cancer during a pandemic should be carried out with the shortest possible delay, warns Prof. Jan Kotarski, however, recalling that cancer also increases the risk of death due to coronavirus infection.
– In the general population, the frequency of deaths as a result of COVID-19 is about 2%, in the 70-79 age group – 8%. The risk of death due to infection in cancer patients is 6%, patients with diabetes – 7%, and in patients with concomitant cardiovascular diseases – 15%. And many ovarian cancer patients are older and have other comorbidities.
In the fight against ovarian cancer, surgery is combined with chemotherapy. The extent of the surgical procedure in which cancer stage and metastatic disease can be assessed may vary, but generally covers the entire reproductive organ. In young women, in the case of a lesion limited to only one ovary and without metastases, sometimes the possibility of pregnancy is left open. Almost all patients receive simultaneous chemotherapy based on platinum and taxoid derivatives.
PARP – new treatment options
Treatment of advanced ovarian cancer, unfortunately, is not always successful. Although there are also signs of positive developments. In maintenance therapy, modern, molecularly targeted PARP inhibitors are currently used, which inhibit the multiplication of neoplastic cells and significantly extend the time to progression.
In Poland, the use of one of these drugs is reimbursed only in patients with mutations in the BRCA1 and / or BRCA2 genes, under the program called Olaparib maintenance treatment of patients with recurrent platinum-sensitive advanced ovarian cancer, fallopian tube cancer or primary peritoneal cancer. This treatment allows in this group of patients to quadruple the progression-free survival time compared to placebo. For patients without mutations in these genes, treatment with PARP inhibitors is not available, although it allows for more than two-fold increase in progression-free time compared to placebo.
That is why, in some European countries, PARP inhibitors can be used by all patients with ovarian cancer, regardless of mutations in the BRCA genes. In many countries, PARP drugs are also administered to patients without gene mutations, because numerous scientific reports indicate not only the positive effect of these drugs on cancer cells, but also the beneficial stimulating effect of PARP on the patient’s immune system.
Recommendations for Ovarian Cancer Patients During the Pandemic
The time of a pandemic poses special challenges. The Polish Society of Oncological Gynecology has issued recommendations for the management of patients with certain cancers, including ovarian cancer during the SAR-COV-2 virus pandemic.
In addition to the general guidelines on the principles of medical care for patients at the present time, PTGO recommends the use of neoadjuvant (preoperative) chemotherapy.
– Delays that may arise from an outbreak may adversely affect treatment outcomes. In many hospitals, intensive care units hospitalize patients with COVID-19. In this situation, radical surgical treatment of ovarian cancer, which determines the patient’s further fate to the greatest extent, and requires a several-day stay in the ICU, may not be performed. Doctors must use a safer method – neoadjuvant chemotherapy, which allows the procedure to be postponed – emphasizes prof. Jan Kotarski, president of PTGO.
It is worth noting that many clinical oncologists believe that neoadjuvant chemotherapy is too rarely used in Poland, and in some cases it could significantly increase the effectiveness of the surgical procedure.
PTGO recommends, among others also intravenous administration of cytostatic drugs in cycles every 3 weeks (not more often), and in patients taking olaparib – dispensing the drug for a period of 3 months and only telephone control of possible side effects.
The time of pandemic restrictions will end sometime. Ovarian cancer awareness needs to increase. And new drugs offer hope to overcome it, provided that patients get access to them.
Press material prepared by the Association of Journalists for Health in connection with the need to raise awareness of ovarian cancer, Quo vadis medicina?, XNUMXnd edition entitled: “Ovarian cancer – an unexpected threat”
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