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Ovarian cancer is an insidious disease: it is asymptomatic for so long that it is picked up when treatment is already very difficult. That is why proper diagnostics is so important.
Every year, over 3 women in Poland will hear the words: you have ovarian cancer. This makes this cancer one of the most common. The worst thing, however, is that over two thousand patients will not survive the disease, because ovarian cancer ranks fourth among all cancers in terms of mortality. Not good, because this type of cancer “likes” to attack relatively young women. The incidence increases from the age of 40, but it happens that it attacks high school graduates and XNUMX-year-olds. It is more common in women with a family history of ovarian cancer and in women who have not given birth. Interestingly, the risk of developing the disease is lower among women who used hormonal contraception.
Ovarian cancer symptoms
Why is this happening? Because ovarian cancer is asymptomatic at the onset of the disease – and when it is symptomatic, it is so subtle that it is easy to mistake it for gastric problems. Women complain of constipation, flatulence, pain in the lower abdomen, and a feeling of fullness in the abdomen. Most GPs treat these symptoms as indigestion and downplay the problem. Meanwhile, a woman – especially if she is over 40 – should undergo an ultrasound examination of the abdominal cavity in order to exclude possible changes in the ovaries. Especially if the symptoms are accompanied by general fatigue, weakness, loss of appetite, malaise. An absolute indication for further diagnosis is urgency for the bladder, pain when urinating in combination with pain in the lower abdomen, and a feeling of pressure in the lower abdomen. Vaginal bleeding is also a fairly common symptom of ovarian cancer. However, the changes are noticeable only when the tumor reaches a considerable size – large enough that it begins to compress the neighboring organs: the bladder, uterus or vagina. It is these uncharacteristic and scanty symptoms that cause almost 80 percent of In women, ovarian cancer is detected in stage III or IV – that is, when the tumor is more than 5 cm in diameter (previously it did not give any symptoms). Only when it reaches 11-15 cm and it begins to “bulge” in the abdominal cavity (often causing ascites), the patient goes to the doctor’s office. Unfortunately, these stages of advancement no longer guarantee complete recovery, despite medical advances.
In young girls (10% of ovarian cancer cases occur in women under 30), ovarian cancer can cause irregular periods, premature puberty and abnormal hair growth.
Check if you are among the people at risk of developing cancer. Perform cancer e-package for women – extended genetic tests available on Medonet Market in a version with the possibility of home blood collection or blood collection in a medical facility.
Tumor metastases
Ovarian cancer is such a difficult enemy because it metastasizes very quickly. It first attacks the peritoneum and abdomen, but quickly spreads to the chest. It travels the path of vessels and lymph nodes (causing them to enlarge all over the body), which cover our entire body with a dense network. That is why cancer cells from the ovary enter the uterus and vagina so quickly, but also into the liver, lungs and even bones. And when they get there, they can cause hemoptysis, bone pain, recurrent pneumonia, and decreased respiratory efficiency. Symptoms depend on the organ in which the cancer cells have nested.
Diagnosis of ovarian cancer
As a rule, it begins in an internist’s or family doctor’s office, where patients go complaining about liver or stomach ailments. If the doctor is vigilant, after the history and basic tests (morphology, necessarily with ESR, which increases in the case of cancer, urinalysis and abdominal ultrasound), he will promptly refer the patient to a gynecologist. Here, the woman will undergo a manual examination (often an ovarian tumor can be felt during a regular gynecological examination) through the vagina and per rectum, during which the doctor will examine the size of the ovaries, their location, shape and tenderness to touch. If your doctor detects a lesion on any of your ovaries, he or she will want to assess its shape, cohesiveness, location and mobility. The disturbing features of the tumor are limited mobility, solid consistency, bilateral location (i.e. the lesion is present on both ovaries). An alarming symptom is also seizure of the so-called Douglas sinus, a small recess of the peritoneum between the rectum and the uterus.
Research in the diagnosis of ovarian cancer
The first examination is ultrasound of the ovaries and lower abdominal organs. The best and most accurate is the transvaginal examination (transrectal examination is less common). The first examination already allows to determine whether the lesion is a harmless cyst or a dangerous growth. Even the size of the ovary is assessed as an important clue: in post-menopausal women, ovarian enlargement itself is considered alarming and suggestive of a neoplastic condition. The echogenicity of the tumor is also important: the more differentiated it, the greater the risk of malignancy. A helpful test is also a transvaginal ultrasound probe with a color Doppler, which allows you to assess the condition of blood vessels and blood flow. This examination allows the identification of neoplastic blood vessels supplying the tumor with blood, indicating the malignant nature of the lesions.
Additional examinations are often recommended: magnetic resonance imaging, computed tomography, urography, chest X-ray.
When it comes to assessing the risk of hereditary susceptibility to ovarian cancer, it is possible through tests such as laboratory mail-order analysis of the BRCA1 and BRCA2 genes.
Test ROMA
This is the latest tool to assess the likelihood that an ovarian lesion is malignant. It is a procedure named after the English language: Risk of Ovarian Malignancy Algorithm (ROMA). This procedure consists in combining several methods used so far into one, consistent risk assessment method, which enables or facilitates the decision to qualify a patient to a specific risk group, and thus also decisions on further tests or surgery. The ROMA study includes three basic components: statistical estimation of the risk of developing a malignant ovarian tumor and two tests of tumor markers: Ca 125 and HE4. The result of the algorithm is given as a percentage: they determine the probability that the patient develops a neoplastic condition.
The statistical risk of developing the disease depends on several characteristics. These include: pre-menopausal and postmenopausal age and related hormonal status, fertility (high means lower risk), socioeconomic conditions (the better, the lower the risk), diet (a high-fat diet is not conducive to health; increased consumption of milk, dairy products) and lactose, as well as drinking coffee slightly increase the risk of ovarian cancer), family history (the presence of cancer in the family is a bad sign), the size of the tumor and its presence on both sides, symptoms accompanying the disease, treatment with drugs stimulating ovulation, breastfeeding (reduces the risk).
Until recently, the main genetic test performed in women suspected of having ovarian cancer was the tumor marker Ca 125. It is a substance whose amount in the blood increases when the body is cancerous, related to the ovary or other reproductive organ. The higher the concentration of this marker in the blood (the norm is below 35 U / ml), the more advanced the disease state. However, the study of this marker cannot be the only test, because the value of Ca 125 also increases in endometriosis, uterine fibroids or inflammation of the pelvic organs. Therefore, ROMA does not only measure Ca 125 but also examines another marker. It is HE4 – a new marker of ovarian cancer. The name comes from English again: human epidymal protein 4; in Polish: the fourth subfraction of the human epididymal cell protein. This protein appears in greater amounts in the blood when the malignant process of cancer occurs in the ovary. There is very little of it in a healthy body. The HE4 test differs from the Ca 125 test in that the latter marker is often undetectable in stage I and II disease, while HE4 is already present in human blood. Therefore, in many women, whose Ca 125 test was normal, it was only the combined HE4 test that allowed the disease to be detected. HE4 is used not only in diagnosis, but also in monitoring disease progression (or recovery) and tumor recurrence.
How to read the ROMA test results?
In the ROMA test, however, it is important that the results of all individual parts correlate with the others, single results do not say enough and can give wrong conclusions. It should also be remembered that this test cannot be used on patients under 18 years of age, women undergoing chemotherapy and previously treated for cancer.
In the case of premenopausal women, the test result is less than 7,4%. indicates a low risk of cancer and a score of 7,4% or more – high risk. For postmenopausal women, high risk is equal to or greater than 25,3 percent. below this value, the risk is considered low.
- Breast and ovarian cancer – genetic testing of the most common mutations is available by mail order. You take a blood sample for testing yourself and send it to the appropriate laboratory. After 2-4 weeks, you can pick up the results.
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