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In recent years, much has been said about cervical cancer – the most common cancer in women. However, it is worth finding out about the next – extremely dangerous – cancer of the female reproductive system – ovarian cancer, known as the “silent killer”.
Generally speaking, the ovaries are located in the abdominal cavity, and more precisely in the smaller pelvis, which is why access to them in the examination is difficult. The best method, apart from a gynecological examination, is an ultrasound examination. Visualizing the ovarian structures is not always easy, and sometimes even impossible. Within the ovary, many pathologies can develop, ranging from benign cysts to the most malignant neoplasms that quickly lead to death. The causes of its formation are not fully understood, so prevention is particularly difficult. All together makes ovarian diseases one of the most difficult diagnostic and therapeutic problems in gynecological oncology.
With whom, how often and where?
The incidence of ovarian cancer varies by region. The fewest diagnoses are made in Japan, and the most in the countries of the Scandinavian Peninsula. The frequency also depends on age. The most common disease is women over 50 (over 60%), although the disease occurs in about 10% of young women before the age of 20. Genetic factors and the family occurrence of not only ovarian cancer, but also breast and colon cancer are of great importance. It should also be strongly emphasized that it occurs much more often in women who have never given birth, therefore obstetric interview is particularly important. It is related to the frequency and number of ovulations in a woman’s life. With fewer ovulations, the chance of lowering the occurrence of ovarian cancer increases. Pregnancy is a physiological state that inhibits the ovulation process, while hormonal contraception exerts a pharmacologically calming effect on the ovary.
When to be concerned
Since ovarian cancer does not show any symptoms in its initial stage, or they are scarce and underestimated by the patient, early diagnosis is unfortunately extremely difficult and usually only accidental. What can worry us in such a situation? Development of lower abdominal pain, constipation or frequent urination. These symptoms result from the pressure influence of the growing changed ovary on the neighboring organs: the large intestine or the urinary bladder. Sometimes the main symptom that should undoubtedly raise suspicions that something is wrong is the unexpected enlargement of the abdomen. Especially when neither diet nor lifestyle have changed.
In women of childbearing age, the situation is complicated by the halt of menstruation, which, together with the enlargement of the circumference of the abdomen, may give the illusion of pregnancy and delay the proper diagnosis of the proliferative disease. In the next stage of the disease, neoplastic cells spread and metastasize to the organs of the abdominal cavity, non-specific symptoms such as nausea, loss of appetite, abdominal pain and bloating still appear. If a woman still does not see a doctor, alarming symptoms suggesting cancer may be added to it, such as: marked weight loss, generalized body emaciation and severe weakness. The appearance of ascites, i.e. the presence of free fluid in the abdominal cavity, accompanies ovarian cancer in 30% and may indicate, for example, liver damage.
In the case of a hormonally active tumor, hormonal disorders and abnormal vaginal bleeding appear.
Final recognition
Every woman of reproductive age – once a year, women in the peri-and postmenopausal age – every six months, and women with a positive oncological history – even more often, should be examined by a gynecologist. A thorough interview with the patient and a gynecological examination together with an ultrasound examination are currently the only methods of early detection of ovarian abnormalities. The ultrasound often allows conclusions about the nature of the change, its location, size and further procedure. It should be emphasized here that the patient’s obesity makes it very difficult or impossible to assess any possible changes in the clinic, and ultrasound with a transabdominal probe is useless. Particularly in these cases, it is necessary to perform an examination with a vaginal probe. More advanced and relatively less frequently performed imaging methods include computed tomography, or even magnetic resonance or PET imaging, used in selected cases as a supplement to ultrasound.
A modern diagnostic and therapeutic method in the case of ovarian tumors is increasingly available and used laparoscopy. It is an invasive method that allows not only to carefully inspect the organs in the abdominal cavity, but also to take material for research and even remove certain types of tumor. Only the histopathological result will make it possible to make a final diagnosis with a clinical grade and classify the lesion to the appropriate morphological group. In the event of ascites, puncture can be performed and fluid collected for cellular examination.
Neoplastic markers, measured from peripheral blood, including CA-125, are also helpful. The marker, unfortunately, is only a supplement to the range of tests, due to its non-specificity for ovarian cancer and a large increase in value also in pancreatic cancer, endometriosis or fallopian tube cancer.
How to heal?
Surgery is the primary treatment. Depending on the severity, type of lesion and age of the patient, a decision is made about the extent. Most often, radical surgery is required, including hysterectomy with both ovaries, the appendix, and the surrounding tissues to remove as much of the tumor mass as possible. It is most advantageous to extract the altered ovary in its entirety, not allowing its capsule to rupture, therefore the method and extent of cutting the abdominal cavity are planned before the operation, depending on the size of the tumor. If it is impossible to excise the entire lesion, as much of the tumor mass as possible is removed using a so-called cytoreductive procedure.
Comprehensive management includes complementary treatment, that is, additionally – chemotherapy. It is possible after the precise diagnosis and the degree of clinical advancement of the lesion in the histopathological examination. Popularly known “chemistry” aims to destroy or reduce small tumor foci and micrometastases. It is a treatment that is burdensome for the body, therefore the general condition should be assessed before starting it, and basic additional tests, such as morphology and parameters of the liver and kidneys, should be monitored frequently. The most common troublesome side effects include hair loss, gastrointestinal irritation and nausea with vomiting.
Radiation therapy, depending on the radiosensitivity of the lesion, is an addition to the therapy of ovarian cancer, which is rarely used at present.
Prognosis
It should be emphasized that approximately 75% of patients at diagnosis are in a very advanced stage of the disease. It should be even more clearly emphasized that in 40% of patients undergoing radical surgery with complete adjuvant combination therapy, recurrence occurs within 5 years. Only 25% of women survive 5 years from the diagnosis of cancer. The above data are constantly changing dry statistics that do not reflect the drama of the woman and her family from the moment of diagnosis, throughout the treatment process and further recovery, and the expectation of the worst. It is all the more important to understand the importance of systematic control and self-observation. There is a slow increase in the incidence of ovarian cancer worldwide and research is constantly being carried out on the early diagnosis and more effective treatment of this “silent killer”. Before that happens, let’s start with ourselves today. Let’s overcome the fear of going to the gynecologist and gynecological examination, because the doctor is the only ally in this unequal fight against cancer.
Text: lek. Katarzyna Kuśmierczyk
Read more in Ovarian cancer – the challenge of XNUMXst century medicine.