Ovarian cancer mainly affects women over 50. It also happens with younger people. Unfortunately, many women see a doctor in an advanced state of disease – at the beginning, the cancer does not show symptoms in the lower abdomen, and it can be manifested by, for example, flatulence. Until recently, the diagnosis of this cancer sounded like a sentence. Currently, it is treated as a chronic disease. How is it treated in Poland? Explains the gynecologist-oncologist, prof. dr. hab. n. med. Mariusz Bidziński.
- Ovarian cancer is one of the most common malignant neoplasms among Polish women
- Early diagnosis of ovarian cancer is difficult due to, among others, no clear typical symptoms, 80 percent. these are gastric problems, such as indigestion or flatulence
- Approx. 70 percent patients are advanced cases, therefore surgery remains the main element of treatment of ovarian cancer. The next stage is systemic treatment based on chemotherapy
- Prof. dr. hab. n. med. Mariusz Bidziński: If we could create the system I dream of, the statistical results could be improved from the current 40-45 percent. survive at a minimum level of 5 years, up to about 70 percent. There is something to fight for
- More information can be found on the Onet homepage.
Prof. dr. hab. n. med. Mariusz Bidziński, gynecologist-oncologist, national consultant in the field of oncological gynecology, head of the Department of Oncological Gynecology of the National Oncology Institute Maria Skłodowskiej-Curie, National Research Institute.
How many women in Poland hear the diagnosis: ovarian cancer each year?
Prof. dr. hab. n. med. Mariusz Bidziński: We have about 4 newly diagnosed cases of ovarian, fallopian tube and peritoneal cancer, of which the most cases concern ovarian cancer. This cancer affects mainly perimenopausal women, i.e. after 50 years of age. However, it also happens in younger people.
What can be said today about the treatment of ovarian cancer in Poland?
We have more and more successes, as evidenced by the statistics of experiences. Early diagnosis is essential. Unfortunately, a large group of women see a doctor in an advanced state of disease, because early-stage ovarian cancer does not show symptoms in the lower abdomen, but rather from the upper abdominal floors (e.g. indigestion, flatulence), which makes diagnosis difficult. It is worth remembering that a family history is important for a doctor, i.e. information about cases of cancer in a close family. The disease is diagnosed by marker, ultrasound and imaging studies.
Women fear visits to the gynecologist-oncologist. How can I get rid of anxiety?
A gynecologist-oncologist is a rare specialization, there are only 330 of us in Poland, and, for example, gynecologists-obstetricians – 7. Fear should not paralyze patients. You should be aware that we are going to a specialist who can reassure us. And if it detects certain irregularities, it will guide us in the right direction.
Until recently, the diagnosis of “ovarian cancer” sounded like a sentence. Currently, it is treated as a chronic disease. How is it treated?
Surgery remains the main element, as about 70% of of patients are advanced cases, in which the disease has spread beyond the ovary and the infiltrates appear in various places. Surgery allows for the removal of visible lesions and enables histopathological diagnosis.
The next stage is systemic treatment based on chemotherapy. It is an effective method – we achieve remission in about 80 percent. female patients. For women with a mutation in the BRCA1 / 2 genes, we still have reimbursed maintenance targeted treatment in Poland, i.e. PARP inhibitors.
If you want to test for the BRCA 1 or BRCA 2 gene mutation, you can purchase a mail-order genetic test through Medonet Market.
How do PARP inhibitors work and what are the benefits for patients?
A cancer cell is damaged as a result of chemical treatment. However, it has its own repair mechanisms, i.e. the PARP (poly-ADP-ribose polymerase) enzyme, which repairs its DNA. If we block such an enzyme, the cell will not be able to recreate the repair mechanism and will be permanently damaged. The therapeutic success of PARP inhibitors is very large.
Women with the BRCA1 / 2 gene mutation constitute a dozen or so percent of all patients with ovarian cancer. Why do other patients not have access to these medications?
PARP inhibitors are most effective in the group of patients with the above-mentioned gene mutation. For the rest, they are less effective. However, because they also work in these others, in many EU countries at least one of the PARP inhibitors (niraparib) has been registered as a drug administered to all patients diagnosed with ovarian cancer in the so-called maintenance therapy, that is, where remission has been achieved after primary treatment.
Economic analyzes are ongoing and I believe they will point the right direction to policymakers in terms of wider reimbursement. PARP inhibitors are another breakthrough in the treatment of ovarian cancer and it would be good if we could use these molecules in Poland not only in women with BRCA1 / 2 gene mutations.
What do patients with ovarian cancer and medics expect in Poland today?
Create a good treatment system. As a national consultant, I strive to ensure that patients can go to centers where the chance for optimal management is the greatest. It is not only about treatment in the appropriate sequences, but also about diagnosis, genetic tests and rehabilitation, enabling the fastest possible recovery and normal life.
This complexity can be expected only in highly specialized reference centers in gynecology oncology, which are established all over the world (Ovarian Cancer Units). This process was delayed by the COVID-19 pandemic, but will be resumed soon. Such facilities in Poland are part of the National Oncological Strategy.
How will these centers cooperate with other hospitals?
Poviat centers can deal with initial diagnostics, and then contact centers of higher reference, consulting individual cases. Patients with high suspicion of oncology would be immediately admitted to a specialized facility. In all countries where such centers already exist, the survival rates are significantly higher. This applies not only to ovarian cancer, but also to other cancers.
How much will the change in the organization of oncological treatment improve the effectiveness of ovarian cancer treatment in Poland?
If we could create the system I dream of, the overall statistical results could be improved from the current 40-45%. survive at a minimum level of 5 years, up to about 70 percent. So there is something to fight for.
A central register of ovarian cancer should also be established in our country so that we can know the exact scale of the problem. Data from the National Cancer Registry (KRN) shows that we have about 3,5 thousand. ovarian cancers, and the statistics of international organizations show that even 6 thousand. This discrepancy is shocking and prevents meaningful planning.
The pandemic thwarted plans for annual gynecological preventive examinations. Is it time to come back to them?
Of course. I urge all the ladies to visit the gynecologist once a year and undergo examinations not only for cervical cancer, but also for other pathologies of the reproductive organ. Thanks to this, many problems can be avoided.
Coronavirus infection is not to be feared. Healthcare facilities are well prepared to safely conduct preventive and therapeutic activities.
Recently, a book of ovarian cancer patients’ conversations has been published. They all had recurrences …
Only 15 percent. women with ovarian cancer can count on a full recovery. In the case of the others, after a few or several months, another incident of the disease occurs. We can then repeat different elements of the treatment in different sequences, depending on the nature of the changes.
I know patients who have had 7-8 cycles of chemotherapy but are still alive! We get longer and longer remissions due to the fact that we use repeated cycles of treatment. Most often, chemotherapy or its combination with surgery or radiotherapy. Of course, I recommend the book.