Every year, over 3 Polish women are diagnosed with ovarian cancer. 2/3 of them die within five years. Despite great medical advances, this tumor is still a “silent killer”. Why? – It is a cancer that we cannot detect early, we do not catch pre-cancerous conditions – explains Dr. n. med. Radosław Mądry, gynecologist-oncologist.
- Ovarian cancer is most common in perimenopausal women, but there are also cases in younger patients and even small girls
- The symptoms of ovarian cancer are non-specific – they usually start with digestive complaints, such as flatulence and indigestion. This makes it easy to underestimate the tumor in the early stages of its development
- According to Dr. Mądry, it is an insidious tumor: – It is aggressive and often proceeds quickly. It happens that we find advanced ovarian cancer in a woman who had been to a gynecologist three months earlier and nothing disturbing happened
- The expert explains what are the current treatment methods and ways to reduce the risk of ovarian cancer
Journalists for Health Association: How many women in Poland develop ovarian cancer?
Dr hab. n. med. Radosław Mądry: Annually, we have approx. 3,5 thousand morbidity, most often in peri and postmenopausal women, rarely before the age of 40. However, they also happen in girls and women over 70. About two-thirds of patients die within the first 2 years, and the cure rate does not exceed 3 percent.
Why is this happening?
It is a cancer that we cannot detect early because we do not have the screening tools. We do not catch precancerous conditions. It is a global problem.
About 70 percent of patients see their doctor when the cancer is spread.
In women who carry the BRCA1 / 2 gene mutation, this cancer is more common than in the group without this mutation. The genetic background affects 20-25 percent of patients with ovarian cancer.
What are its symptoms?
They are nonspecific and may be present a year before diagnosis, most often affecting the gastrointestinal tract. These are empty belching, constipation, loose stools, a feeling of fullness in the stomach. There are also symptoms of the urinary system – a feeling like inflammation of the bladder and problems related to defecation. Spotting may occur in postmenopausal women. The classic combination of symptoms indicative of ovarian cancer is abdominal fluid, a tumor in the appendages, and a high marker of CA 125. Histopathological material is required for complete diagnosis.
- See also: Ovarian cancer often confused with indigestion and flatulence
What do we know about the nature of this tumor?
He is aggressive and often runs quickly. Its cells peel off easily from the epithelium covering the ovary or from the fallopian tube and circulate in the abdominal cavity, implanted at various sites.
It happens that we find advanced ovarian cancer in a woman who had been to a gynecologist three months earlier and nothing disturbing happened.
In Poland, the mortality rate from ovarian cancer is increasing and is 15 percent higher than in other countries. Is there any hope for improvement?
Molecular diagnostics, which allows to detect people with gene mutations, mainly BRCA1 / 2, offers great opportunities. We can offer these people a treatment that extends the time to progression. In addition, after detecting a pathogenic mutation in a woman, we can conduct genetic tests in her family and, if necessary, propose measures to reduce the risk of cancer – removal of the fallopian tubes and ovaries. This method reduces the risk of developing ovarian tumors from 50-60 percent to about 4 percent.
In Israel, where genetic testing and risk reduction surgery are advanced, the number of new cases of ovarian cancer is declining.
- Read: Ovarian cancer is a challenge for XNUMXst century medicine
How is ovarian cancer treated?
Combined treatment: surgery and chemotherapy. The basis of surgical treatment is laparotomy, i.e. opening the abdominal cavity and removing the uterus, ovaries with fallopian tubes and neoplastic lesions with the intention of completely removing these lesions.
After surgery, 90% of patients receive chemotherapy (carboplatin with paclitaxel). Some patients may receive an additional third drug – bevacizumab during and after chemotherapy. Patients who cannot undergo such a procedure, after obtaining a histopathological result – currently, mainly by laparoscopy, undergo neoadjuvant chemotherapy consisting of the three above-mentioned drugs.
What is this third drug?
It is a monoclonal antibody that inhibits the formation of blood vessels. Extends the life of patients with advanced ovarian cancer by approximately 10 months.
After chemotherapy, 70% patients, we obtain a complete or partial response to treatment. The problem with ovarian cancer, however, is that about 70 percent of patients relapse after first-line treatment. However, if these women are given a long enough timeout before they relapse, they may receive another chemotherapy treatment. If they respond to treatment, the use of PARP inhibitors as maintenance therapy is a chance of prolonging the time to progression.
What are PARP inhibitors?
It is a new group of molecular drugs that inhibit the growth of tumors. This drug can be used to treat people who responded to treatment in the first line or after relapse (in the second, third or fourth line). This is the aforementioned maintenance treatment in the form of tablets or capsules. Research shows that these drugs significantly delay disease progression both after the first line of treatment (from about 10,4 to 22 months) and after relapse (from about 5,5 months to about 19-21 months). We do not yet have overall survival data. The patients with the BRCA1 / 2 mutation benefit most from the use of PARP inhibitors.
Are these drugs available in Poland?
Yes, we have a therapeutic program financed by the National Health Fund. The indications only apply to treatment after relapse. The drug available in Poland is reimbursed only for use in people with the BRCA mutation. For patients without this mutation, maintenance therapy with PARP inhibitors is currently not reimbursed.
Where should ovarian cancer be treated?
In specialized centers. The patient should be looked after by a team of doctors – gynecologist-oncologist, oncologist surgeon, clinical oncologist, geneticist, histopathologist and radiologist. This allows for a quick treatment path. Unfortunately, some patients in Poland are treated in centers that do not have the appropriate experience and equipment. We are far from, for example, the Netherlands or Sweden, where ovarian cancer treatment is carried out only in accredited centers.
What is important in the prevention of ovarian cancer?
The ability to reduce the frequency of ovulation is important. The incidence of ovarian cancer is reduced in women who have had multiple pregnancies, are breastfeeding for a long time or who use hormonal contraception. On the other hand, obesity and hormone replacement therapy are factors that increase the risk of ovarian cancer.
On May 8, we celebrate the World Ovarian Cancer Awareness Day, symbolized by a turquoise bow. To sum up – what stage are we at?
In recent years, there has been a breakthrough in molecular diagnostics and treatment with PARP inhibitors, which our patients can benefit from. Advanced genetic tests can be performed with the NFZ money. In the group of patients with BRCA1 / 2 gene mutation, the possibility of using PARP inhibitors changes their fate, because it significantly prolongs the time to disease progression. I believe that in the short term, half of our ovarian cancer population will have very long remissions. Maybe we will even have a chance to significantly improve the cure rate.
gynecologist-oncologist, head of the Oncological Gynecology Department at the Transfiguration Hospital in Poznań, member of the board of the Polish Society of Oncological Gynecology, chairman of the Polish Ovarian Cancer Group
Authorized interview prepared by the Journalists for Health Association in connection with the World Ovarian Cancer Awareness Day, May 8, 2020, Quo vadis medicina, XNUMXnd edition, “Ovarian cancer – an unexpected threat”
This may interest you:
- The biggest myths about ovarian cancer
- Every year, 3,5 people hear the diagnosis. Polish women, and 2,5 thousand dies. The first symptoms are confusing
- It doesn’t happen! The nine-year-old fell ill with ovarian cancer