Why ovarian cancer is dangerous and how it can be cured

Senior Researcher, Department of Clinical Pharmacology and Chemotherapy, Research Institute of Clinical Oncology, N.N. N.N. Blokhin “of the Ministry of Health of the Russian Federation

Ovarian cancer statistics in Russia and in the world

Despite the fact that this is not the most common type of cancer, it comes out on top in mortality among all oncogynecological diseases. So, in the world about 150 women die from ovarian cancer every year, in Russia – about 000.

A feature of this type of tumor is its “creeping threat”, that is, for a long time the disease does not manifest itself in any way and is diagnosed already at the 3-4th stage, when the chances of recovery are only 10-15%. In most cases, the disease is chronic, and patients live for about four years.

Age and heredity: the most important thing about risk groups

The peak incidence of ovarian cancer increases in postmenopausal women, i.e. by the age of 55-60. TO high risk group this tumor includes women with a genetic predisposition to ovarian cancer and other types of cancer. In these women, the risk of developing ovarian cancer increases after the age of 40.

Ovarian cancer can be of two types. The first is the one that arises on its own, the second type is hereditary. Hereditary ovarian cancer occurs in 20—30% of cases. Therefore, those patients whose parents (as well as grandparents, aunts, uncles, brothers and sisters) suffered from cancer (breast, ovary, prostate, pancreas, melanoma) should be especially careful about their health.

Ideally, a healthy woman with a family history of cancer or a confirmed mutation in the BRCA1 / 2 genes should be tested for this mutation. If there are genetic changes, such a woman is called a healthy carrier of the BRCA1 / 2 gene mutation, and in this case, more close supervision of specialists (clinical genetics, mammologist, gynecologist) is required to detect ovarian cancer and breast cancer in the early stages. But it is worth remembering that the presence of a mutation does not always lead to the development of an oncological process.

What are the BRCA1 / 2 genes? These are two genes that are responsible for repairing our DNA when minor breakdowns occur in it (which happens regularly under the influence of various environmental factors). If the BRCA1 and BRCA2 genes do not work as they should, the protective proteins are not produced, and changes gradually accumulate in the DNA. At some point, these changes can provoke uncontrolled cell division and start the oncological process.

Knowing that you have a genetic predisposition to ovarian cancer greatly increases the chances of early detection of the disease. And, accordingly, successfully cure it. So if you are aware of your family history, it makes sense to go to a genetic counseling center to assess the need for a mutation test.

Do I need to take a mutation test if there are no pathologies in the family? Generally, women without a family history of cancer are advised not to take this test. The risk of spreading the mutation in the general population is low.

Symptoms to watch out for

Unfortunately, in the early stages in ovarian cancer no symptoms… Usually women feel great and do not even suspect that something bad is happening in their body.

General symptoms:

• sharp weight loss or, conversely, an increase in the volume of the abdomen due to fluid in the abdominal cavity (at later stages);

• weakness, lower abdominal pain, difficulty urinating, or constipation (in later stages);

• uterine bleeding, spotting from the genital tract (it is very rare).

All these symptoms indicate a worsening of the situation – that the tumor extends beyond the ovaries and spreads into the abdominal cavity.

Early prevention and detection of disease

To prevent the development of ovarian cancer, it is important to visit a gynecologist regularly – once every 6 months… Usually the doctor makes a visual examination and, when he does not like something, prescribes an ultrasound of the pelvic organs. An ultrasound examination helps to determine if the ovary is enlarged and if there are changes in the peritoneum (neoplasms, metastases, fluid). After that, if the fears are confirmed, the whole range of examinations necessary for the diagnosis begins, including MRI, CT of the abdominal cavity and small pelvis.

Why do you need to go to the gynecologist so often? The disease progresses rather quickly, and in just six months it can reach 3—4th stage, which are considered the most dangerous. At the same time, the detection of the disease at an early stage increases the chances of recovery up to 60%.

Examinations by a gynecologist and even an ultrasound scan can not always show the presence of abnormalities, so often doctors use blood tests for tumor markers CA-125 and HE4… But, alas, even all these tests together do not give one hundred percent guarantee that ovarian cancer will be detected at an early stage.

What can be done for prevention?

On the Internet and literature, you can find many recommendations on the topic. Someone writes that the absence of pregnancy increases the risks, someone – that pregnancy causes ovarian cancer. Some say that breastfeeding increases the risk, others that breastfeeding reduces the risk. They also argue about the early or late onset of menstruation and the number of sexual partners. But the truth is that all these statements have no scientific basis… At least enough for medical professionals to consider them seriously.

Modern methods of therapy for ovarian cancer

A woman who has been diagnosed with ovarian cancer has a difficult path ahead of her. First of all, it is surgery, which will allow you to determine the stage of the disease and remove all its manifestations as much as possible. Then comes the systemic treatment – chemotherapy… After that, you need to hope that the treatment carried out will be enough so that the disease does not return. If a relapse occurs, then we are talking about a chronic course of the disease, requiring regular chemotherapy in order to dull the symptoms of the disease and return the patient to a normal rhythm of life.

As for new developments, not so long ago there was an opportunity to use PARP inhibitor – a drug that works well in patients with a mutation in the BRCA1 and BRCA2 genes. That is why a mutation test is now prescribed for all ovarian cancer patients.

How does the drug work? A PARP inhibitor blocks another pathway for cell repair (the first was blocked by a mutation), so that the tumor cell cannot repair, divide normally, and eventually dies. Thanks to this drug, 64% of patients with the mutation have a chance of recovery, although earlier we could only talk about 10-15%.

If the patient has a BRCA1 / 2 gene mutation, then after surgery and / or the end of chemotherapy, he receives maintenance therapy with a PARP inhibitor for 2 years in order to reduce the risk of recurrence. Today we can say that more than half of patients continue to live without signs of illness for three years. And these are very good numbers, given that previously in 50% of cases, relapse in ovarian cancer patients occurs in a year.

Why is cancer coming back? The reasons can be different, but most often because the tumor is heterogeneous. Some cells have one set of factors, functions and characteristics, while the other part has a slightly different set. Therefore, when chemotherapy affects cells, some of them are more sensitive to treatment, others less, and still others do not respond to chemotherapy at all, temporarily falling into “sleep”.

Today we know that in patients with the BRCA1 / 2 gene mutation, the tumor is more sensitive to chemotherapy, so that it is in them that it is more often possible to completely destroy it, and the use of modern drugs in a supportive mode after chemotherapy allows to maintain remission for a long time or talk about a cure from this insidious disease.