Ovarian cancer is considered to be one of the most insidious cancers in women. The symptoms of ovarian cancer are not very specific, therefore the disease is very rarely detected in the early stages of development. Find out what the risk factors for ovarian cancer are, what symptoms ovarian cancer can cause, how are ovarian cancer diagnosed, and what are the treatments for ovarian cancer.

Ovarian canceris difficult to diagnose due to its unspecific symptoms. Unfortunately, there are still no effective screening tests for ovarian cancer. Women in whom the cancer does not have time to spread to other organs have the best chance of curing ovarian cancer completely. Research is constantly being carried out to improve the diagnosis and treatment outcomes of ovarian cancer.

Ovarian cancer - causes

Ovarian canceris the third most common malignant neoplasm of female reproductive organs (after endometrial cancer and cervical cancer). Ovarian cancer is most often found in patients between the ages of 50 and 70, although it is also diagnosed in younger women.

Ovarian cancer is a collective term for malignant neoplasms of the ovary, which are made up of cells of epithelial origin. These cells may differ in structure and function, which makes the histological classification of ovarian cancer quite complicated.

To simplify the perception of the different types of ovarian cancer, two main types of ovarian cancer have been distinguished:

  • Type I ovarian canceris less common (about a quarter of cases), is characterized by slower growth, and is usually detected early. These features mean that type I ovarian cancer is associated with a relatively better prognosis.
  1. Type II ovarian canceris found much more often (approximately ¾ cases). The second type includes more aggressive neoplasms, characterized by rapid growth and spread to nearby organs, and thus - a worse prognosis.

The exact mechanisms by which ovarian cancer develop are not fully known. It is known that hormonal factors, mainly related to the number of ovulations during a woman's life, play a certain role in the development of ovarian cancer. Women who have had a high number of ovulations have an increased risk of ovarian cancer.

This situation applies to women who have never been pregnant, had their first menstruation at a very young age, or had late menopause. In turn, the protective role against ovarian cancer is attributed to the circumstances that reduce the number of ovulations throughout life.

Ovulation inhibition occurs during pregnancy, during breastfeeding and also during the use of hormonal contraception. These factors are associated with a reduced risk of ovarian cancer.

The best knownfactors in the development of ovarian cancerare genetic predispositions. It is believed that genetic factors cause about 10% of ovarian cancer cases. Patients with a family history of ovarian cancer are at risk, as well as carriers of certain gene mutations. The best known mutations associated with ovarian cancer are in the BRCA1 and BRCA2 genes, which also increase the risk of developing breast cancer.

Another genetic condition often associated with ovarian cancer is Lynch syndrome. It is a syndrome of inherited predisposition to various types of cancer, the most common of which are colorectal, endometrial, ovarian and gastric cancer.

Patients with a genetic predisposition require regular diagnostic tests, because ovarian cancer may develop at a young age.

Ovarian cancer - symptoms

Ovarian canceris mildly or asymptomatic in the initial stage of development. Due to the biological features of ovarian cancer and its location in the abdominal cavity, the cancer cells spread early to other organs.

Ovarian cancer spreading usually begins when the tumor is still small and causing no symptoms. The disease begins to cause symptoms at an advanced stage, which is why its detection is in most cases too late.

The first symptoms of ovarian cancer usually come from the spread of the cancer cells through the abdomen. Ovarian cancer causes ailments that are misinterpreted as gastrointestinal. The feeling of early satiety, bloating or indigestion symptoms may be the first symptoms of ovarian cancer.

Pelvic pain may or may not be associated with ovarian cancer. As more organs are involved, new symptoms appear. If the ureters or bladder are involved, the so-called Urgent pressure, i.e. a sudden need to urinate.

A common symptom of advanced ovarian cancer with peritoneal dissemination is ascites. Progressive neoplastic disease can lead to disordershunger, weight loss, chronic fatigue and exhaustion of the body.

Ovarian cancer - diagnosis

The diagnosis of ovarian canceris very difficult at an early stage. Unfortunately, there are no screening tests to detect the disease in the early stages of development. The basic diagnostics of the ovaries includes a gynecological examination (the so-called two-handed examination) and an ultrasound of the ovaries.

Unfortunately, these methods have low sensitivity and specificity in detecting early ovarian cancer. Many of the changes found in these tests are benign. On the other hand, ovarian cancer may not be visible on ultrasound and not felt during a gynecological examination.

During the diagnosis of ovarian cancer, the concentration of the so-called tumor markers. The markers typical of ovarian cancer are Ca-125 and HE4. Tumor markers should be interpreted accordingly. Elevated markers do not necessarily mean the presence of cancer - their concentrations may also be increased in other diseases, e.g. in the course of inflammation.

Tumor markers are not an ideal diagnostic tool in ovarian cancer. Their usefulness is much greater in the later stages of the disease - they allow for the assessment of the effectiveness of treatment and monitoring of possible tumor recurrence. In the diagnosis of ovarian cancer, the levels of tumor markers are interpreted together with the patient's clinical data.

For this purpose, the so-called ROMA test. It is an algorithm that takes into account, inter alia, patient's age, medical history, and said tumor markers. The ROMA test result shows the probability of a malignant ovarian tumor in a given patient.

A reliable diagnosis of ovarian cancer can only be obtained thanks to the histopathological examination of the material obtained during the surgery. Surgery with subsequent histopathological evaluation enables both the diagnosis and the assessment of tumor advancement. The material for the study comes from many places - the removed ovary, the surrounding lymph nodes, samples from the surrounding organs and peritoneal washings are assessed.

Some examinations are performed while the operation is still in progress (intraoperative examination). If the diagnosis of ovarian cancer is confirmed, the scope of the surgery is extended accordingly.

Ovarian cancer - stages

Determining the stage of ovarian cancerplays an important role in choosing the path of further treatment. The full picture of the advancement of the disease can usually be obtained only during the surgery to remove the neoplasm.

The stage of the cancerthe ovary is about the extent of the disease - it tells about which organs, apart from the ovary itself, are occupied by the tumor. In order to be able to accurately determine it, during an operation to remove an ovarian cancer, it is necessary to collect numerous specimens from various locations for histopathological examination. The FIGO classification is used to describe the staging of ovarian cancer. According to it, there are four stages of ovarian cancer - from I to IV.

  • Stage 1 ovarian canceris limited to the ovaries only.
  • II degree ovarian cancer- spread to pelvic organs
  • III degree ovarian cancer- dissemination into the abdominal cavity
  • IV degree of ovarian cancer- means distant metastases to the lungs, liver and other organs outside the abdominal cavity.

Only a quarter of cases of ovarian cancer are detected in the early stages (I or II). Unfortunately, most patients with ovarian cancer are diagnosed only in stage III and IV, which significantly worsens their prognosis.

In addition to the stage of advancement, the assessment of the histological malignancy of the neoplasm plays an important role in the selection of treatment for ovarian cancer. As mentioned earlier, the microscopic structure of ovarian cancer can be very diverse.

In order to simplify the assessment of the degree of malignancy of ovarian cancer as much as possible, the two-stage classification is used more and more often. According to it, ovarian cancers are divided into low grade - with a low degree of malignancy, and high grade - with a high degree of malignancy. Grading is important in assessing the prognosis as well as in predicting the tumor's response to chemotherapy.

Ovarian cancer - treatment

Treatment of ovarian cancer requires a combination of different treatments. It is based on a surgical procedure along with chemotherapy. Radiation therapy is not used to treat ovarian cancer. New drugs that increase the effectiveness of ovarian cancer therapy are constantly being investigated. Some of them have already been introduced for treatment in specific groups of patients.

Ovarian cancer - surgery

The basis of ovarian cancer therapy is surgery, used in all stages of the disease. The more advanced the tumor is, the greater the extent of the operation. The standard surgery for ovarian cancer is to remove the affected ovary along with the uterus, other ovary, and surrounding lymph nodes.

If the neoplastic process is more extensive and the spread of neoplasms in the abdominal cavity is visible, the so-called maximum cytoreduction. This is a term that means removing all visibletumor foci. It has been proven that this procedure improves prognosis in the disease.

For this reason, many surgeries in ovarian cancer are very extensive - often apart from the reproductive organ, it is necessary to remove fragments of other organs (including the spleen or part of the gastrointestinal tract).

Completeness of the operation is one of the conditions for the effectiveness of treatment, therefore conserving procedures are performed extremely rarely in ovarian cancer. Leaving the second ovary and uterus is considered only in young patients planning motherhood, provided the cancer is low (stage I).

Ovarian cancer - chemotherapy

Chemotherapy is an important element of both the first-line treatment of ovarian cancer and disease relapses. The standard treatment regimen is chemotherapy after surgery.

Chemotherapy for ovarian cancer is based on 2 main groups of drugs: platinum derivatives and taxanes. Carboplatin is most commonly used in combination with paclitaxel. Standardized are 6 cycles of chemotherapy followed by assessment of the response to treatment.

In the event of ineffectiveness of the applied treatment, subsequent lines of therapy are implemented. In the second-line therapy, the sensitivity of the tumor to drugs from the platinum group is of great importance. It is a criterion for the division into neoplasms, the so-called platinum resistant and platinum sensitive.

Platinum resistance, i.e. the lack of response to platinum derivatives, is associated with a significant worsening of the prognosis and a lower chance of the success of the second-line therapy. In turn, platinum sensitivity is an indication for the use of other treatment lines based on platinum derivatives.

In the context of ovarian cancer chemotherapy, it is also worth mentioning the way of administering drugs. The standard form of chemotherapy is the intravenous form. In ovarian cancer, a non-standard route of administration of chemotherapy is also used, as the spread of the tumor takes place within the abdominal cavity.

We are talking about the so-called intraperitoneal chemotherapy, i.e. chemotherapy administered inside the abdominal cavity. Intraperitoneal chemotherapy is used in those patients who failed to remove all tumor lesions during surgery. At the same time, the foci left must be relatively small ( <1cm), ponieważ tylko w takich przypadkach udowodniono skuteczność chemioterapii dootrzewnowej.

Ovarian cancer - new treatments

In the past few years, many new drugs have been introduced into the treatment of ovarian cancer. Some of them are also available in Poland. The latest treatments are mainly used in ovarian cancer reference centers. A list of such institutions can be found, among others on the Polski websiteSociety of Oncological Gynecology.

It is worth knowing, however, that qualification for modern therapies follows strictly defined rules. Not every drug is effective in all patients - most of them are registered for patients who meet predefined criteria. It is always worth asking the attending physician about the legitimacy of introducing additional drugs into the therapy.

The first of the new, so-called of molecular drugs used in the treatment of ovarian cancer was Bevacizumab (Avastin), also available in Poland for several years. Bevacizumab belongs to the group of VEGF inhibitors - drugs that inhibit the development of blood vessels within the tumor.

Reducing the blood supply to the tumor slows down its growth. In addition to ovarian cancer, bevacizumab is used to treat many other types of cancer, including breast, colorectal, kidney and lung cancer.

In Poland, patients with highly advanced disease are eligible for Bevacizumab treatment in ovarian cancer. The drug program includes patients with stage IV cancer, as well as some patients with stage III (if large tumor foci cannot be surgically removed).

The second group of breakthrough drugs in the treatment of ovarian cancer turned out to be the so-called PARP inhibitors. These are drugs with a very complex mechanism of action, influencing genetic changes in cancer cells. The representative of PARP inhibitors, Olaparib, is available under the drug program reimbursed by the National He alth Fund since 2016.

Importantly, the effectiveness of Olaparib was initially demonstrated only in patients with a genetic predisposition to develop ovarian cancer - BRCA1 or BRCA2 mutations. For this reason, the drug is currently reimbursed only in patients with this mutation.

Additionally, the remaining eligibility criteria for the drug program must be met (relapse after treatment with two lines of standard chemotherapy, serum type of ovarian cancer, sensitivity of the tumor to platinum derivatives).

It is worth knowing that the latest studies have shown the effectiveness of PARP inhibitors also in patients who are not carriers of the BRCA1 and BRCA2 mutations, as well as in the first-line treatment of advanced ovarian cancer (before disease recurrence). Perhaps in the future the reimbursement criteria for drugs from this group will be extended.

  • The first symptoms of ovarian cancer. How to recognize early symptoms of ovarian cancer?
  • Hereditary breast and ovarian cancer. What you need to know about the BRCA1 and BRCA2 genes

Category:

Oncology