Ovarian cancer

Ovarian cancer represents 20% of all female genital cancers. It usually occurs after the age of 50. It is difficult to detect in its early stages. That is why it is one of the most dangerous types of cancer.

Symptoms that patients experience may be:

  • Abdominal swelling or pain.

  • Unspecified but persistent gastrointestinal symptoms (gas, nausea, bloating, indigestion).

  • Frequent and urgent urination.
  • Change in defecation habits (chronic diarrhea or constipation).
  • Unjustified weight gain or loss.

  • Pain during sexual intercourse.

  • Unusual blood loss from the vagina.

  • Unexplained fatigue.

Predisposing factors

  • Age over 50 years.

  • Smoking.

  • Women who developed breast cancer before the age of 50.

  • Family history in women with ovarian, breast or colon cancer.

  • A mutation in the BRCA 1 or BRCA gene associated with breast cancer.

  • Women who did not have children.

  • Hormone Replacement Therapy for more than 10 years.

Contrary to popular belief, the use of ovarian stimulant drugs (gonadotropins) in previous IVF treatments is not an aggravating factor in the development of this type of cancer.

It goes without saying that if a woman is suffering from cancer, she does not make an IVF attempt by taking medication. If it is necessary, she does it during a natural cycle.

The opposite is true of clomiphene citrate, which women have received in pill form for many years. There is evidence that they should give this drug occasionally (usually for 6 months) and not longer.

How prevention and diagnosis are done

There are no preventative measures for ovarian cancer such as the Pap test for cervical cancer. Practically, as with all other forms of cancer, survival has to do with early diagnosis and treatment.

The wisest thing to do is to perform the necessary annual examination with ultrasound and gynecological examination at her gynecologist. She will also report any of the above symptoms that concern her. The gynecologist will evaluate the symptoms. In addition to the standard check-up, he may request further examination for the problem.

Transvaginal ultrasound is currently the most reliable way to diagnose a gynecological problem early. If the gynecologists finds a suspicious ovarian cyst or other tumor, then the cancer markers are further determined (CA-125 etc).

Cancer markers

Unfortunately, cancer markers do not have the sensitivity we would like and are a reliable tool only for the diagnosis of the problem and not for the prognosis.

The BRCA1 and BRCA2 genes are responsible for the production of proteins that suppress breast cancer and help correct DNA abnormalities. So mutation of these leads to cancer.

Inherited mutations in these genes increase the risk of breast and ovarian cancer as well as other types of cancer that we will analyze later. They are responsible for the appearance of breast cancer usually at the age of less than 50.

The risk of breast cancer in the general population is 10%. In contrast, in mutations, this risk is 70% for BRCA 1 and 45% for BRCA 2.

Regarding the risk of ovarian cancer, in the general population it amounts to 1.4% while in the carriers of the BRCA 1 mutation to 39% and 17% in the carriers of the BRCA2 mutation.

Studies have shown that, in women carriers the risk of developing peritoneal tumors increases. In men the risk of prostate cancer is also high.

Studies have shown that the prevalence of these mutations is particularly high in the Ashkenazi Jewish population as well as in the Dutch, Norwegian and Icelandic populations.

Clearly they exist and are performed with a simple blood draw. The results come out in 3 weeks.

This is a rare mutation. This means that some criteria are required to push someone perform the test.
The American epidemiological company suggests that the test be performed on people with:

  • History of breast cancer at a young age (before menopause), history of bilateral breast cancer and history of breast and ovarian cancer.

  • History of ovarian cancer and family history of a relative with ovarian cancer or breast cancer at a young age or both.

  • Family history of breast cancer in 2 or more first-degree relatives.

  • Family history of male breast cancer.

  • History in the family : a relative with ovarian and breast cancer.

  • Family history of bilateral breast cancer.

  • With more than 2 relatives with ovarian cancer.

  • Relative to the mutation.

In any case, a woman who suspects that she needs to be checked must necessarily talk to her personal gynecologist. He/she will judge if it is necessary. Discussion and guidance is important. In case of a positive result, psychological support is very important.

The genetic test can be positive, negative or controversial.

A positive test means that the chance of developing some cancers is very high, but it does not mean that it is absolutely certain. Also, it is important the chance of inheriting the mutation to the next generation (50% in case one parent is a carrier).

In case of a negative or controversial result this case is false negative (there is a mutation but the test is negative) is very low. In any case, a discussion with a gynecologist and genetic advice is always required.

The treatment is based on the following:

Strict screening

Young women can start screening at a younger age than the general population (25 years old). This consists of an annual clinical examination by an experienced mammologist as well as a breast ultrasound. She can even do a mammogram according to some researchers although it is highly debatable due to the radiation received. They often use MRI on an annual basis. In any case, the treating physician is the one who will decide on the type of examination.

There is no reliable test for ovarian cancer. Today we can only rely on vaginal ultrasound and clinical examination. The search for the CA 125 cancer marker is not a specific test at all. It often leads to erroneous conclusions. Recently, they apply the new cancer marker ROMA, high sensitivity especially for ovarian cancer.

Prophylactic surgery

Since the most common cancers directly associated with BRCA 1 and BRCA 2 mutations are breast, ovarian, and fallopian tube cancers, preventive surgery is based on bilateral mastectomy and bilateral removal of women parts (ovaries, Fallopian tubes).

Chemoprophylaxis

Tamoxifen appears to reduce the risk of breast cancer in BRCA1 and BRCA2 mutations. Raloxifene is still under control and more studies are needed for its safe administration.

Numerous studies have not shown that annual screening of cancer markers offers more to the survival of women who will eventually develop ovarian cancer.

In addition, screening for ovarian cancer may include:

  • CT ot MRI scan of the pelvis
  • Research laparotomy (surgical procedure that examines the abdominal cavity).

How doctors treat it.

Doctors treat ovarian cancer mainly with surgery. It is usually followed by chemotherapy and radiation of various forms.

However radiation seems to play a very limited role in the treatment of ovarian cancer.

In surgery, we almost always remove the uterus and both ovaries.

Follow-up after treatment

As with all cancers, postoperative follow-up is common. Visits to the gynecologist should be as the following:

  • The first 2 years every 3 months.
  • The next 5 years every 6 months.
  • After the 7th year, once every year.

The examination definitely includes clinical examination and ultrasound. It also includes cancer markers and CT scan at regular basis.

We understand that both chemotherapy and radiation are prescribed in collaboration with specialist oncologists and radiotherapists.