Ovarian cancer
Ovarian cancer is an uncommon cancer that affects about 4 women every year. It occurs when ovarian cells, originally normal, transform and multiply anarchically to form a malignant tumour. In almost 9 out of 10 cases, ovarian cancer develops from ovarian cells. We’re talking about adenocarcinoma. Other forms of cancers can develop from ovarian follicles or the support fabric that forms the body of the ovaries.
Medium age
The average age of ovarian cancer diagnosis is 65 years old. However, there are rare forms of ovarian cancers that affect young women and even teenagers. They are usually discovered early and are good predictions.
Stadiums
Cancer stage corresponds to its degree of extension within the body. Thus early stage cancer corresponds to localized cancer while advanced stage cancer is a cancer that has spread to several organs of the body. Based on different criteria, ovarian cancer is ranked in one of 4 stages defined by the federation International Obstetric Gynecology (FIGO). These stadiums are numbered from I to IV:
Stage 1 (I): Cancer is limited to ovaries
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Stage AI - Cancer is limited to only one ovarian and remains contained inside.
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Stadium IB - Cancer reaches both ovaries and remains contained inside.
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IC Stage - Cancer affects one or both ovaries, but the tumor may have crossed the ovarian capsule or spread to the ovarian surface. Cancer cells are found in the abs liquid.
Stage 2 (II): The tumor has spread locally to the organs of the pelvic (pelvic organs: womb, Fallope’s trumps, bladder…).
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Stadium IIA - The tumor spreads to the womb or to the Fallope’s tubes. there are no cancer cells in the abdominal.
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Stage IIB - The tumor has spread to other pelvic organs (bladder, rectum…). There are no cancer cells in the abdomen.
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IIC Stadium - The tumor has spread to pelvic organs (as in stages IIa or IIb) AND cancer cells are found in the abdominal fluid.
Stage 3 (III): The tumor has extended to peritonia or lymph nodes located in the pelvic pool (pelvic ganglia). We’re talking about regional metastases
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Stage IIIIA - Microscopic metastases are discovered on peritone, during microscope analysis carried out after surgery or after biopsy.
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Stadium IIIB - Peritone metastases measure up to 2 inches, but no pelvic ganglion is reached.
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Stage IIIC - Some peritony metastases measure more than 2 cm and / or cancer has spread to pelvic ganglia.
Stage 4 (IV): Cancer has spread to remote organs: pleasures (lung envelope), liver in the form of remote metastases.
Symptoms: ascite, blood, pain…
The challenge of early management of ovarian cancer is that it is silent: it is initially not manifested by any symptoms. However, some non-specific symptoms may exist: abdominal discomfort, gravity, recent constipation and persistent for more than a month.
At a more advanced stage, often when cancer has spread to other areas of the pool, other symptoms appear more or less isolated. ′′ These symptoms are non-specific and varied says Dr. Wautier:
A gradual increase in the abdominal volume due to mass or ascite (liquid effusion);
Abnormal vaginal bleeding;
Abnormal vaginal losses;
Symptoms of compression in the pelvic zone: transit problems, subocclusion, false needs, urinary symptoms (imperiosis, pollakiuria);
More rarely, an edema of a lower limb, phlebitis or sciatalysis by compression of a vein or nerve of the spine;
A dyspnea that can be related to a pleural effusion;
Chest pain;
A weight loss
An alteration of the general state
Causes
There are no direct causes of ovarian cancer today, but there is a beam of known risk factors: family history of ovarian cancer, BRCA gene mutations (this gene normally helps control cell growth cancer), Lynch syndrome (colorectal cancer without polyposis), age, family history of certain cancers (inherited), personal history of breast cancer, large size to adulthood, hormonotherapy (treatment proposed to control menopause symptoms such as hot flashes, vaginal dryness and mood swings), smoking, exposure to asbestos, endometriosis.
Diagnosis and screening: exams, smears, MRI…
The diagnosis of ovarian cancer comes first through a clinical examination in the gynecologist which will, if necessary, prescribe different examinations:
The pelvic or transvaginal ultrasound that allows you to find a ovarian mass and see if it’s a solid tumor or a cyst filled with liquid, to see the shape and size of the ovarian and observe its contents, to evaluate any abnormalities in other organs of the pool, to check if there is an accumulation of liquid in the abdomen (ascite)
Blood checks: tumour marker dosage, complete blood formula and biochemical blood tests
A tomodensitometry (TDM) to evaluate the basin, abdominal and lymph nodes surrounding ovaries and determine if cancer has spread to other organs or tissues
The MRI that tends to substitute the TDM (its directions are the same)
The biospia that allows you to diagnose, stadify and determine the treatment adapted to ovarian cancer. She is usually done under laparoscopy
′′ No screening tests are effective: we could never show that pelvic ultrasounding to all women every year would be effective because it’s rare cancer In addition, doing too many ultrasounds, we worry and operate a lot of patients for nothing. explains Dr. Wautier. It is only in case of a call point that we do an imaging, or if there is a big family context. The only possible prevention when there are many family backgrounds and / or there is a genetic predisposition known as a mutation of the BRCA gene consists of a preventive removal of ovaries during quarantine ".
Treatment: can ovarian cancer be treated?
Ovarian cancer treatments depend on several factors (stage, grade (i.e. cancer malignity / aggression), type of tumour, child project). Surgery is today the main treatment for ovarian cancer no matter the stage and type. She aims to cure cancer by removing the whole tumor. ′′ You have to remove everything that is sick, otherwise surgery is useless explains Dr. Wautier.
When cancer is diagnosed at an early stage (stages 1 and 2), surgery can be the only treatment needed. When cancer is limited to ovaries, it’s about removing at least two ovaries, womb and Fallope’s trumps. This is called a ′′ total hysterectomy with bilateral annexectomy ".
When cancer is at a more advanced stage (stages 3 to 4) and has reached other organs of the abdomen, including digestive organs such as colon or rectum, these are also removed during the intervention.
Chemotherapy can be administered before or after surgery as appropriate. It can reduce the risk of cancer recidivism when the surgeon tumour overall, reduce the size of the tumour and its extensions before operating and slowing the development of cancer cells if no surgery is possible.
Hormone therapy and targeted treatments may be useful depending on the case.
Ovarian cancer and metastases
Cancer cells can spread from the ovarian to other organs. They are called metastases. If ovarian cancer spreads, it can cause metastases in: Fallope’s trunk, the other ovarian, the uterus, the cervical, the vagina, the epiploon (peritoine folding that covers and supports organs and blood vessels present in the abdominal), parietal peritone (membrane that covers the walls of the abdominal and pelvis) or visceral peritone (membrane that covers and supports most abdominal organs), the diaphragm (thin muscle located under the lungs and the heart that separates the chest cavity from the abdominal), lymph nodes of the pelvis and retroperitony, bladder, large intestine, rectum, small intestine, liver, lungs.
Healing and Survival Rates
Today, net survival after 5 years for ovarian cancer is estimated at 45 which means that approximately 45 % of women diagnosed with ovarian cancer will survive at least 5 years. years. But these numbers are very general estimates and depend on the stage, grade and type of tumour.