Ovarian cancer is an infrequent disease: diagnosed in 4,500 French women each year, it affects around 1 in 70 women.It is not a cancer of young women: it develops rather after menopause, around the age of 55.” notes Dr. Magali Provansal, oncologist. There are also much rarer forms that develop in adolescent girls or young women.
On the occasion of World Ovarian Cancer Day this May 8, 2021, it is important to remember the importance of visiting your gynecologist regularly, and ideally once a year. In fact, ovarian cancer is one of the silent pathologies, with symptoms that appear gradually. Diagnosed early, ovarian cancer is best prognosis.
“There is still no systematic organized screening for this cancer. This is why it is recommended to consult your gynecologist once a year. It is also important to add that the survival rate is increasing thanks to the appearance of new treatments and advances in research, and that the frequency of this cancer is decreasing. Between 2002 and 2012, there was also a 10% drop in the mortality rate in France and Europe – a very encouraging figure for the years to come“, explains Clémence Le Dreff, Medical Project Manager at Wefight, who has developed with the association Imagyn, an application (Vik IMAGYN ovary) Who answers all your questions about ovarian cancer throughout your treatment journey and even afterwards.
Ovarian cancer: what is it exactly?
A little reminder of anatomy: the female reproductive system consists of two ovaries located on either side of the uterus, two fallopian tubes which bring the egg from the ovaries to the uterus, the uterus in which the pregnancy, vagina and vulva.
The ovaries are located behind the abdominal wall and the intestines: they are the ones that contain the oocytes (which mature into eggs, ready to be fertilized) and which secrete estrogens and progesterone (female hormones).
Ovarian cancer: what are the causes? In approximately 90% of cases, ovarian cancer results from the uncontrolled proliferation of local epithelial cells: a tumor develops – this is called adenocarcinoma. More rarely, this cancer can form from the ovarian follicles (this is called a “malignant germ cell tumor”) or from the supporting tissue that forms the body of the ovaries (“stroma and sex cord tumors”). “The tumor grows rapidly – within about 3-4 months“says Dr. Provansal.
Ovarian cancer: are there any risk factors? About 10% to 15% of patients with ovarian cancer carry a gene mutation that promotes its occurrence. Aside from genetics, women with endometriosis who have had in vitro fertilization (IVF) also have a higher risk of developing ovarian cancer in their lifetime.
On the other hand, the prolonged use of oral contraception (the pill, for example) and breastfeeding would reduce the risk of ovarian cancer.
Ovarian cancer: what are the symptoms?
“Symptoms of ovarian cancer are non-specificemphasizes Dr. Provansal. Patients who suffer from it sometimes undergo a long diagnostic wandering that can last several months.“
Some of the “warning signs” of ovarian cancer include:
- Abdominal and/or pelvic pain (in the lower abdomen) that is diffuse and not necessarily lateralised – which means that it is not necessarily localized on one side of the body,
- Transit disorders: constipation or (less frequently) diarrhoea,
- An increase in the size of the abdomen – which may suggest pregnancy,
- bloating,
- At a more advanced stage: ascites, that is to say the presence of fluid in the peritoneal cavity.
Ovarian cancer: diagnosis and treatment
Diagnostic. The diagnosis of ovarian cancer is usually made by the gynecologist. “The tumor is usually discovered during a pelvic or abdominal ultrasound, which reveals the presence of a heterogeneous cyst (composed of liquid and tissue parts) at the level of an ovary“explains Dr. Provansal.
The diagnosis is then confirmed using medical imaging examinations (MRI or scanner), blood tests (to identify markers specific to ovarian cancer) and laparoscopy.
“Performed in a hospital environment under general anesthesia and on an outpatient basis (the patient does not spend the night in the hospital), laparoscopy consists of introducing a small camera into the abdominal cavity (using an incision at the level of the navel) to observe the ovaries and take samples (biopsy) which will then be analyzed in the laboratory“says the oncologist.
Treatments. There are 4 stages for ovarian cancer:in the majority of cases (about 3 out of 4 cases) patients are diagnosed at stage 3 or 4, i.e. when there is damage to the peritoneum and when the tumor has begun to spread to the belly set“regrets Dr. Provansal.
“In case of ovarian cancer, it is necessary to operate to remove the tumor“explains the oncologist. But when the pathology is at an advanced stage, it is necessary to do chemotherapy upstream to reduce the size of the tumor and the tumor lesions as much as possible.
“There are therefore two possibilities: if the patient is diagnosed early enough, we operate and then we do 6 courses of chemotherapy (carboplatin + taxol). If the patient is at an advanced stage, we do 3 courses of chemotherapy, the operation, then 3 other courses of chemotherapy“develops the specialist.
Performed under general anesthesia and by laparotomy (a technique which consists in opening the belly), the surgical intervention consists in removing the uterus, the fallopian tubes and the ovaries of the patient: “it is sometimes necessary to remove certain organs affected by the tumoral lesions: this is major surgery which is performed in expert centers“says Dr. Provansal.
Ovarian cancer: what next?
To know. In the case of ovarian cancer, the prognosis is guarded and the 5-year mortality rate is approximately 50%. The risk of relapse is high: about 70%.
To limit the risk of relapse after ovarian cancer, there are maintenance treatments: in women carrying the BRCA genetic mutation which predisposes to ovarian cancer (10% to 15% of cases), it need to take olaparib (Lynparza®) for 2 years after chemotherapy. This anti-cancer drug halves the risk of relapse.
In the absence of genetic predisposition, a treatment with bevacizumab (Avastin®) can be offered to the patient: this consists of an infusion every 3 weeks for 15 months. In addition, blood samples are taken every 3 months for 2 years.
Doctor’s advice: “remember to see your gynecologist at least once a year, even after menopause. And do not neglect a stomach ache that does not “pass”: an ultrasound can be enough to make the diagnosis of ovarian cancer.“
Thanks to Dr. Magali Provansal, oncologist and specialist in female cancers at the Paoli-Calmettes Institute (Marseille).
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