Women with a familial incidence of epithelial ovarian and/or breast cancer or a previous history of breast cancer have twice the risk of developing ovarian cancer compared to the general population.
The ovary is the female gonad that performs the physiological functions such as being a part of the center of hormonal secretion and production of ovocytes which are necessary for reproduction. Different types of tumors can develop regarding this organ, depending on the different cell types.
Ovarian cancer is the fifth most common tumor in women and represents only 3% of the diagnosed neoplasms.
Although there are many types of ovarian tumors (depends on the cell type from which they originate), 90% of cases come from the epithelium cover of the gland giving it the name epithelial ovarian carcinoma. The borderline subtype represents a distinct group compared to those tumors mentioned previously. It is a heterogeneous group of lesions that are non-invasive and represent 10-20% of malignant epithelial ovarian tumors with an excellent prognosis.
Etiology and risk factors
Compared to the general population, the risk is doubled with women who have a prior history of breast cancer, a family history of epithelial ovarian and/or breast cancer of developing ovarian cancer. Although genetic alterations associated with the susceptibility of suffering this disease are known, they are not present in all patients and are not useful for managing treatment or for establishing a diagnosis. Its usefulness lies in providing genetic counseling to the affected patient’s family. The family will be referred to the most appropriate Genetic Counseling Unit when the oncologist considers that this information is important.
Incidence is greater in industrialized countries. The most relevant and demonstrated risk factors for suffering this type of cancer are: an absence of pregnancies, continuous ovulation, endometriosis and post-menopause. Treatment with oral contraceptives has been shown to be protective against this disease although the risk of suffering other diseases increases. This is why its use as preventive method is not recommended. The consumption of tobacco, as in other diseases, has also been associated with increased risk of certain subtypes of ovarian cancer.
It should be considered suspicious in all women with an average age of 55 (postmenopausal), with little or no parity who show symptoms of abdominal distention or pelvic mass.
Other forms of non-specific and non-pathognomonic appearance are: pelvic discomfort, changes in urination unexplained by the most common pathologies as well as vaginal bleeding, abdominal pain, pleural effusion, groin, axillary or supraclavicular lymphadenopathies, or the casual discovery during a pelvic examination or ultrasound.
Tumor makers such as CA 125, CEA serum levels or other protein levels will never be considered valid as a diagnosis in the absence of other suspicious clinical signs.
60%-70% are diagnosed at an advanced stage because of the deep intraperitoneal location and non-specific initial symptoms. The diagnosis of this pathology involves a comprehensive overview of the patient which includes:
- Medical history, general physical examination and gynecological exam.
- CBC and blood biochemistry, including LDH, hepatic and renal function, CA-125, CEA, CA-19.9.
- Chest x-ray. Abdominal and pelvic CT.
- PET/CT if there is difficulty in diagnosis. It is not considered necessary if the suspicion is confirmed by prior testing.
These tests may be sufficient for carrying out a reasonable differential diagnosis. Optional explorations that may be necessary are:
- Abdominal and pelvic ultrasound.
- Intravenous urography/cystoscopy.
- Opaque enema/colonoscopy.
- Gastrointestinal transit time/gastroscopy.
In order to obtain a final diagnosis a histopathological study should always be done by:
- Thoracentesis or paracentesis for cytological studies.
- Lymph node biopsy.
In each case a complete diagnosis should include the final staging of the disease which is obtained via imaging tests along with an exploratory laparotomy if necessary.
Patients can be divided into early or advanced stages according to the final classification of the International Federation of Gynecology and Obstetrics (FIGO staging).
iTAcC recommends surgery with total removal of the uterine corpus, both ovaries and fallopian tubes. This also includes a surgical exploration of the abdominal cavity in addition to an evaluation of adjuvant chemotherapy based on clinical tumor characteristics.
In localized stages at the pelvic/abdominal level and in patients with advanced disease
The option of extensive surgical treatment can be chosen initially in order to obtain a complete resection of the tumor (optimal surgery) along with chemotherapy, subsequent or adjuvant (either intravenous or intraperitoneal). A second option would be an interval treatment with chemotherapy before and after the tumor resection.
The following is an option right now whose choice will depend on the symptomatic situation of each patient: maintain a postoperative treatment with antiangiogenic drugs for 12-15 months after suboptimal surgery or adjuvant chemotherapy in patients with unresectable/inoperable disease after being treated first with chemotherapy.
Radiation therapy is currently performed in symptomatic situations when alleviating a symptom difficult to control is required with its use being defined in each particular case.
The multidisciplinary team establishes a customized control plan after treatment. It is done according to the needs of each patient and the biology of the disease for ruling out or early detection of any recurrence. The follow up is done based on a comprehensive control of the tumor by image and analysis testing.
Follow up is done as in the case of all oncological work at iTAcC in a personalized manner along with the cooperation of physicians who have been involved in the diagnosis and treatment of each case.