There are different types of ovarian cancer due to the different composition of the tissues of which they are composed (epithelium, stroma, and germ cells). Epithelial tumors are the most common in the detection of pathology. Germinal and stromal tumors are less common. These cancers are treated differently than epithelial tumors.
The average age of women at the diagnosis of 65 years. Some ovarian epithelial tumors are genetic. A systematic search is made for mutations in the BCRA1 and BCRA2 genes. If a mutation is detected, the risk of developing breast cancer increases.
Verification of all female family members is suggested if a mutation is found. If a mutation is detected, the tumor will be sensitive to PARP inhibitors (poly-ADP-ribose polymerase-1). These are therapies that act on the DNA repair system in synergy with loss of tumor cell BRCA function, causing significant genetic instability that leads to cell death. The clinical benefits of PARP inhibitors have been demonstrated in breast and ovarian cancer in patients with a germline mutation in the BRCA gene.
Ovarian cancer usually has few symptoms. The disease can be detected by chance during an ultrasound or CT scan of the abdomen. There may be a deterioration in general condition, weight loss, pain in the lower abdomen, mass palpation.
A gynecologist or radiologist will conduct an endovaginal and / or external ultrasound to determine the size of the tumor, its characteristics (shape, content). Ovarian tumors are not systematically malignant; they can be cysts (with a fluid content).
An additional examination report also includes an MRI scan to assess the invasion of ovarian cancer in the surrounding organs, such as the bladder or uterus, to search for affected pelvic lesions or peritoneal carcinosis cysts.
A chest and abdomen scanner are also performed to search for metastases in the liver or lungs. A blood test for the tumor marker CA 125 is highly recommended. A tumor biopsy allows an accurate diagnosis to be made. Most often, it is performed by a gynecological surgeon under general anesthesia. Surgery is the gold standard for ovarian cancer. The surgeon will remove the uterus (hysterectomy), two ovaries (bilateral adnexectomy) and possibly some pelvic lymph nodes (courage).
In extremely rare cases, organ preservation treatment for young women planning a pregnancy can be considered. Treatment is selected individually.
In ovarian cancer, chemotherapy can be indicated in several situations:
- Before surgery (neoadjuvant) to reduce the size of the tumor and to increase the success of the operation.
- After surgery (adjuvant chemotherapy): consists in avoiding the risk of local, regional and long-term relapse.
- In case of metastases: the main goal of chemotherapy is to reduce the size of the tumor. Allows you to stabilize the lymph nodes and metastatic lesions and control the disease.
The most common treatment methods:
Taxanes (platitaxel, docetaxel): which are anticancer agents that block mitosis and therefore prevent cell division.
Platinum Salts (Carboplatin): These are anti-cancer drugs that bind to DNA and stop the replication of DNA and, therefore, the proliferation of cancer cells.
PARP inhibitors (e.g., Olaparib or Niraparib): as monotherapy for the supportive treatment of adult patients with recurrent ovarian cancer with a BRCA mutation, with a full or partial response to platinum-based chemotherapy.
Neoangiogenic inhibitors, Bevacizumab, in combination with carboplatin and paclitaxel, in the first line of treatment for late stages of epithelial cancer of the ovaries, fallopian tubes or primary abdominal tumor in adult patients.