ovarian cancer | Ovarian Cancer-Symptoms and treatments

Ovarian Cancer-Symptoms and treatments

Prevention
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The ovary is a specific organ of the woman, forming part of her genital tract. It's the reservoir of primordial follicles. These follicles are at the origin of the release in the fallopian tubes, each month, of an oocyte ready to be fertilized by a sperm. Such a meeting will give birth to the embryo, which will implant in the uterus and start a pregnancy.
Scheme

The ovary can be reached by evolutionary lesions, called cysts. Of these, some are related to the normal functioning of the ovary: they are called functional cysts. The others are described as organic. Among these organic cysts, some may have a benign character, while others are malignant: these are ovarian cancers. Initially, it is not possible to predict the functional or organic value, benign or malignant, because the symptoms are the same. However, this distinction should be made to consider the optimal treatment of these cancers. Malignant character is more often suspected in a menopausal patient, and ovarian cancer is predominantly for women over 50 years of age.
Symptoms
The symptoms, infrequent, multiple and non-specific, explain that ovarian cancer is often diagnosed at a late and advanced stage. Patients suffering from ovarian tumours and, a fortiori, ovarian cancer may have low abdominal pains called pelvic pain, a sensation of weight in the lower abdomen known as pelvic gravity, bloating, a Frequent urge to urinate, recent constipation, and bleeding, i.e. vaginal bleeding occurring outside the rules, or in the menopausal woman who no longer has a menstrual cycle. Sometimes the ovarian tumor is asymptomatic, which explains its potentially late discovery.

Grades

Stage I of ovarian cancer means that it is a cancer that is limited only to the ovaries, while at stage II the tumor extends to the pelvic organs such as the uterus, fallopian tubes or bladder. Stage III corresponds to the attainment of peritoneum and pelvic lymph nodes. During stage IV, this means that the cancer has spread to other more distant organs such as the liver. 

Diagnosis

Whether the discovery is fortuitous, in the course of an examination for another reason, without any suggestive sign, or in the presence of clinical signs, an ultrasound is performed. This can be done externally at the lower part of the abdomen, but sometimes via a probe entering the vagina: it is called endo-vaginal ultrasound. This ultrasound allows to study the tumor, its size, its shape, its contours and, according to these criteria, to evoke rather a benign lesion or ovarian cancer. It can be supplemented by a scanner or an MRI. In the case of a probably functional cyst, a new ultrasound, carried out three months later, will often show its disappearance. In case of persistence or suspicion of cancer, the ovary must be removed: it is then referred to as oophorectomy. The tumor must then be analyzed to identify its nature and, in the case of certified cancer, an extension balance must be carried out. A sample of the suspect tissue is then carried out during a surgical procedure, by laparoscopy or laparotomy. 

CA 125

CA-125, a molecule present on the surface of certain normal cells, is produced in very large quantities by certain cancerous cells, including ovarian tumor cells. An increase in the blood quantity of CA 125 can testify to the presence of an ovarian tumor. But be careful: other pathologies, whether benign or malignant, can cause elevation and some ovarian tumors do not produce CA-125.

Treatment

Surgery and chemotherapy are the two major treatments of ovarian cancer. 

Surgery

At the early stage of ovarian cancer, surgery, which can be performed during a coelioscopy, involves removing the two ovaries, the uterus, the lymph nodes and the omentum, part of the peritoneum. 

When only one ovary is reached and a pregnancy is considered, the ovary reached and the associated trunk can then be removed only. 

A laparotomy is sometimes carried out when it is necessary to remove the affected tissues and according to the tumor extension, other organs such as the colon, the rectum, and part of the small intestine. 

Chemotherapy

Surgery usually precedes chemotherapy but sometimes chemotherapy is done first if the tumor is not operable, or to decrease its volume so that the intervention less important. Chemotherapy is then resumed after surgery.

Targeted Therapies

Targeted treatments can help combat abnormalities related to cancer-predisposing genetic mutations, BRCA1 and BRCA2. 

Increasingly targeted and effective therapies will be proposed through the identification of PCR tumor subtypes

Let us recall that each case is the subject of a multidisciplinary consultation meeting, the RCP, during which specialists, oncologists, surgeons, geneticists... decide together the treatment plan.

Prevention

Prevention is only possible for certain familial forms of ovarian cancer: ablation of both ovaries and two tubes can be envisaged under these conditions.