Ovarian cancer is the third most frequent gynecological tumor worldwide but it is still the first cause of death in gynecological cancer as it is usually diagnosed in advanced stages. Read more about ovarian cancer symptoms, causes, diagnosis and treatment.
It usually appears after menopause, although it can arise in young women with a family history of breast or ovarian cancer as a result of a mutation in the BRCA gene and in other genes such as BRIP1, RAD51C and RAD51D.
These mutations also make the tumor itself more fragile and are allowing us to treat it with newer specific drugs that destroy it more easily.
What are the symptoms of ovarian cancer?
Ovarian cancer symptoms
Ovarian cancer often goes unnoticed for a long time and is often only discovered at a late stage. The problem: the tumor has plenty of room in the lower abdomen to grow and therefore causes hardly any symptoms. It is only when it is so large that it presses on other organs or forms metastases in other organs that abdominal pain or digestive problems occur. Sometimes women notice a sudden increase in their waist circumference.
ICD codes for Ovarian cancer symptoms: C56 | D39 | C57
No ovarian cancer symptoms: late diagnosis
The insidious thing about tumors on the ovaries is that they do not cause any symptoms in the early stages of the disease. Ovarian cancer only causes problems as the disease progresses. The tumor is only discovered in 29 percent of cases when it is still limited to the ovarian tissue (level one of the so-called FIGO classification). One ovary or both ovaries can be affected. In 59 percent of patients, the disease is only diagnosed when the tumor has already formed metastases in the abdominal cavity (FIGO III).
Ovarian cancer symptoms: non-specific signs
As soon as there are metastases in the abdominal cavity, women with ovarian cancer experience non-specific symptoms. These symptoms are not typical of malignant ovarian tumors and can also occur in connection with other diseases.
The main signs are:
- Feeling of pressure in the lower abdomen, possibly accompanied by nausea.
- General digestive problems, such as feeling full, loss of appetite, flatulence, increased urge to urinate, constipation (the tumor may be pressing on neighboring organs such as the intestine or bladder).
- Weakness, tiredness and exhaustion.
- Production of excessive abdominal water (medical: ascites), so that the abdomen swells – despite constant or even falling weight.
- Bleeding outside the normal menstrual period, bleeding after menopause (rare ovarian cancer symptoms).
- In the advanced stage, fever and night sweats may also occur.
Cancers that form as secondary tumors of other types of cancer of the ovaries, such as Krukenberg’s tumor, also have similar symptoms. The origin is gastric cancer.
Ovarian cancer symptoms: swollen lymph nodes
In the third stage of the cancer, metastases can form in the lymph nodes. Because the cells of the cancerous tumor get into the tissue fluid and are filtered out by the lymph nodes. They settle there and multiply. The result: the lymph nodes swell. This usually does not cause any problems.
However, the lymph nodes can swell to several centimeters in diameter due to the multiplication of cancer cells. You can then see them with the naked eye or feel them. In some cases only a thickened lymph node leads to the diagnosis of cancer. If painless swelling of the lymph nodes occurs for no apparent reason and does not go away on its own after a few weeks, you should consult a doctor.
Ovarian cancer symptoms: metastases outside the abdominal cavity
In the case of advanced ovarian cancer, the tumor has left the abdominal cavity (FIGO IV. Then there are symptoms caused by distant metastases in other organs. Metastases in the lungs often remain asymptomatic because they usually settle in the periphery of the lungs. However, there can also be stubborn ones Coughing attacks, coughing up blood or pneumonia occur.Distant metastases in other organs, for example the liver, result in weight loss, loss of appetite, night sweats or nausea.
There are no specific symptoms and it is usually confused with what can be produced by the digestive system and the bladder, especially if the symptoms are persistent.
Among the most frequent symptoms, abdominal swelling, gas sensation, poor digestion, constipation or diarrhea, frequent urination can be mentioned.
There may also be loss of appetite or weight for no apparent reason. Sometimes, genital symptoms appear such as menstrual disorders, postmenopausal bleeding or pain during sexual intercourse.
The most common symptoms of ovarian cancer are:
- Abdominal pain or discomfort.
- Feeling of fullness.
- Abdominal distension.
- Altered gastrointestinal transit.
What are the causes of ovarian cancer?
90% of ovarian cancers develop from epithelial cells (located in the ovary and fallopian tubes), which are divided into 5 types: high-grade serous, low-grade serous, endometrioid, clear cell and mucous.
The rest of the tumors have a different biological behavior and treatment.
The exact cause of ovarian tumors is still unknown, although among the various theories it is admitted that the incessant ovulation with the consequent scarring phenomena on the surface of the ovary may have something to do with it.
The possible relationship with chronic inflammatory processes or a certain hormonal environment, such as androgens in the polycystic ovary or the elevation of gonadotropins in menopause, has also been admitted.
What are the risk factors for ovarian cancer?
The main risk factors are:
- Inheritance of mutated genes such as BCRA1 and 2, which is also related to the risk of developing ovarian cancer. Hereditary non-polyposis colorectal cancer (HNPCC) syndrome.
- Family history: Sometimes ovarian cancer can occur in more than one member of the family, without this having to do with known hereditary factors.
- Personal history of breast cancer.
- Age: more frequent in postmenopause.
- Fertility: not having had children. Having been subjected to ovulation-inducing treatments, although this seems more related to the context of sterility itself than to the medication.
- Estrogen-only hormone replacement therapy.
- Obesity or high-fat diet.
How is ovarian cancer diagnosed?
Working in collaboration with the Radiodiagnosis, Nuclear Medicine, Pathological Anatomy and Genomic Medicine services allows us to make a precise diagnosis in a short space of time.
The chances of surviving when this type of tumor appears are closely related to whether or not it has spread outside the ovary. Only about 20% are still undisseminated when diagnosed.
It is diagnosed through:
- Clinical examination.
- Transvaginal or transrectal ultrasound. It has a very high diagnostic accuracy.
- Tumor markers in the blood, especially CA-125.
- Imaging tests: CT, abdominal ultrasound or MRI.
- Surgical exploration: confirm and treat localized disease in the abdomen.
How is ovarian cancer treated?
Molecular studies have proven to be of great importance in selecting the most appropriate treatment for patients, which is why we carry them out in all cases.
Surgical treatment
The gold standard in the treatment of ovarian cancer is the complete removal (exeresis) of the visible disease, or at least the possibility of leaving a maximum residual disease of less than 1cm.
We have gynecological oncologists with high surgical specialization in cytoreduction. The goal of this technique is to remove all visible tumor to increase patient survival.
Sometimes this surgery is performed in collaboration with experts in thoracic surgery or heátpica surgery to eliminate the locations of the disease that may appear in the chest or liver.
This approach has been shown, together with effective chemotherapy, to significantly improve the curability of patients suffering from this disease.
We administer intraoperative radiotherapy, a high-precision technique that is administered in a single fraction during the surgical act on the tumor bed or microscopic tumor residue. This direct application of the treatment allows the surrounding healthy tissues to be spared and avoids unnecessary radiation.
For some years now, it has been recommended that postoperative chemotherapy treatment also include intraperitoneal administration of chemotherapy in cases in which optimal initial surgery has been performed. Recent studies have shown that this strategy, together with the complete removal of the disease as we mentioned at the beginning, achieves the best results.
In our center we have more than twenty years of experience in the intraperitoneal administration of chemotherapy.
Currently, and based on the same principles, the intraperitoneal administration of chemotherapy under hyperthermic conditions during the operation, once the disease has been resected, is becoming generalized among some reference centers in the treatment of this disease. This procedure has come to be called “HIPEC” or intraperitoneal administration of chemotherapy with hyperthermia.
We carry out the most innovative chemotherapy treatments such as antiangiogenic therapies and PARP inhibitors.
Neoadjuvant chemotherapy
On some occasions, due to the areas affected by the disease, it does not seem possible to achieve the objective of what is called “optimal cytoreduction”, which means not leaving residual disease, as the ideal objective.
This assessment is based on the findings of imaging tests (CT, PET-CT) and direct information through laparoscopy, which allows a simple way to better understand the extent of the disease and take the necessary biopsies to catalog the disease. type of tumor (on some occasions it may not be of ovarian origin and require another type of approach).
This technique, compared with laparotomy in which it is necessary to make a wide incision in the abdomen, makes it possible to start treatment with neoadjuvant chemotherapy (NAC) associated with new antiangiogenic treatments in a very few days if the possibility of performing optimal surgery is ruled out.
The objective of NCT is to reduce the volume of the disease, usually after three or four cycles, and thus be able to carry out the desirable surgical treatment (“interval surgery”), whose objective is the same as in primary surgery: no leave visible disease.
Naturally, if necessary, it requires the same strategy of technical procedures and surgical team as the initial surgery. After this surgery, the patient completes the treatment with a few more cycles of chemotherapy.
Treatment of recurrences
Some patients with ovarian cancer may have a recurrence of their disease and in this case, depending on the time elapsed since the end of chemotherapy until the diagnosis of recurrence, as well as the location and extent of the disease (hepatic, splenic, exclusive intestinal metastases , pelvic, etc.) would once again be candidates for surgical treatment that must pursue the same objective: leave no visible residual disease.
This would require implementing a strategy similar to the treatment of the disease when it first appeared: appropriate surgery followed by chemotherapy.
