Ovarian cancer is not one thing, and several different diseases, united under a common name. From a histological point of view, the ovaries consist of different tissues, each of which can be affected by an oncological disease with a specific histological characteristic.
The type of tumors, the stage of the disease, the age and accompanying diseases of the patients are the reference points in the preparation of an individual therapeutic strategy by the specialists.
- Women with the following symptoms should consult a gynecologist:
- Pelvic pain, which does not pass
- Unusual vaginal bleeding or discharge
- A thickening or lump, that causes pain or can be palpated (groped) in the pelvic area. The tumor mass is often fixed and dense
- Pain or tension in the pelvic area
The study of tumor markers only complements the process of diagnostic refinement. Tumor markers can also be elevated in other diseases or physiological conditions in the pelvic area, for example endometriosis, benign ovarian cysts, pelvic inflammatory disease, pregnancy etc.
The risk of developing ovarian cancer for women without a family history is 1-2%, and the average age of onset of the disease is 60 years. The risk for women with a family predisposition is between 10% and 40%, while the average age of diagnosis of the disease is 40-50 years.
Diagnostics and screening
In the early stages of its development, ovarian cancer is most often asymptomatic. Unfortunately, more than 70% of the patients are diagnosed in advanced stage III or IV of the disease. Globally, there is no reliable screening test for ovarian cancer. Regular examinations at a gynecologist are the main preventive measure for early diagnosis of the disease.
On the other hand, for part of the patients, the markers may not be excessive and may not be indicative of the development of an oncological disease. The statistics show, that only half of the cases of early ovarian cancer have elevated values of the tumor marker CA 125. In most cases, the markers have meaning in the context of their dynamic regular monitoring during the therapeutic process.
All imaging studies have a clarifying role in the spread of the disease. Comparatively, transvaginal ultrasound is the most sensitive study for evaluating pathological processes in the pelvis. However, imaging studies cannot definitively prove the origin of the tumors or specify the histology, which is of decisive importance for the formation of an individual therapeutic plan for patients.
The stage of ovarian cancer determines the degree of spread of the oncological disease in the body, which is relevant to therapy and prognosis. The stages are numbered I to IV with corresponding subdivisions. With proper therapeutic behavior, ovarian cancer in an early stage is definitively cured in more than 90% of the cases. The more advanced the stage, the more difficult it is to achieve long-term control over the disease. On the other hand, advanced stage is not indicative of chemotherapy insensitivity and in most cases a significant therapeutic effect is achieved with chemotherapy.
- I herd – The cancer is confined to the ovaries only (or the fallopian tubes)
- II stage – the cancer involves the ovaries, fallopian tubes and uterus
- III Stage – cancer covers the peritoneum in addition to the genitals
- IV Stage – Scatters of the malignant tumor spread throughout the body
An invariable part of ovarian cancer treatment is surgery. In most cases, in addition to the ovaries, the fallopian tubes are surgically removed, along with the uterus and regional lymph nodes. If the tumor has spread to the abdominal cavity, sometimes it is necessary to remove part of the intestine, spleen or bladder, thereby removing as much of the visible tumor as possible.
Follow-up of patients after achieving complete clinical remission is of utmost importance. Regular control examinations are carried out, imaging studies and strict tumor marker follow-up. With objective data on disease progression, patients are presented to the General Hospital and Specialized Oncology Committee for assessment of further therapeutic behavior.
Laparotomy – It is possible to surgically open the abdominal cavity in the second stage after first-line chemotherapy (the so-called second look laparotomy) in order to remove tumor masses in locally advanced disease.
Radiotherapy has a relatively limited role in the radical treatment of ovarian cancer. On the other hand, it can be very useful as a palliative treatment aimed at controlling a specific symptom or controlling pain in advanced cases..
Decisions about the need to administer and the type of chemotherapy are made by the Clinical Oncology Committee on Chemotherapy. The committee is made up of medical oncologists and meets several times a week. A written decision is drawn up for each patient, determining the type of chemotherapy, number of courses, frequency, as well as the way of monitoring the patient and reporting the therapeutic effect. Every patient has an attending physician, tracking its status.
Adverse drug reactions are minimized after premedication, careful assessment of doses, active monitoring of patients during their hospital stay. Follow-up of patients is through follow-up examinations and constant communication of patients with their treating physician. The medical oncologist informs patients about possible side effects and about their prevention and control when they occur.
How long does chemotherapy last??
The treatment scheme, the number of courses and their method of administration are individual for each patient and are determined by an oncology committee. There are many different types of modern chemotherapy drugs. Some of them function better on their own, others work better in combination. Your doctor may prescribe a combination of chemotherapy drugs, which is called a chemotherapy regimen. A small number of chemotherapeutic agents exist, which can be taken as tablets by mouth, to be injected intramuscularly or subcutaneously into adipose tissue, but most of them are administered intravenously.
Aimed (target) therapy – this type of systemic therapy still has limited use in the treatment of ovarian cancer in a small contingent of patients at an appropriate stage or with specific gene alterations. In addition to imaging studies, the effect of chemotherapy is evaluated objectively by monitoring the values of the tumor marker CA 125, when it is indicative of the specific patient.
Sometimes targeted therapy is administered alone, and in other cases together with classical chemotherapy. Modern hormonal treatment is an integral part of medical treatment (endocrine) therapy, which is extremely important in prostate cancer. With them, in certain cases, endocrine therapy can also be preceded by classical chemotherapy.
Neoadjuvant chemotherapy – drug treatment, previous surgery or radiotherapy. Most often, the goal is to achieve tumor volume reduction and thus make subsequent surgical treatment technically feasible and successful.
Adjuvant chemotherapy (prophylactic) - adjuvant chemotherapy is chemotherapy given after surgery has removed the tumor and its spread in the abdomen. Its purpose is to reduce the chance that some potentially remaining tumor cells will start a relapse. Adjuvant chemotherapy is very common in ovarian cancer.
Palliative chemotherapy – chemotherapy, which is given for already existing relapse or for metastatic disease is called palliative. It aims to slow tumor growth and can sometimes eliminate cancer for long periods of time. This chemotherapy usually does not cure the cancer, and is given to slow the development of recurrence or metastasis.
Modern drug treatment of malignant tumors includes both classical cytotoxic and cytostatic drugs (chemotherapy), as well as medicines from the target group (aimed) therapy, which selectively attack specific targets in tumor cells, representing genetic mutations. They are established by genetic studies. Sometimes targeted therapy is administered alone, and in other cases together with classical chemotherapy. It either destroys tumor cells, or slows/stops their division in the primary tumor and/or its metastases (metastases).
According to national standards, based on the golden rules of the European (ESMO) and the American one (DISGUST) oncology associations (including NCCN).