Ovarian cancer

Ovarian cancer is the 7th most common cancer in women and the 18th most common cancer in the world. There are nearly 300,000 new cases of ovarian cancer each year worldwide.

Where is the ovary?

The ovaries are the female sex glands. They are part of the female reproductive system.

The woman has two ovaries, one on each side of the pelvis, connected to the uterus by the fallopian tubes. The ovaries are located in the pelvic cavity, between the uterus and the pelvis wall. Each ovary weighs about 10 g and has an almond shape (1 x 0.5 x 0.1 cm). Depending on the menstrual cycle and age, its size may change. The ovaries are fixed by ligaments that connect them to the uterus or peritoneum.

The ovary is covered with a whitish tunica, the tunica albuginea, and has small yellowish scars on the surface that correspond to ovulations already made.

What are the ovaries for?

The ovary has a dual function:

Produce female gametes (reproductive cells), also called ova

From puberty, at each menstrual cycle, an ovary brings a follicle to maturity and releases an egg. The latter is expelled to the fallopian tube via its enlarged end, the flag. This is where this female germ cell, or gamete, can be fertilized by a spermatozoon. The fallopian tubes lead the fertilized egg from the ovary to the uterus, where it nests and a pregnancy can begin. If the egg is not fertilized, it dies and disperses.

Produce hormones

Ovaries produce female sex hormones. 2 types of sex hormones exist: progesterone and estrogen. Each of these hormones has a specific impact on the woman's body.

Estrogen

Estrogens are responsible for the development of female organs at the time of puberty: uterus, breasts and thickening of the vaginal wall. They also act on the brain, help to strengthen the bones, feminize the voice and play an important role in the quality of the skin and hair. They are also responsible for the distribution of adipose tissue (fat) on the hips and thighs, and make women more sensitive to venous problems (like, for example, phlebitis).

Progesterone

Progesterone is produced by the ovaries after ovulation (the moment the egg is released from the ovary). It supplements and controls the effects of estrogens. It allows the implantation of the egg in the uterus and participates in the smooth progress of the pregnancy. It tends to slightly increase the temperature of the body.

What is ovarian cancer?

Ovarian cancer originates in the cells of the ovary. It happens that some cells of the ovary undergo a transformation that makes them cancerous. Under certain conditions, an abnormal cell can start to proliferate uncontrollably and lead to the formation of a malignant tumor of the ovary. Cancerous tumors of the ovary are classified according to the type of cells in which the cancer appears.

The ovaries are architected from several layers of tissue. There are 3 layers:

  • The epithelium: which is the tissue of the ovarian surface
  • The stroma: which is a fabric called "support" because it gives its shape and consistency to the organ and serves as protection for other cells
  • The germ cells: which are the most important cells of the ovary, because they provide the functions of ovulation and hormonal production

Ovarian cancer develops in 90% of cases from the epithelial cells that cover this organ. We talk about epithelial carcinoma of the ovary. As the tumor grows, it can break the envelope around the ovary, expand to the peritoneum, and invade the intra-abdominal organs. It can also be rare forms (malignant germ cell tumor or stromal tumor).

In 10% of cases, these are non-epithelial tumors. Germ cell tumors and stromal tumors are mainly distinguished by the nature of the cells from which they develop. They usually occur in younger people, even teenagers.

Stromal tumors originate in stromal cells. Of the stromal tumors that may be malignant, tumors of the granulosa are the most common type.

Germ cell tumors appear in germ cells. Of all ovarian tumors, mature cystic teratoma (dermoid cyst) is the most common type. In general, it is not cancerous. The most common type of cancerous germ tumor is dysgerminoma.

What are the symptoms of the ovary?

Ovarian cancer usually goes unnoticed in its early stages of the disease. Symptoms often appear as the tumor develops in nearby tissues and organs. Other medical conditions can cause the same symptoms as ovarian cancer.

If you notice any of the following symptoms, we advise you to consult a doctor:

  • persistent pain in the lower abdomen;
  • an increase in the volume of the abdomen;
  • feeling of early satiety and digestive disorders;
  • unusual disorders of the menstrual cycle;
  • blood loss through the vagina between menstruation or after menopause.

What tests can be done to detect ovarian cancer?

To date, there is no screening test for ovarian cancer. The doctor therefore performs tests to detect ovarian cancer when the symptoms described above appear.

The clinical examination

The doctor conducts a palpation of the abdomen and lymph nodes, a breast examination, a digital rectal examination, and a gynecological examination with vaginal examination to identify any abnormalities. If a lump in the lower abdomen or ovaries is found, the doctor will prescribe additional tests to determine their nature.

Endovaginal ultrasound

Ultrasound is an imaging method that uses ultrasound, ie high-frequency (harmless and painless) sound waves, to generate relatively accurate organ images. Ultrasound is a central examination to guide the diagnosis of ovarian cancer. It is usually performed by endovaginal route: the probe is introduced into the vagina. It allows to visualize a possible cyst in one or both ovaries and to specify its nature. For this, the doctor evaluates the size, shape, content (solid or liquid). These elements allow him to determine whether it is a benign cyst - not serious - or a malignant cyst (cancer).

Magnetic Resonance Imaging (MRI)

The MRI arrives in a second time after the ultrasound, when this one does not manage to determine precisely the nature of the cysts or masses observed. In addition, MRI can provide information on possible invasion of ovarian cancer to surrounding organs such as the bladder or uterus.

Surgical specimens

When the doctor suspects ovarian cancer and in the presence of an abnormality detected during the clinical examination and on the images of the radiological examinations, a surgical sample (or biopsy) is generally necessary to confirm the diagnosis of cancer of the ovary. ovary.

Following the operation, the specimens are examined under a microscope during an anatomopathological examination. It is an examination of microscopic cells and tissues taken from the ovary and other parts of the abdomen. It gives precise information about the type of ovarian cancer and its characteristics. Only this examination eliminates or definitively asserts the diagnosis of cancer.

Who is most likely to be affected by ovarian cancer?

Certain behaviors and individual characteristics increase the risk of cancer occurrence. In the case of ovarian cancer, the main risk factors identified are age and heredity. But there are others like tobacco or obesity ...

Family history of ovarian cancer

When there is a family history of ovarian cancer, it means that one or more blood relatives have or have had this form of cancer. If many of your relatives have ovarian cancer, your risk of having it may be higher. These parents may be on the mother's side or on the father's side.

You may be at higher risk of having ovarian cancer if a first-degree relative (mother, sister or daughter) has it. Your risk is higher if it is your mother who has been diagnosed with ovarian cancer rather than your daughter.

Your risk may be even greater if this relative was diagnosed before turning 50 or after menopause. Having at least 2 first-degree relatives who have been diagnosed with ovarian cancer can also increase your risk.

Your risk may be slightly higher if 1 first-degree relative and 1 second-level relative (aunt, grandmother, niece) have been diagnosed with ovarian cancer.

The age

Age is the main risk factor. The risk of developing ovarian cancer increases steadily with age. It is around age 60 that the risk is highest.

No pregnancy or childbirth

Women who have never been pregnant are more likely to have ovarian cancer than women who have ever been pregnant. Researchers believe that this lower risk is attributable to hormones in pregnancy that have a protective effect. It is also possible that the higher risk of women who have never been pregnant is related to factors that could make it difficult for them to become pregnant. The risk of ovarian cancer is also higher in women who have never given birth to a child, even if they have been pregnant. Researchers do not really know if this increased risk is related to the same factors that increase the risk of ovarian cancer in women who have never been pregnant.

Smoking

Smoking increases the risk of mucinous carcinoma, a type of epithelial carcinoma of the ovary in women.

Obesity

Being obese means having a body mass index (BMI) of 30 or more. Some studies have shown that obesity may increase the risk of ovarian cancer.

What are the treatments for ovarian cancer?

The choice of treatment in cervical cancer depends on 2 criteria:

  • Characteristics of the tumor, including its size, location, tumor stage and tumor grade;
  • The general condition of the patient.

With these criteria, health professionals develop an appropriate protocol of care.

The treatment of ovarian cancer is organized around 2 axes that are: surgery and chemotherapy. The protocols can be used alone or in combination and have the objective of: destroying the tumor (s), reducing the risk of relapse, slowing down the development of the tumor and treating the symptoms related to the disease.

Surgery

Surgery is recommended in most cases. At an early stage, it consists of removing the uterus, the two ovaries, the lymph nodes and the omentum, which is part of the peritoneum. The procedure can be performed by laparoscopy, that is to say that the surgeon introduces his instruments and a camera by small incisions in the abdomen, and guides his actions through a screen. He can also perform biopsies, samples of other organs, which will be analyzed to verify that they are not reached. If the cancer is at a very early stage (only one ovary affected) and the patient still wants to have children, it is sometimes possible to remove only this ovary and the associated fallopian tube. But most often, the operation requires a laparotomy: the abdomen is open from the pubis to the sternum. The surgeon can observe and palpate all organs to see if they are affected. For advanced cancer, the procedure can be much heavier and last up to 8 hours. It begins with a laparoscopy to assess the extent of the disease. Then, a laparotomy is performed to ideally remove all affected tissue, including the colon, rectum, part of the small intestine if necessary. At the end, the surgeon may have to connect the end of the digestive tract to an opening in the belly, a stoma. The stool will then be evacuated into a pouch glued to this hole for a few weeks while the intestine heals. A new intervention will then reconnect the intestine to the rectum.

Chemotherapy

The chemotherapy treatment is based on carboplatin combined with paclitaxel (known under the trade name Taxol). They are injected into the blood via an implantable chamber, outpatient: the patient comes to the hospital for the few hours that the injection lasts and then returns home. The treatment usually consists of 6 to 9 cycles of injections, spaced three weeks apart. More and more people are trying to inject smaller doses at a weekly rate. This forces the patient to move more often to the hospital, but Taxol is better tolerated by the body. Most often, surgery precedes chemotherapy. However, it is sometimes decided to start with chemotherapy, either because the tumor is not operable, or to reduce the tumor volume and perform less extensive surgery. We begin with three to four cycles of chemotherapy to reduce the size of the tumor, before operating to remove it. The procedure is thus simpler and its complications reduced. The cycles of chemotherapy then resume. In general, chemotherapy is supplemented with three or four courses of treatment by adding bevacizumab (Avastin), a drug that blocks the formation of new blood vessels. This more targeted treatment is continued for 15 months to prevent potential residual cancerous foci from developing.

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