November 10, 2022 Author : João Casanova Ovarian cancer is one of the most common gynecological cancers , accounting for 30% of cases. Europe is the world region with the highest incidence of ovarian cancer and this has increased in recent years; In Portugal, around 700 cases of ovarian cancer are diagnosed per year; It is more frequent between 50 and 65 years of age; Among gynecological cancers, it has the highest associated mortality. The causes of ovarian cancer are not well known, but it is known that: About 25% of cases are related to gene mutations, both hereditary and acquired . It may be related to ovulation , as hormonal contraception and pregnancy reduce the risk of its occurrence: Pregnancy and delivery before age 26 decrease the risk, with each new pregnancy and delivery increasing. Breastfeeding also reinforces this risk reduction. Tubal ligation and removal reduce the risk , as most ovarian cancers are thought to originate in the tubes. Types of ovarian cancer There are three main types of ovarian cancer , which are distinguished by the cells in which they originate: Tumors of epithelial cells They originate from the epithelial cells that cover the surface of the ovary, they are called carcinomas and are the most common ovarian cancers (about 85%-90%). There are several subtypes of ovarian carcinomas, being the high-grade serous carcinoma the most frequent, representing almost 80% of ovarian cancer cases. Other less frequent subtypes are, for example, low-grade serous carcinoma, clear cell carcinoma, endometrioid carcinoma and mucinous carcinoma. Germ cell tumors They originate in the cells that produce the eggs. They represent 5% of ovarian cancers. There are several subtypes of germ cell cancers: immature teratomas, dysgerminoma and yolk sac tumors. They tend to appear in younger ages: teenagers and young women. Stromal tumors They originate from tissue cells that participate in the architecture of the ovary and that produce estrogens and progesterone. These are rare ovarian tumors (less than 1% of cases), but their diagnosis is generally earlier. Epithelial, germ and stromal cells of the ovary can also give rise to benign tumors, which are much more frequent than malignant tumors or cancer. Factors that increase the risk of ovarian cancer In the general population, the lifetime risk of ovarian cancer is about 2%. However, there are several factors that increase this risk , for example: Age over 55 years; Never having had a full-term pregnancy; First menstruation before age 12 or menopause after age 52; First child at a late age: women over 35 years old when their first child is born have a higher risk of ovarian cancer than those who have younger children; Hormone replacement therapy with estrogens or estrogens + progesterone after menopause; Family history of ovarian, breast and colorectal cancer; Heredity: mainly BRCA1 (30%-70% risk) and BRCA2 (10%-30% risk) mutations increase the risk of ovarian cancer and breast cancer. There are other, less important mutations that can also increase the risk of ovarian cancer. Ovarian cancer symptoms Early in its development, ovarian cancer may not cause any symptoms, or these may be very mild. In addition, the symptoms associated with ovarian cancer are not specific , they happen in many other situations. The main ones are: Increase in abdominal volume; Pelvic discomfort or pain; Lack of appetite or rapid feeling of fullness after meals; Increased urinary frequency or urinary urgency. Other possible symptoms are: Unexplained weight loss; Permanent tiredness; Back pain; Changes in bowel habits (constipation or diarrhea); Vaginal bleeding after menopause. Diagnosis In case of suspicion of ovarian cancer, several tests may be ordered, including: Ultrasound, computed tomography and other imaging tests . These exams do not allow the definitive diagnosis by themselves, but provide information on the location and extent of the disease; Blood tests , among which the tumor marker CA 125, which is increased in ovarian cancer, but also in other diseases, both oncological and non-oncological. The definitive diagnosis of ovarian cancer is only possible through the anatomopathological evaluation . This can be done on a biopsy sample or during an exploratory laparotomy or laparoscopy, helping to define the extent of the intervention. Ovarian cancer treatment The treatment of ovarian cancer depends on the evolution of the disease and whether or not it has spread to other organs and tissues. In the early stages, it always includes surgery to remove the ovaries, fallopian tubes, uterus, and other procedures, which can be done by open surgery, laparoscopy or robotic surgery. In advanced stages, surgery involves the removal of all visible disease, a procedure called debulking surgery, which may involve the removal of several organs. In cases where surgery cannot be performed (because of associated diseases or because the disease is not resectable), chemotherapy is given before surgery (neoadjuvant chemotherapy) to reduce the size of the tumor and increase the likelihood that it will be surgically removed. complete later. Ovarian cancer requires regular periodic medical surveillance after , which is more frequent in the first few years, to ensure that the disease is not present and to detect any signs of recurrence early. Ovarian cancer prevention For most women, routine gynecological surveillance does not include ovarian cancer screening. This may be indicated in women who are at high risk of developing the disease and most often includes determination of CA 125 values and an imaging test. Meet the obstetrics-gynecology clinical team from Hospital da Luz network and book your consultation The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
