Ovarian Cancer – Causes, Stages, Prevention and Treatment

Ovarian cancer, a serious condition of the female reproductive system, is a major concern for the medical community and patients alike. Ovarian cancer develops when the cells of the ovary undergo genetic mutations and begin to divide chaotically, forming malignant tumours. Unfortunately, most ovarian cancers are discovered at advanced stages of their progression, which limits the treatment options available to affected patients. However, when found early, ovarian cancer can be successfully treated, significantly increasing the chances of survival and improving the quality of life of affected patients.

Ovarian Cancer – Risk Factors

Ovarian cancer occurs when a cell undergoes DNA mutations, triggering uncontrolled growth and malignant tumour formation. Research shows that genetic mutations may play a significant role in the development of this type of cancer. There are also a number of risk factors that can increase a woman’s likelihood of developing ovarian cancer, and among the main risk factors associated with this disease are:

  • Ageing and menopause: The risk of developing ovarian cancer increases with age, especially after the onset of menopause.
  • Number of pregnancies: The risk of ovarian cancer is inversely proportional to the number of pregnancies of the patient. Women who have had more pregnancies have a lower risk of developing ovarian cancer compared to those who have had no or fewer pregnancies.
  • Hereditary history of ovarian or breast cancer: Women with first-degree relatives (mother, sister, daughter) who have had ovarian or breast cancer are at increased risk of developing ovarian cancer.
  • Personal history of ovarian tumours: Patients who have had ovarian tumours in the past are at increased risk of developing ovarian cancer.
  • Overweight: Overweight and obesity are associated with an increased risk of ovarian cancer.
  • Administration of hormone replacement treatments after the onset of menopause: Their long-term use may increase the risk of ovarian cancer.
  • Endometriosis: The presence of endometriosis, a condition in which endometrial-like tissue grows outside the uterus, may be associated with an increased risk of ovarian cancer.

Understanding and awareness of these risk factors can help identify patients at increased risk of developing ovarian cancer and implement appropriate prevention and screening strategies.

Stages of Ovarian Cancer

Ovarian cancer is classified into four stages, determined by the extent to which the disease has spread. Here is a brief overview of each stage:

Stage I:

In stage I ovarian cancer, the disease is located only in the ovaries (one or both ovaries).

At this early stage, the tumour may be relatively small and restricted to the surface of the ovary.

Patients usually have no obvious symptoms and may have a good chance of recovery if the disease is treated at this stage.

Stage II:

In stage II ovarian cancer, the disease has spread beyond the ovaries and can affect other tissues in the pelvis, such as the fallopian tubes, uterus or bladder.

Although more advanced than stage I, the cancer is still located in the pelvis and has not spread outside this area.

Stage II treatment may involve surgical removal of the tumour and affected tissues, followed by chemotherapy or other therapies.

Stage III:

Stage III ovarian cancer is characterised by the spread of the disease to the abdominal cavity and/or lymph nodes around the pelvis.

At this stage, the tumour may affect abdominal organs such as the intestine or stomach.

The prognosis in stage III is more guarded than in earlier stages, but modern treatments may still offer a chance of survival.

Stage IV:

In stage IV ovarian cancer, the tumour has spread outside the pelvic cavity and metastasised to distant organs such as the liver, lungs or other parts of the abdomen.

Because the cancer has spread farther, treatment can be more difficult and the prognosis is often poor.

However, modern therapies can improve patients’ quality of life even at this advanced stage of the disease.

Ovarian Cancer Diagnosis

Diagnosis of ovarian cancer involves tests and investigations such as blood tests for tumour markers, transvaginal ultrasound, abdominal CT, biopsy and laparoscopy. Medical imaging, such as ultrasound and CT, can detect abnormalities in the ovary and provide information about the size, shape and composition of any mass. Blood tests for tumour markers, such as CA-125, can be useful but are not definitive. In some cases, a biopsy may be needed to confirm the diagnosis.

Ovarian Cancer Treatment

Treatment options for ovarian cancer are largely determined by the stage of the disease and the patient’s overall health. Standard treatment includes:

Surgery

Surgery: Surgery is often the first treatment option and involves removing the tumour and affected tissues, as well as other organs or tissues if the cancer has spread.

Surgical treatment for early stages of ovarian cancer, I and II, may involve the following procedures:

  • Total hysterectomy: Removal of the uterus.
  • Bilateral salpingo-oophorectomy: Removal of the ovaries and fallopian tubes on both sides.
  • Omentectomy: Removal of the omentum, a fold of the peritoneum that surrounds the organs of the abdominal cavity.

Biopsies from the paracolical recesses and para-aortic pelvic lymph nodes are required to estimate the risk of metastasis of tumour cells. In young patients who want a future pregnancy, unilateral salpingo-oophorectomy may be indicated if the tumour is confined to one ovary and the histology is favourable.

For advanced stage IIB-IIIC tumours, surgery may include removal of the entire female reproductive tract, omentectomy and staging biopsies to achieve optimal cytoreduction and reduce the risk of residual disease.

In patients with stage IV ovarian neoplasm, radical surgery can increase the survival rate up to 5 years postoperatively for about half of them and even up to 10 years in certain circumstances.

Chemotherapy:

After surgery, chemotherapy may be used to destroy the remaining cancer cells and prevent the disease from recurring.

Targeted Therapy:

This form of treatment targets specific genetic abnormalities or proteins that promote the growth of ovarian cancer, attempting to stop or slow the growth of the tumour.

Prognosis and Evolution of the Disease

Patients diagnosed at early stages, 1 or 2, generally have better survival prospects and more treatment options than those diagnosed at advanced stages – 3 or 4.

However, even in advanced ovarian cancer, advances in cancer treatment have significantly improved survival prospects. Modern surgical interventions and targeted therapies allow better control of tumour growth and improve the quality of life of patients.

It is important to emphasise that each case of ovarian cancer is unique and that prognosis may vary depending on several factors, such as the patient’s age, general health, histological type of tumour and individual response to treatment. However, with a multidisciplinary approach and personalised treatments, many ovarian cancer patients can significantly improve their quality of life and live with the condition for a long time.

Ovarian Cancer Prevention

Although there are no guaranteed ways to prevent ovarian cancer, adopting a healthy lifestyle and being aware of risk factors can help reduce the likelihood of developing the disease.

Fighting ovarian cancer is an ongoing battle that requires collaborative efforts between patients, doctors and researchers. Awareness of symptoms, early diagnosis and access to effective treatments are crucial to improving the prognosis and quality of life of those affected by this disease.

HIPEC: An Innovative Strategy in the Treatment of Ovarian Cancer

Ovarian cancer is often diagnosed in advanced stages, when cancer cells can spread into the abdominal cavity, a process known as peritoneal carcinomatosis. In these cases, the treatment option of HIPEC (hyperthermic intraperitoneal chemotherapy) may offer hope and improve the chances of long-term survival.

The HIPEC procedure is a complex treatment that combines surgery to remove visible tumours (known as cytoreductive surgery) with direct administration of heated chemotherapy into the abdomen. This treatment aims to remove cancer cells remaining after surgery that cannot be seen with the naked eye.

How is HIPEC run?

In a single surgery, the HIPEC procedure includes four essential steps:

  1. Abdominal exploration: a thorough evaluation of the extent of cancer in the abdominal cavity.
  2. Surgical resection: Removal of tumours and affected tissues.
  3. HIPEC: Administration of heated chemotherapy that circulates in the abdominal cavity to destroy remaining cancer cells.
  4. Reconstruction: Restoring the functionality of the affected organs, if possible.

HIPEC treatment is personalised and depends on several factors, including the origin of the cancer and its extent at diagnosis. In ovarian cancer, HIPEC is considered as part of treatment, especially when the disease has spread to the peritoneal cavity.

Although an innovative treatment, HIPEC is an invasive procedure and is not without risks or complications. It is essential that patients are carefully assessed to determine if they are suitable candidates for HIPEC. In addition, the success of the procedure is influenced by the ability to surgically remove all visible tumour nodules and the patient’s overall health.

What comes after HIPEC?

After the HIPEC procedure, patients are closely monitored, and in some cases, systemic chemotherapy may be required to prevent or delay cancer recurrence.

In conclusion, for ovarian cancer patients facing spread of disease into the peritoneal cavity, HIPEC represents a ray of hope, offering not only the potential for prolongation of life but also improved quality of life. It is crucial that any medical decision is made following a thorough discussion with a specialist medical team who can assess all relevant aspects of treatment.

Our medical team, under the direction of Dr Bartos, is available to help you better understand the treatment options available for ovarian cancer.