Your cancer

Living with the disease

Ovarian cancer

What is it ?

The ovaries, part of the female reproductive system, consist of two hormone-producing organs (glands). They are located on either side of the uterus and are connected to the uterine cavity via fallopian tubes. Ovarian cancer most commonly expressed as a tumor (or tumors) in the outer layer of tissue that surrounds the ovary, which is called the ovarian epithelium. Although ovarian cancer mainly affects women over 65 years of age, younger women may also be at risk, especially if they are genetically predisposed. Ovarian cancer was responsible for 161,000 deaths in 2015.

Témoignage Patient


Angelique, who has ovarian and uterine cancer, tells you how she discovered her disease and how she was followed by her doctors during her treatment. 

The symptoms

As the disease most commonly develops in an "expandable" hollow space, symptoms do not usually appear until the cancer is already relatively advanced. Most often they include: 

feeling of abdominal heaviness

unexplained weight gain

an increase in abdominal circumference

There may also be functional signs such as: 

altered bowel movements

urinary disorders

General symptoms include: 

Fatigue

Loss of appetite

Although none of the above symptoms are 100% specific to ovarian cancer, you should consult a health care practitioner if they are intense and/or persist over time.

Screening

An accurate test for early detection of ovarian cancer does not currently exist. Pelvic ultrasounds and screening for the Ca-125 marker have not been proven as efficient methods.

Diagnostic Process

Most often, symptoms lead to abdominal and pelvic ultrasound. If a malignant ovarian lesion is suspected, a lumbopelvic MRI is recommended.

The diagnosis of certainty is based on histological sampling, (i.e., the analysis of a fragment of the tumor tissue removed via laparoscopy in most cases). Laparoscopy is performed in the operating room under general anesthesia. Three small incisions (one below the navel and one on each side) are made as entry points for the camera and surgical instruments. The entire abdominal cavity, including the ovarian lesion, can explored and viewed live and samples can be taken.

It takes about a week to receive the biopsy results.

Risk factors

Women of childbearing age (15-49 years old on average) ovulate once a month. During this process, called ovulation, the ovaries produce a mature egg (ovum) which migrates to the uterine cavity to be potentially fertilized. Ovulation also causes the secretion of hormones and inflammatory materials and the repeated scarring of the ovary’s surface, factors which can each lead to cancer. Thus, a higher number of ovulations correlates to a higher risk, as does:

The absence of pregnancy

Early menstruation

Late menopause

Age (>65 years)

Overweight or obesity

Conversely, oral contraceptive is considered a form of protection.

Finally, the main risk factor is an inherited genetic anomaly. 

Predisposing factors are responsible for 15 to 20% of high-grade ovarian cancer cases. These are mainly abnormalities of the BRCA 1 or 2 genes or, more rarely, of Lynch syndrome. 

In the event you are diagnosed with a high-grade epithelial tumor, medical staff should automatically suggest that you be tested for these anomalies.

Treatments

Treatment differs depending on the stage of the disease: 

In case of a localized tumor, surgical treatment will be recommended.

If the cancer is more advanced, chemotherapy combined with targeted anti-angiogenic perfusion therapy will be continued as "maintenance" for 15 months. If the disease is due to a BRCA mutation, the anti-angiogenic targeted therapy will be replaced by a specific oral targeted therapy for at least 2 years. 

If extension is limited, surgery will be performed first followed by systemic treatment. If immediate resection of the tumor is not possible, 3 to 4 cycles of chemotherapy will be performed, followed by an "interval" surgery, provided that there has been a satisfactory response to the chemotherapy.

Finally, chemotherapy combined with targeted anti-angiogenic perfusion therapy will be continued as "maintenance" for 15 months. In case of BRCA mutation, the anti-angiogenic targeted therapy will be replaced by a specific oral targeted therapy for at least 2 years.

If surgery is not possible after the first few cycles of chemotherapy, chemotherapy will need to be continued for life.

Ovarian cancer is currently the only cancer where the presence of a BRCA 1 or 2 mutation can be better managed using new therapeutic class of drugs called PARP inhibitors. In the case of a high-grade tumor, it is essential that the patient be tested for BRCA regardless of family history or age at diagnosis.

The notion of platinum sensitivity

The standard chemotherapy protocol for ovarian cancer includes a molecule called Carboplatin. In the event of a late relapse (6 months after the last dose of Carboplatin), a patient is said to be "platinum sensitive" and is expected to be able to obtain a favorable result from using the drug again.

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