Your cancer

Living with the disease

Ovarian cancer

What is it ?

The ovaries are two glands (i.e. hormone-producing organs), located on either side of the uterus and connected to the uterine cavity via the fallopian tubes. They belong to the female reproductive system. Ovarian cancer is a tumor most often developed at the expense of what is called the ovarian epithelium, the outer layer of tissue that surrounds the gland itself. With a little more than 5000 cases per year in France, it is the 8th most common cancer in women. It mainly affects women over 65 years of age but earlier forms are possible, especially in cases of genetic predisposition.

Symptoms

Most often, since the disease develops in an "expandable" hollow space, symptoms do not appear until late in the disease, when the cancer is already relatively advanced. Most often they are: 

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 may also be present: 

Fatigue

Loss of appetite

one of these signs is 100% specific but their intensity and/or persistence over time should lead to consultation.

Screening

There is currently no validated test for early detection of ovarian cancer. The role of pelvic ultrasound or the Ca-125 marker has not been demonstrated.

Diagnostic Process

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

The diagnosis of certainty is based on histological sampling, i.e., a fragment of the tumor tissue, via laparoscopy in most cases. Laparoscopy is performed in the operating room under anesthesia. It does not leave a large scar but is performed via 3 entry points for the different instruments (one below the navel and one on each side). This examination allows the entire abdominal cavity to be explored under direct vision with a camera, the ovarian lesion to be visualized and samples to be taken of each suspicious element.

It takes about a week to obtain the complete results of the biopsy.

Risk factors

During the entire period when a woman is of childbearing age (on average 15-49 years), each month the ovaries produce a mature egg (ovum) which migrates to the uterine cavity to be potentially fertilized: this is ovulation. This phenomenon is accompanied by the secretion of inflammatory factors, hormones and repeated scarring of the surface of the ovary which could individually be the cause of the disease. A higher number of ovulations is therefore a risk factor, i.e.:

The absence of pregnancy

Early menstruation

Late menopause

Age (>65 years)

Overweight or obese

Conversely, taking an oral contraceptive would be a protective factor.

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

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

In case of high grade epithelial tumor, the research of these anomalies will be systematically proposed to you.

Treatments

Depending on the stage, the treatment differs: 

In case of localized tumor, the reference is surgical treatment.

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 the extension remains limited, surgery will be performed first followed by systemic treatment; If the extension prevents immediate resection of the tumor, 3 to 4 cycles of chemotherapy are performed, followed by an "interval" surgery if the response to chemotherapy is satisfactory..

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, it will be continued for life.

Ovarian cancer is currently the only cancer where the impact of the presence of a BRCA 1 or 2 mutation really modifies the management thanks to a new therapeutic class: PARP inhibitors. This is why it is essential to look for it (in the tumor tissue and/or in the blood) in the case of a high-grade tumor, 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 it is then possible to use this drug again and obtain an effect.