Ovarian cancer

By Dr. Alessandra Pipan, Consultant in Obstetrics & Gynecology

The term ovarian cancer includes many different types of tumors –  each with its own characteristics of malignancy,  behavior, markers and sensitivity to medications – arising from the different cells which form the female endocrine reproductive organs. It is now understood how one of the most common, aggressive and fast growing types (epithelial) originates from cells of the fallopian tubes whilst those originating from the ovarian cells are more indolent and slow growing.

Among all of the female reproductive tract malignancies, ovarian cancer is still to be considered the most obscure and less preventable, a silent neoplasia, third cause of death after uterine and cervical cancer. 

Contrary to cervical cancer, which can be early detected through a pap smear (the test to discover disease before any symptoms), it is the lack of similar methods and protocols that leads to delayed diagnosis in 60% of cases. 

As symptoms may be misinterpreted at an early stage, it is well understood how persistent bloating, feeling of fullness, abdominal pain are common in other pelvic pathologies, often appearing late in the disease. 

Similarly, the combination of Ca 125, a blood  marker, and  transvaginal ultrasound  are of no benefit in terms of mortality. Ca125 indeed can be elevated in a number of benign conditions and transvaginal scan needs a high level of expertise acquired after specific training in recognizing specific patterns. Furthermore, early detection of small, poorly distinguishable changes by imaging is not feasible with conventional instruments, the reason why research is very active in the field. 

Therefore, is there feasible screening and for whom? The whole female population? Only postmenopausal women? Only women with a strong family history of cancer – and which cancer? Women with certain risk factors? Which is to be considered an effective and applicable screening method for this neoplasia? And finally, is the screening policy effective at reducing mortality or is it only leading to more unnecessary medical treatments?

  • Age
  • Close relative with oc
  • Being carrier of a genetic mutation
  • Having had breast colon uterine ca
  • Being of eastern european or ashkenazi descent
  • Having had endometriosis
  • Having had troubles getting pregnant
  • Use of contraceptive pills
  • Breastfeeding
  • Tubal ligation
  • Having given birth
  • Patients with family history positive for breast/ovarian ca
  • Patients with Lynch syndrome carry a risk of other rare genetic syndromes
  • Search for epigenetic markers, gene expression, methylation based arrays Liquid biopsies
  • Search for specific combination of proteins in the blood A combination of biomarkers
  • New imaging techniques, in particular
  • Radiomic or radiogenomic, are extremely promising in evaluation of the tumor, by combining qualitative and quantitative information extracted from clinical images and data, with or without associated gene expression
  • Future integration w AI in order to tailor treatments

Since no early detection is available for patients at average or low risk, a considerate approach implies normal routine check ups while waiting for development of more effective, individualized medical treatments to be successfully implemented  by the public health sector.

It is well recognized how diagnosis at an early stage of diseases improves outcome and results in less invasive procedures.

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