Ovarian cancer

About one in 70 women will develop ovarian cancer during her lifetime. The majority of these women are already post-menopausal. However, over the last few decades, the incidence of ovarian cancer in younger premenopausal women has been increasing.

The cause of ovarian cancer is multifactorial, with biological and genetic factors playing a key role.

Furthermore, early menarche, late menopause, atocia, as well as frequent menstrual periods are deteriorating risk factors.

Though rarer compared to other gynecologic malignancies, its biological “behavior” is more aggressive. Furthermore, due to its general, unclear and often “silent” symptoms, it is usually diagnosed at advanced stages. Approximately 70% of cases are diagnosed when the malignancy has already reached stage 3 (out of four); this presents treatment and surgery challenges for both patients and oncology teams.

Prevention or early diagnosis of ovarian cancer is of paramount importance considering its “silent” and general symptoms even at an advanced stage, as mentioned above. Unfortunately the Oncology Community has not managed to find as yet an efficient testing technique to ensure ovarian cancer prevention and early diagnosis which would substantially reduce ovarian cancer mortality rates, i.e. using regular transvaginal ultrasound or Ca-125 blood index (as applied in mastography or PAP test). However, recent studies seem to refute this established opinion. In specific, preliminary results from the study “United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)” are encouraging. Preliminary study results show that the use of Ca-125 and/or transvaginal ultrasound on an annual basis in a population of 202,638 post-menopausal women being monitored for up to 10 years from enrollment to the study may lead to earlier diagnosis, and hence more successful treatment of patients diagnosed with ovarian cancer. The final study results will be announced at the end of 2014-early 2015 and are much anticipated worldwide.

Ovarian cancer treatment is mainly surgical. For earlier stages, the procedure of choice is the so-called primary surgical staging. For more advanced stages where cancer has spread in the abdominal area with multiple tumor growths, the procedure is called tumor debulking and consists of removing all tumors, if possible. Removal of a part of the small intestine or the colon, or liver or stomach or spleen and possibly any abdominal organ obviously affected may be required to ensure such treatment. Primary surgical treatment is almost always followed by adjuvant chemotherapy (3 - 6 cycles depending on stage). In some cases, chemotherapy precedes surgery and is maintained post-operatively.

Ovarian cancer prognosis depends directly on surgical stage. First- and second-stage patents are usually treated successfully. Complete treatment success rates decrease at the third and fourth stage; however, great strides have been made compared to past decades.