Database of diseases - Sexual health

     

Statement prof. Dr. med. Jan Zielinski on early diagnosis of ovarian cancer:
" Diagnosis of ovarian cancer at its earliest, not advanced stage of development and optimal treatment in the so-called early and late stage is one of the most important problems of modern gynecology. "


Ovarian cancer causes the most deaths among malignant genital cancers.

In over 70% of patients it is diagnosed in II-III-IV stages of clinical advancement. Thus, only about one in three patients with advanced ovarian cancer survive for 5 years after the diagnosis. When it is detected in the first stage of clinical advancement and properly treated - 80% of women have a chance of surviving for 5 years and more.



Difficulty to diagnose ovarian cancer

However, it should be realized that the detection of ovarian cancer, which is limited only to its original seat, is very difficult. The ovary is in fact both the primary cancer development seat, as well as the place generating disease metastases to other organs. Detection of the disease in the ovary itself is possible only when the tumor reaches a diameter of 1 cm, and a weight of about 1 g. It is the smallest tumor that can be detected by gynecological examination or imaging (the latter technique can detect a slightly smaller tumor).


High risk to life due to diagnostic limitations

A tumor with a diameter of 1 cm contains about one trillion cancer cells with their potential for metastasis. The ability to detect and eliminate smaller tumors, such as microscopic size, could prevent metastases and increase the survival rate, but with the current advancement of diagnostic methods, this is not yet possible.


The constant increase in ovarian cancer

The number of patients increases, especially in highly industrialized countries (except Japan, where mortality due to this cancer is low). Ovarian cancer occurs more often in the urban than rural population. In Poland, according to epidemiological data of the Oncology Center in Warsaw, the increased risk of disease is observed in the following provinces: Bialystok, Lodz, while the region of the highest risk is Wielkopolska. The lowest risk is in south-eastern Poland. Northern and central Poland are voivodships with average mortality rates for ovarian cancer.


The highest number of cases is between 50 and 59 years.

With the aging of a woman, the ovary ages and, although it becomes too old to fulfill its hormonal function, it never becomes too old to develop cancer. This phenomenon should be considered when making decisions to leave the ovaries during the hysterectomy, due to benign pathological changes in the uterus. This is particularly true for women with an increased risk of ovarian cancer, for example with family history (5-10% of all cases).


The risk of developing ovarian cancer in women increases:

1. In whom breast cancer has been diagnosed - they have twice the risk of developing ovarian cancer.

2. Increased risk of cancer is also found in the hereditary occurrence of non-coliform colorectal cancer or "Lynch II syndrome", which includes: early non-lipid colorectal cancer, endometrial cancer, upper gastrointestinal cancer.

3. Many epidemiological studies indicate that ovarian stimulatory disorders may contribute to the initiation of cancer.


It reduces the risk of ovarian cancer:

1. The increase in the number of children born by a woman.By adopting a risk factor for ovarian cancer at the rate of-1.0, the same rate for a woman who has 1 or 2 children is twice as low! (it is 0.49), and for a woman who gave birth to 3 or more children, the index decreases nearly three times! (it is only 0.35 to 0.36). It should be added that each additional pregnancy reduces the risk of ovarian cancer by 10%.

2. It is believed that the use of oral contraceptives reduces the risk of developing cancer. The risk of developing cancer slightly decreases after a few months of using oral contraception, while it drops significantly (from 40 to 50%), when contraception is used for a very long time. Ovarian function stimulation may be considered to promote cancer development, and ovulation suppressants such as pregnancy and contraceptives reduce this risk. (Barber HRK). The above epidemiological data should increase the vigilance of physicians and patients themselves directed to the early diagnosis of ovarian cancer. This is especially true for women who have high-risk factors.


The requirement of oncological alertness should arouse the so-called early signs of ovarian cancer

If present, they are very tricky and often manifest themselves with complaints from the digestive tract or the entire abdominal area. They include:
- bloating,
- indigestion,
- constipation,
- burping,
- hiccups,
- feeling of fullness in the abdomen, occurring even after light meals
- slow loss of appetite


Early symptoms do not necessarily have to be considered as specific symptoms of the cancer process,

However, I know from many years of experience that they occur long before the onset of symptoms of advanced ovarian cancer. This results from the demand for close cooperation between gynecologists and gastroenterologists. Therefore, the internist may and should show a high sensitivity to the oncological anxiety of his patients associated with nonspecific symptoms of cancer and play a significant role in the early diagnosis of ovarian cancer.


 

It is now assumed that routine gynecological examination manages to detect 1 "asymptomatic" cancer, i.e. in the first stage, for 10,000 of the examined women.

Gynecological examination, despite such low detection, remains the most viable and widely available method of early detection of ovarian cancer. The condition, however, is to take into account the above-mentioned epidemiological data and to closely observe women with an increased risk of disease.

Doctors have a special oncological alertness

In particular, a gynecologist to whom a woman should regularly go for an examination must show a high oncological alertness when determining the following conditions in the genital organ:

1. Enlarged ovary;
2. Low mobility of the tumor, or immobile tumor;
3. Hard bumps! - in Douglas Bay;
4. Low pain or insensitivity of the tumor to the examination;
5. Tumor growth in the short observation time;
6. Bilateral tumors (70% in cases of cancer, 5% in benign lesions)
7. A tumor above 5 cm in postmenopausal women and above 8-10 cm in women of childbearing age.

Beware of lymph nodes

In a clinical trial, the status of peripheral lymph nodes should be strictly evaluated
especially on clavicular and inguinal (metastatic cancer). The statement of the above states, or only some states, is the basis for refining the diagnosis by implementing additional tests.

Recommended tests in case of suspected ovarian cancer:

- Ultrasonography - transvaginal and transabdominal,
- Computed tomography,
- Doppler studies,
- Nuclear magnetic resonance,
- Study of tumor markers, especially CA 125 and OC 125 monoclonal antibodies.
It should be remembered that these are complementary clinical trials
not generally used in the so-called screening tests, on large populations (because they involve huge costs). However, they play a big role in monitoring patients after oncological treatment. As can be seen from the above, the diagnosis of ovarian cancer at its early stage may be more accidental now than to be a successful standard diagnosis.

The ultimate diagnosis of ovarian cancer

is a tumor microscopic examination

Therefore, laparoscopy is indicated in the following cases:

1 / the tumor was found after menopause,
2 / the tumor grows rapidly - over 5 cm,
3 / the tumor has a size of 10 cm and more,
4 / the tumor found in the pelvis can not be accurately differentiated, whether it is a fibroma or an ovarian tumor, or maybe a tumor of the surrounding tissues.

Attention, the necessary gynecological examination before surgery in the abdominal cavity

Some authors believe, and the author fully shares this view, that every patient who is to be performed by a surgeon in the abdominal surgery should be examined gynecologically. Such behavior increases the level of medical care.

Removing the ovaries in women over 40-45 years old
 
one should remember about the possibility of using hormone replacement therapy, which protects against adverse consequences of gonadal removal. And this is one of the methods of prevention that significantly inhibits the development of ovarian cancer. Surgical treatment of ovarian tumors is aimed at the final diagnosis and determination of the stage of cancer. It should be remembered that a fully binding diagnosis of cancer is based on a microscopic examination of collected specimens or the whole tumor.
 
Finally, the general conclusion:

one should strive to change the opinion of the widespread, especially among doctors, that ovarian cancer at its early stage of development is unrecognizable. I have reasons to argue that in many cases ovarian cancer patients reported their symptoms "airy", which the doctors were underestimated, which was why they were later referred with a high degree of clinical cancer for treatment at the Clinic, which I managed for many years. Ovarian tumors are an interdisciplinary unit in the diagnostic and therapeutic sense, so I think that constant oncological vigilance and sensitivity to patient anxiety and close cooperation in this respect between a family doctor, internist, gynecologist, surgeon and urologist, and especially a gastroenterologist, can in a substantial way contribute to the diagnosis of ovarian cancer at its early stage, such a perception of the problem can contribute in a significant way to improving the results of treatment.

Professor Dr. med. Jan Zielinski
President of the Polish Society of Gynecology-Oncology