Ovarian cancer

Ovarian cancer

Ovarian cancer is a malignant disease of the ovaries and can develop within just a few months. The main functions of the ovaries include the production of ova that are capable of being fertilised – follicle maturation, ovulation and formation of the corpus luteum. It also produces the hormones estrogen and gestagen. Each year, about 225,000 women worldwide are diagnosed with ovarian cancer, which occurs most frequently between the ages of 50 and 70 years. The susceptibility to ovarian cancer is hereditary.

In certain genetic combinations the likelihood of contracting ovarian cancer is about 60 percent. As with breast cancer, the two genes BRCA1 and BRCA2 play an important role here. But the genetic aspect should not be overemphasized: only about ten percent of all ovarian cancers are genetic. The likelihood of ovarian cancer is linked to the number of ovulations a woman undergoes. Oral contraceptives, such as the pill, as well as frequent pregnancies therefore offer a certain protection, as they reduce the activity of the ovaries.

Prevention and early detection

The earlier ovarian cancer is detected, the greater are the chances of recovery. Modern science does not offer any special medical check-up for an early detection of ovarian cancer. Through palpation, any physical changes in the ovaries can be felt, but early stages of ovarian carcinomas rarely produce palpable tumours. Especially women with related complaints or with a family history of abdominal tumours should have their ovaries ultrasound scanned, ideally on a regular basis.

The use of hormonal contraceptives can offer some protection against ovarian cancer. Their benefits and drawbacks must, however, always be individually clarified with the gynaecologist.

Diagnosis

Because it does not show any early symptoms, ovarian cancer is usually identified only at a later stage. There is no special screening available for its early detection. The first indication is often found through palpation during a regular check-up at the gynaecologist. In addition, ultrasound screening through the vagina is used to check for ovarian tumours. But even this method cannot guarantee that malignant tumours are found.
If an ovarian cancer is considered likely, screening by computer tomography (CT) or magnetic resonance imaging (MRI) are usually performed to gain more information about its location and spread.

A blood analysis can reveal the presence of any “tumour markers” – constituents that indicate the possibility of a tumour – in the blood. In ovarian cancer, the protein CA 125 plays an important role. In people with ovarian cancer the concentration of this protein in the blood often increases significantly, but this can also happen with other illnesses, such as pelvic inflammation.

Tumour markers alone are not, therefore, sufficient to reliably diagnose ovarian cancer but rather serve as an indicator during treatment.

To clearly diagnose ovarian cancer, an operation is necessary to remove some of the tumour tissue, which is then examined histologically to determine whether it is malignant. During this operation, the whole abdomen and the individual organs are thoroughly examined. Usually the surgeon removes the entire tumour as far as possible and all of its metastases as well as both ovaries, the uterus and any affected lymph nodes from the pelvic and abdominal cavity.
As more than ten percent of all ovarian cancers have a genetic cause, you should always tell your doctor if there is a history of tumours in your family. Patients are considered to have a family predisposition if a first-degree relative has contracted ovarian or breast cancer. Recently developed investigations of specific genes (BRCA1, BRCA2 and HNPCC) allow high-risk ovarian cancer patients to be identified. These methods allow patients and their relatives to be medically examined early on, thereby significantly increasing the chances of diagnosing ovarian cancer on time.

Treatment

The treatment depends on how far the ovarian cancer has progressed, whether it has spread to the abdominal cavity and whether other organs are affected.
For uncomplicated ovarian cysts, drug therapy has no benefits and is therefore not indicated.

For complicated ovarian cysts and solid ovarian tumours, a surgical diagnosis and treatment are always necessary, even before the menopause. After the menopause, an operation is definitely recommended in the case of permanent or complicated cysts, solid ovarian tumours or elevated CA 125 values.

The treatment of ovarian cancer usually consists of a complex, lengthy operation that requires great surgical expertise and interdisciplinary cooperation, especially between surgeons and urologists. The surgeon must remove the tumour and its metastases completely as possible. Depending on the stage the tumour has reached, both ovaries, the fallopian tubes, the uterus, the greater omentum and possibly also the lymph nodes in the pelvis and along the large abdominal vessels must be removed. If the cancer has spread to the intestine, parts of the intestine are also removed, since the further diagnosis will also depend on whether all visible cancer cells that have spread in the abdominal cavity are caught and removed.

If surgical treatment is considered too risky for the patient due to her general condition or because the cancer is too advanced, the tumour’s size can be reduced with debulking (chemotherapy before primary surgery) to allow an operation at a later date.
Often, the operation must be followed by chemotherapy to eliminate any remaining cancer cells. This acts on the whole body, also reaching tumour cells that may have formed further away from the original tumour.

For patients with advanced cancer, an antibody therapy has been available since December 2011. The active ingredient used (a so-called angiogenesis inhibitor) binds itself to growth factors of the tumour, thereby preventing the formation of blood vessels that are responsible for supplying the tumour with oxygen and nutrients.

 

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