Dr Eric Ortiz
It is called ovarian epithelial cancer to the set of diseases formed by malignant cells in the tissue that covers the ovary or the lining of the fallopian tube or the peritoneum. This type of cancer occurs mainly in women between 50 and 65 years of age. There are other types of ovarian tumors that are less common and behave differently: ovarian germ cell tumors and ovarian low malignant potential tumors; Unlike epithelial tumors, they occur mainly in young women and their treatment differs from that of epithelial tumors. In this publication we will focus on epithelial tumors.
The ovaries are a pair of organs of the female reproductive system located in the pelvis, one on each side of the uterus (also called the womb), each ovary is about the size and shape of an almond and produces eggs necessary for the conception of a fetus and the production of hormones; The fallopian tubes are a pair of long, thin tubes located on each side of the uterus. ovules Produced in the ovaries; they travel through the fallopian tubes to the uterus. Cancer sometimes begins at the end of the fallopian tube near the ovary and spreads to the ovary, while the peritoneum is the tissue that lines the abdominal wall and covers the organs in the abdomen, sometimes cancer begins in the peritoneum and spreads to the ovary.
There are some characteristics that make women more likely to present the disease, they are called risk factors. The most important for ovarian cancer are: older age (over 60 years), endometriosis, postmenopausal hormone therapy, obesity; having a relative (mother, daughter or sister) with said diagnosis, knowing oneself with gene mutations BRCA1 or BCR2 or have Lynch syndrome. Currently, there is no method of preventing ovarian cancer, however, in patients with a family history, diagnostic strategies should be started early with the intention of identifying probable cases of cancer.
Many times this type of cancer does not cause symptoms, or they can be very non-specific, so its detection can be difficult and only be evident in advanced stages or in the case of metastasis. The most common signs and symptoms are:
- Increased volume or feeling of pressure in the abdomen.
- Lump in the pelvic area.
- Pain, which increases as the size of the abdomen increases.
- Heavy or irregular vaginal bleeding; in particular, after menopause.
- Light-colored, white, or blood-stained vaginal discharge.
- Gastrointestinal disturbances such as gas, bloating or constipation.
As part of the study of patients, the following tests and studies are applied:
- Personal history and physical exam: Interview of the patient to know probable risk factors, as well as complete physical examination, including pelvic examination.
- Lab tests: Blood studies such as blood cytometry, liver function tests, blood chemistry, and tumor marker CA-125(substance released by ovarian cells into the bloodstream).
- Imaging studies: They allow to visualize the integrity of pelvic structures. The most used are pelvic ultrasound, computed tomography or, if greater definition is required, magnetic resonance imaging.
It is necessary to obtain important information about the characteristics of the disease such as tumor size, location, affected structures. Based on the above, it is possible to classify the disease in stages. There are different treatments for patients with epithelial ovarian cancer, the type of treatment or the combination of these will depend on the type of tumor and the stage in which it has been detected. The approved treatment options for epithelial ovarian cancer are: surgery, the goal of which is to remove as much of the tumor as possible, chemotherapy, a treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from forming. its multiplication, targeted therapy or target therapy,
The main forms are:
- Monoclonal antibodies. A therapy that uses laboratory-made antibodies (defense proteins) that identify specific proteins on cancer cells or normal substances that help cancer cells grow. An example is the drug bevacizumab.
- Inhibitors of poly (ADP-ribose) polymerase (PARP). Medications that cause damage to the cancer cell by preventing the repair of damaged structures in the genetic material or DNA. Examples of these are Olaparib, rucaparib and niraparib.
Treatments are in development and are being tested in clinical trials. A clinical trial is a research study that aims to improve current treatments or obtain information about new treatments. When clinical trials show that a new treatment is better than the standard treatment (standard or approved treatment), the new treatment may become the standard treatment. Currently in our country, one of the sites where clinical trials are carried out is the National Cancer Institute through its Pharmacological Research Center (CIF). As part of these studies, patients can receive a new experimental treatment at no cost.
It is very important to highlight that this type of illness must be treated by a multidisciplinary team made up of both specialists in the treatment of tumors (gynecological oncologists, medical oncologists, surgical oncologists) and support specialties such as nutrition, psychology, among others. After treatment, patients should maintain consultations with tracing in order to rule out the return of the disease, and if so, treat it in a timely manner.
REFERENCES
- National Cancer Institute, (2020). Ovarian cancer. Types of Cancer, Taken from https://www.cancer.gov/espanol/tipos/ovario JAMA. (2011). 305(23):2484.
- Lacey JV, Sherman ME, (2009). Ovarian neoplasia, Robboy’s Pathology of the Female Reproductive Tract, in (Eds) Robboy SL, Mutter GL, Prat J, et al., p.601, Churchill Livingstone Elsevier, Oxford.
- BMJ. (2011). 344:d8009. Epub 2011 Jan 4.
