Ovarian Cancer

Ovarian cancer can develop from the ovary, but also from the fallopian tube. Due to the anatomical location of the ovary, cancer cells can quickly spread within the abdominal cavity and lead to peritoneal carcinomatosis. The cancer is most often detected at this stage, as the disease produces few symptoms in its early stages (when it is confined to the ovary).

There are several subtypes of ovarian cancer, depending, among other factors, on the type of cells from which it originates. The prognosis and the treatments offered vary from one subtype to another. High-grade serous adenocarcinoma is the most common (90% of cases) and develops from the outer surface (epithelium) of the ovary.

The incidence of ovarian cancer increases with age, with the average age at diagnosis being around 65 years.

Understanding Ovarian Cancer

About 15–20% of the most common ovarian cancers (high-grade serous) are linked to a hereditary genetic mutation. The most frequent abnormalities are mutations in the BRCA1 and BRCA2 genes, which also predispose to other types of cancer, particularly breast cancer.

Depending on the type of cancer and the patient’s personal and family history, a genetic test may be offered to detect such abnormalities.

The presence of genetic abnormalities can influence not only the proposed treatment but also prevention and screening for family members.

Ovarian cancer often remains minimally symptomatic for a long time, which is why the disease is unfortunately frequently diagnosed at an advanced stage.

The symptoms are non-specific and may include bloating, abdominal swelling, pain, and digestive disturbances.

There is no specific screening method for ovarian cancer. Ultrasound and tumor marker testing are not sensitive enough to be recommended as screening tools.

For the specific case of patients carrying a genetic mutation that increases the risk of ovarian cancer, a prophylactic bilateral salpingo-oophorectomy may be offered after the age of 40–45, depending on the type of mutation detected.

In addition to a clinical examination and a complete blood test including tumor markers, other tests are required, such as a gynecological ultrasound, an abdomino-pelvic MRI, and a PET scan.

Biopsies are necessary to confirm the diagnosis, determine the type of ovarian cancer, and identify certain molecular abnormalities that may influence treatment.

If surgical removal is planned, a diagnostic laparoscopy or coelioscopy is performed to assess the extent of the disease. This is a minimally invasive surgical technique that allows visualization of the inside of the abdomen using small cameras inserted through tiny incisions in the abdominal wall.

Surgery plays a central role in the management of ovarian cancer. Its goal is to remove all tumor lesions. Depending on the extent of the disease, the surgeon may need to remove other organs, such as the other ovary, the uterus, the fallopian tubes, peritoneal folds, lymph nodes, and sometimes the spleen, a portion of the liver, or part of the intestine. This type of surgery requires the expertise of specialized surgeons and is performed at the Delta site.

Chemotherapy is usually indicated for ovarian cancers. It may be given after surgery (adjuvant chemotherapy) to eliminate remaining cancer cells and reduce the risk of recurrence, or before surgery (neoadjuvant chemotherapy) to shrink the tumor if it does not appear immediately resectable.

For epithelial ovarian cancers, maintenance treatment with targeted therapies may be initiated after chemotherapy. The choice of drug will depend on the stage of the disease and the genetic and molecular abnormalities of the tumor.