Ovarian cancer constitutes a group of diseases with different prognosis and even different symptoms. However, over 95% of ovarian tumours are epithelial carcinomas. Epithelial cancer is the second gynaecological neoplasia in frequency, after endometrial cancer, and it is the main cause of death from gynaecological cancer. It represents 3% of tumours in women and is the fourth cause of death due to cancer in women after lung, breast and colon cancer.

 

The 5-year survival rate for women in advanced stages of ovarian cancer is 15%-20%, while in initial phases it is close to 90%. The high mortality is explained by two reasons: the absence of specific symptoms, which means, in most cases, that it is diagnosed in late phases (70-80%), and the absence of effective early diagnosis methods. Although it may occur at any age, it is more frequent after 50 years of age. Every year there are approximately 205,000 new cases worldwide. In Spain, around 3,300 cases are diagnosed annually.

The exact causes of ovarian cancer are unknown. It is produced by an accumulation of genetic alterations which cause an uncontrolled growth and proliferation of the epithelial cells. However, some factors may increase the probability of developing this disease.

 

Family history: first degree relatives (mother, daughter, sister) of a woman who have had ovarian cancer have a greater risk, and this is especially high if two or more first degree relatives have had the disease. Around 10% of the cases of ovarian cancer are the result of a hereditary tendency.

 

Age is also important, since risk increases as a woman gets older. Most cancers occur in women over the age of 50, and the risk is greater in women over 60. Furthermore, women who have never had children are more likely to develop ovarian cancer than women who have been mothers. However, the risk decreases in those who have taken oral contraceptives.

Until now, what is known about the risk factors has not been translated into practical forms of prevention. This means that over 50% of women with ovarian cancer are diagnosed in advanced stages. There are no effective detection tests; none of the available techniques -clinical examination, pelvic ultrasound scan or tumour markers-, have been effective. Genetic consultancy is advised for the genes BRCA1, BRCA2 and HER-2/neu, and, if there are mutations in said genes, surgery to remove the ovaries in women who are no longer of childbearing age. Experts also recommend frequent pelvic examinations.

The initial stages of ovarian cancer are asymptomatic or with very slight symptoms which go unnoticed and are confused with benign processes. The symptoms are late and non-specific: general abdominal pain (gas indigestion, swelling, inflammation, etc.; nausea, diarrhoea, constipation; loss of appetite; weight gain or loss; repeated and persistent feeling of being full after eating, and abnormal bleeding from the vagina. Ovarian cancer is therefore difficult to diagnose early and this is the main cause of its high mortality rate.

If there is a suspicion of ovarian cancer, it is first necessary to perform a clinical assessment. Radiological examinations, such as gynaecological ultrasound scan, computerised axial tomography of abdomen and pelvis, and nuclear magnetic resonance (NMR) should also be performed. The quantification of the tumour marker CA 125 should also be performed, although there are patients who do not have a high level of said marker and, furthermore, it may also be high in benign diseases whose symptoms are ascites or inflammation of the peritoneal cavity.

 

The definitive test for carrying out a clinical diagnosis is exploratory laparotomy to perform a biopsy. It serves to perform the definitive diagnosis and the staging of the disease simultaneously.

 

There are different treatments and therapeutic combinations. The choice depends on a woman's age and her general clinical condition, and the type and extension of the tumour. Surgery is the treatment for most cases. Depending on the extension of the tumour and whether adjacent organs are affected, it is advised to remove the ovaries, the fallopian tubes, the uterus, the lymphatic glands or other abdominal tissue.

 

Surgery is one of the main pillars and it is associated with external or internal chemotherapy and/or radiotherapy (less used). In most cases, standard chemotherapy is used as postsurgical treatment for ovarian cancer in advanced stages.