To name cancer, oncologists have always opted for a simple and pragmatic mentality. Thus, ovarian cancer arises and develops in the ovary. Although in a display of cruel originality, it usually begins in nearby communicating structures with the ovary such as the fallopian tubes.
The ovary is an organ that combines different tissues and functions, so many different tumors are grouped within this cancer, divided into three types: epithelial carcinoma, germ cell tumors, and stromal cell tumors.
However, these three types do not believe in equal opportunities: 90/95% of all cases are epithelial ovarian carcinoma. It occurs in the cells that cover the outside of the ovary.
Like most cancers, its frequency increases in developed countries. In women, it is the sixth most common cancer, after breast, colon, lung, uterus, and lymphomas. Interestingly, despite being less common than uterine cancer, it has a higher mortality rate.
There has been an 84.2% increase in the incidence of ovarian cancer from 1990 to 2017. Its incidence has almost doubled in less than 30 years.
It is the fourth leading cause of cancer death in women in the United States and the first for gynecological cancer in the Western world. It is estimated that one in 78 women worldwide will develop ovarian cancer at some point in their lives.
In 2015, there were 1.2 million women affected by this disease globally, causing 161,100 deaths that same year.
This is because it is difficult to diagnose, which means that when it is discovered, it is often already in an advanced state. Its lethality is also correlated with the age of the patient, being more serious the older the affected person is. The median age of onset is between 50-59 years. However, most diagnoses occur after age 60.
Most ovarian cancers occur after menopause.
The quiet guy is the dangerous one
In addition to this, we have to add that early prognosis for this disease has hardly advanced in recent years. It is a disease with few symptoms, which allows it to reach an advanced stage without the woman realizing it. Only 30% of cases are discovered in the early stages.
The first symptom that is usually noticed is a mild discomfort in the lower abdomen, which can be either ovarian cancer or gas. If over time the pain increases and weight loss and anemia occur, we can rule out gas. These symptoms can last for months before the correct diagnosis is made.
The most severe physical symptoms that help distinguish ovarian cancer from other diseases occur when there is metastasis or when it has grown to a size that causes pain by pressing on other organs in the abdominal and pelvic region.
Because the ovary secretes female hormones, in some cases, hormonal production increases, which can aid in a faster and more effective diagnosis.
Unfortunately, there is no reliable test that guarantees the detection of the disease. Similar to endometriosis (see our blog), laparoscopies are commonly used to confirm and determine the status of the pathology.
When laparoscopies or surgeries are performed, biopsies of the tumor tissue are taken advantage of.
To check for the presence of cancer, different tumor markers are also measured, such as CA 125, a glycoprotein produced in various epithelia. Although it is not a good marker for cancer, once the disease has been confirmed in the patient, it is useful for monitoring response to treatment and as a prognostic factor.
In the case of adnexal masses (masses of tissue near the uterus, which may or may not be malignant tumors), transvaginal ultrasounds are used to identify them.
Once the cancer has been confirmed, the treatment varies depending on the size and position of the tumor, whether it has spread to other tissues or not, and the patient’s physical condition.
The most common treatments are surgery, chemotherapy, and biological therapy.
When it spreads to other regions of the body, it usually invades the abdominal area, lymph nodes, lungs (for some reason, cancers love to metastasize to the lungs), and liver.
The most characteristic risk factor for this cancer is the amount of time a woman spends ovulating. Therefore, any factor that increases the number of ovulatory cycles a person experiences automatically increases the risk of developing the disease.
Similarly, anything that suppresses ovulation is considered a protective factor.
This would include having children (which does a lot for their mother) or using oral contraceptives. During pregnancy, women do not ovulate, so the number of ovulatory cycles they go through compared to a woman who has not had children is lower. In this case, having children beats having cats.
One example of a risk factor would be the use of ovulation stimulation treatments for infertility. Their use for one year or more increases the incidence of ovarian cancer. The ovarian cells end up OVER stimulated. We would also have on this list early menarche or late menopause.
The presence of cysts or endometriosis, as well as close relatives who have suffered from the disease, are also considered other risk factors.
Genetics as a risk factor
When ovarian cancer is due to a hereditary genetic factor, it is called familial or hereditary ovarian cancer, and it is estimated that 5-10% of ovarian cancers belong to this group. Some authors recommend the use of oral contraceptives as chemoprevention in women who have a high hereditary risk.
These individuals not only have a higher probability of developing the cancer, but also on average they develop it 15 years earlier than individuals without a genetic predisposition.
When there are mutations in the BRCA1 and BRCA2 genes, two genes well-known for their link to breast cancer, the chances increase. It is considered one of the greatest risk factors for this cancer, with mutations in the BRCA1 gene being more dangerous than in its companion number 2. Women with an altered BRCA1 gene have a 39% – 44% risk of ovarian cancer.
Other genes linked to ovarian cancer include NF1, CDK12, CHEK2, RAD51, BRIP1, and PALB2. The TP53 gene is also commonly involved, and its loss indicates an aggressive cancer. Most of these genes are tumor suppressor genes or involved in DNA repair.
The Erβ gene (estrogen receptor beta), although belonging to the family of estrogen receptors, has tumor suppressor functions and has been found mutated in ovarian cancer. Alterations in this gene have also been reported in breast cancer (see our blog) and prostate cancer (see our blog).
Some familial cancer syndromes, such as Lynch syndrome (hereditary non-polyposis colon cancer) and Peutz-Jeghers syndrome, are also associated with a higher risk of ovarian cancer.
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