1) Epidemiology of ovarian cancers:
Who ?
One woman out of 70 will develop an ovarian cancer in her lifetime; if she has an hereditary genetic predisposition (5% of women) the statistics show 1 out of 2 women will be stricken.
Frequency ?
Ovarian cancer is the fourth most common female cancer. It is 6 times less common than breast cancer. It occurs with greater frequency among white women. Asian women have less ovarian cancers than their American counterparts, and their off-spring, born in the United States , keep this characteristic.
Age ?
The average onset age is 59; in women with the heriditary genetic predisposition it is 49. It can also be a cancer of younger women (20-30).
Risk factors ?
• Ovulation is a major risk: any ovulation build up is a risk factor:
- with increasing age;
- and ovulation facilitators for women who have had several pregnancies (multiparas).
• Nutrition: the association of fats and animal proteins, as well as excessive weight gain.
Protective factors ?
- Any situation which decreases ovulation (multiple childbirths, breast feeding, oral contraceptives).
- A vegetable-rich diet (especially beta-carotenes).
2) The diagnosis of ovarian cancers:
The ovary is a deep-seated organ, the cancer spread within the abdomen is often without symptoms; the result is often a late diagnosis and advanced disease : 75% of these cancers are diagnosed at an advanced stage and with a gloomy outlook; this is a formidable cancer. Thus, effective prevention measures must be taken early on in life, before any clinical signs have shown.
While the overall five-year relative survival rate is on the order of 30%, the survival rate for Stage III and IV disease combined is only 10%. In contrast, a survival rate of 90% may be achieved for patients with early stage disease confined to the ovary.
Symptoms: pelvic-abdominal pain, abdominal swelling, non-menstruation related bleeding (spottings, metrorrhagy). Ovarian cancer is very often associated with other cancers which must be screened and detected simultaneously: breast, colon, endometrium (womb lining), cervix.
3) Diagnostic methods:
1) ultrasound scan: pelvic ultrasound, and endovaginal; Doppler ultrasound scan.
2) MRI : its tissue sensitivity allows perfect anatomic delimitation of tumors and their location in relation to the
bladder and the rectum, and to the pelvic walls.
3) Tumor markers (blood test):
- CA125: the cut-off rate is 35 U/l; its level is NOT in proportion to tumor volume and to the advancement of the
illness, because the marker's secretion by the tumor is variable. Doubling of CA 125 levels in serum above
baseline at any interval should prompt physical examination, transvaginal sonography, CT scan.
- AFP and BHCG: useful in detecting germinal ovarian tumors.
- CA19-9 and CEA : applicable in mucinous tumors, when there is no CA125 reading.
4) Surgery: exploratory endoscopy, exploratory laparotomy.
4) Treatment of ovarian cancers:
1) Surgery: vital for the diagnosis (staging and evaluation of abdominal spread), and for optimum tumor removal.
2) Chemotherapy: initial chemotherapy is a polychemotherapy.
3) Radiotherapy: not utilised in this type of cancer. The combination of radio/chemotherapy is of no help in ovarian
cancers, although very useful in other types.
4) Surveillance and follow-up: the object is early detection of a possible recurrence of the cancer in women who
appear to be in total remission; and also the evaluation of the efficacy of the prescribed treatment being
followed. The CA125 level is extremely important; after the operation for the removal of an ovarian tumor, it is
imperative to measure the CA125 level as of the 5th day; this time-frame seems to correspond with the
marker's half-life. If the level has not returned to normal a residual tumor may be suspected; however, a normal
reading does not necessarily rule out the persistence of tumorous tissue; depending upon the medical center,
about 15% of patients have to be reoperated after incomplete initial surgery. The increase in the CA125
level at recurrence is signalled very early, several months before clinical diagnosis: recommendations are to test
CA125 levels every three months during the first year, afterwards every six months.
An increase in CA125 means obligatory further screening of the recurrence, by ultrasound scan and immunoscintigraphy.
IN PRACTICE, please note:
Ovarian cancer PREVENTION, ovarian cancer DETECTION are essential:
Early screening of these tumors increases patient survival. -all women (risk factor 1.4%) should have a gynaecological check-up once a year;
-in cases of hereditary ovarian cancer syndrome (risk factor 40%), you should perform: yearly clinical examinations, tumor marker tests, and pelvic ultrasound scans. An NIH consensus statement has recommended (2002 Laboratory Medicine Practice Guidelines) that these women undergo at least annual rectovaginal pelvic examination and transvaginal sonography, with measurement of CA 125.
And the use of tumor markers, an essential step forward for the detection of ovarian cancers and their recurrence: to screen and detect ovarian cancers, CA125 is a MUST, coupled with CEA , and even better, with CA19-9, AFP and BHCG.
In POSTMENOPAUSAL women, CA-125 is
useful in the differential diagnosis of benign and malignant pelvic
masses : significantly elevated values (>95 U/l) in a postmenopausal
woman with a pelvic mass should prompt referral to a surgeon
specializing in thorough abdominal exploration, node sampling,
omentectomy and cytoreductive operations.
CA125, CA19-9, AFP and BHCG are part of Biomarkers C12 test. Cancer can be detected : do it NOW.
