Ovarian cancer: early diagnosis is difficult

Ovarian cancer evolves for a long time without causing many signs. Buried deep in the small pelvis, the ovaries are difficult to examine for the doctors which complicates the early diagnosis. Treatment has evolved surgically and treatment can be adapted to genetic abnormalities.

What is ovarian cancer?

The woman’s reproductive system consists of three types of organs: the vagina, the uterus and the ovaries. The ovaries are located symmetrically on both sides of the uterus, to which they are connected by the fallopian tubes.
In the shape of an almond, the ovaries measure about 1.2 to 1.6 in.
They have a dual function: the manufacture of eggs and the production of female sex hormones, estrogen and progesterone. Each ovulation period, an egg is expelled to a tube and the uterus to allow, if it is fertilized by a sperm, the formation of an embryo. Hormones, on the other hand, are used to prepare the uterus for nesting and to express female sexual characteristics at the time of puberty and regulate menstrual cycles.
Three types of cells make up the structure of the ovary. The peripheral layer is composed of epithelial cells that have a role of protecting the ovary. It is lined with a thin and resistant wall called “the capsule”. The germ cells or ovarian follicles, located inside the ovary, constitute the egg reserves that will be released every month. Finally the stromal cells, which constitute the egg support tissue and guarantee the integrity of the ovary.
Ovarian cells sometimes undergo changes that make them abnormal and increase their multiplication. The rapid proliferation of these cancer cells will form a mass that is called the cancerous tumor. More than 90% of ovarian cancers develop at the expense of epithelial cells, so-called “epithelial carcinoma”. Other types of cancer are much rarer and may involve stromal cells or ovarian follicles.
When the cancer evolves without treatment, it can spread to neighboring organs and ganglia: it is called “locoregional dissemination”. If the cancer cells come off and go elsewhere in the body, they can develop so-called “secondary” cancers that we call “metastases”. Ovarian cancer metastasizes preferentially in the liver and lungs.

What are the causes of ovarian cancer?

There is no formally identified cause responsible for the occurrence of ovarian cancer.
However, the presence of risk factors can favor its development. It is important to bear in mind that the presence of one or more risk factors does not systematically result in cancer. Similarly, the absence of a recognized risk factor does not prevent its occurrence. The risk factors demonstrated include age, personal and family history of cancer, genetic mutations, hormone therapy, smoking and exposure to asbestos.
• The average age of onset of ovarian cancer is around 65 years old and is infrequent before age 50.
• Regarding personal history, women who have had breast cancer are at higher risk of developing ovarian cancer. For family history, the risk is not insignificant when a first-degree relative (mother, sister, daughter) or second-degree relative (aunt, grandmother, niece) was diagnosed with cancer. ovary. In addition, the presence of other types of cancer in the family such as colorectal, breast, uterine, or pancreatic cancer is associated with higher risk.
• The presence of genetic mutations in the BRCA1 and BRCA2 genes is responsible for an increased likelihood of ovarian cancer, in the same way as for breast cancer.
• The estrogen-based hormone replacement therapy prescribed during menopause to prevent minor discomforts such as hot flashes, if prolonged over time, may increase the risk of ovarian cancer.
• Fertility abnormalities, more than fertility treatments, are associated with increased risk
• Smoking increases the risk of a rare type of cancer of the ovary: the “mucinous” epithelial tumor.
• Finally, in addition to causing cancer of the pleura, exposure to asbestos can cause ovarian cancer, especially in women exposed in their work. It appears that asbestos fibers accumulate in the ovaries.

What are the signs of ovarian cancer?

Because of the deep localization of the ovaries, when the cancer develops, the clinical signs are very discreet or nonexistent. Therefore, the diagnosis of cancer is usually made very late, at the advanced stage of the disease.
In addition, the signs that appear are not specific to ovarian cancer. A feeling of heaviness in the belly or lower abdomen that may be accompanied by stomachaches and constipation. Sometimes gynecological signs are present with bleeding externalized by the vagina outside the rules “metrorrhagia”, or pain during sexual intercourse.
When the tumor grows and compresses nearby organs or nerves, there are signs of repercussion on the bladder with frequent urination (“pollakiuria”) and urge urges (“urgencies”), but also pain in the back or legs.
Later, there will be an alteration of the general condition with loss of appetite, weight loss and a feeling of persistent fatigue.
If the cancer progresses to advanced stages of metastasis, other signs may appear as an accumulation of fluid in the abdomen “ascites”, an accumulation of fluid around the lungs, “a pleural effusion”, or a swelling of the legs “lymphoedema”.


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