Ovarian cancer

Ovarian cancer is a rare form of cancer that mainly affects women who have been through menopause. The risk factors associated with ovarian cancer are still poorly understood, but endometriosis, absence of pregnancy and ethnic origin may all play a role. Approximately 10% of ovarian cancers are hereditary and linked to a mutation (anomaly) in the BRCA genes. This is why most patients are offered a consultation with a genetic counselor at the beginning of their treatment.

Diagnosis

Because early-stage ovarian cancer rarely causes any symptoms, it is usually diagnosed quite late, often when the cancer has spread to other parts of the abdominal cavity. Symptoms that may appear at this time include abdominal pain or swelling, constipation, difficulties in eating, weight loss and fatigue.

If ovarian cancer appears likely, you will be given a clinical examination, a blood test and a chest and abdomen scan in order to assess the extent of the disease. The scan will detect any anomalies within the abdominal cavity and show how far the cancer has spread.

 

Treatment

Once the diagnosis has been made, each case is discussed at a multidisciplinary team (MDT) meeting, during which the specialists involved in treating ovarian cancer decide on the most appropriate treatment option for each patient. Treatment usually involves surgery combined with chemotherapy.

The medical team may ask if you would be prepared to take part in a clinical trial. As well as giving patients the opportunity to benefit from a new form of treatment, clinical trials may be used to improve understanding of how cancer arises and develops, or to evaluate patients’ quality of life and see how it can be improved.

 

Surgery

Surgery involves removing the ovaries, uterus (hysterectomy), pelvic and lumbar-aortic lymph nodes, and omentum (a fatty structure that drapes over the intestines). These organs are then analyzed in order to determine how far the disease has spread and thereby decide which additional treatments are needed. If the disease has spread to other organs, it may be necessary to carry out a visceral resection to remove the affected organs (e.g., the intestine or the spleen) or a peritonectomy to remove the cancerous part of the peritoneum (the tissue that lines the abdominal cavity). Before performing this surgery, an endoscope may be used to visually examine the abdominal cavity (coelioscopy) in order to determine exactly how far the disease has spread and adapt the sequence of treatment accordingly.

Under national and international guidelines, this surgery should be carried out only by gynecological oncologists who specialize in ovarian cancers. The prognosis (probable outcome of  the treatment and survival rate) depends on the quality of the surgery.   

If the disease has spread widely through the abdomen or if the patient is very weak, surgery may be preceded by chemotherapy. This is called preoperative chemotherapy.

 

Chemotherapy

Chemotherapy generally involves two drugs administered intravenously, sometimes in association with an anti-angiogenic antibody. Treatments are usually administered every three weeks. Side effects mostly impact the digestive system and blood. Although these side effects are generally moderate, medication to control them is systematically included in the treatment.

At the IUCT-Oncopole, you will be cared for by a team of professionals who can treat and, in some cases, prevent side effects and the physical/psychological distress caused by the disease and the treatment. They can also address any hormonal problems arising from the disease/treatment, especially for young women.