May 8th has been established as World Ovarian Cancer Day and is dedicated to public awareness and information. It is noted that ovarian cancer also affects the fallopian tubes and peritoneum.

“These organs are part of the internal genital organs of the woman and are located in the pelvis. Globally, it is recognized as the seventh most common form of cancer in women and one of the most aggressive cancers of the female reproductive systemas it is often diagnosed in advanced stages”, says Mr. Nikolaos Plevris, Obstetrician – Gynecologist, Doctor of the School of Medicine of the University of Athens, Director of the 1st Gynecological Clinic – Department of Robotic and Laparoscopic Surgery Metropolitan General.

Frequency

Ovarian cancer is estimated to affect approximately 300,000 women worldwide each year. In the US, it is the fifth leading cause of cancer death in women. The chances of its occurrence increase with age, especially after 50 years, although it can occur at any age. The probability of it occurring is greater in women with a family history of ovarian or breast cancer in first and second degree relatives.

Symptoms

Ovarian cancer often has no symptoms in the early stages, which makes early diagnosis difficult. When symptoms do occur, they are usually vague and non-specific, meaning they can be attributed to many other conditions.

The most common symptoms include pain in the pelvic or abdominal area, a feeling of fullness or heaviness in the abdomen, increased frequency of urination, changes in digestive function such as diarrhea or constipation, unexplained weight loss or fatigue.

Diagnosis

Ovarian cancer is often diagnosed through a series of tests. “The most common test is a pelvic ultrasound, which can show abnormalities in the ovaries. Other diagnostic techniques include computed tomography (CT), magnetic resonance imaging (MRI), and blood tests to detect CA-125, which may be elevated in women with ovarian cancer. Also, the final diagnosis results from a biopsy to definitively ascertain the presence of cancer, in which a tissue sample is taken from the ovaries for microscopic examination.

Early diagnosis is critical to the success of ovarian cancer treatment. Unfortunately, due to the lack of specific symptoms in the initial stages and the general vagueness of the symptoms that appear, many women are diagnosed in advanced stages of the disease.

For this reason, women are encouraged to closely monitor their health and discuss with their doctor any changes or unusual symptoms that appear, in order to facilitate an early diagnosis,” emphasizes the expert.

Lifetime risk of developing ovarian cancer for BRCA1 and BRCA2 mutation carriers

“In the case of mutations in the BRCA1 gene, the incidence of ovarian cancer by the age of 70 reaches about 45%, while corresponding mutations in the BRCA2 gene present a risk of 16.5% by the same age. Other genes associated with ovarian cancer have also been confirmed, while variants of unknown clinical significance (VUS) remain unclear.

It is estimated that approximately 13-15% of patients with ovarian cancer carry gene mutations in the BRCA1 and BRCA2 genes, so they have inherited the cause of this cancer from their parents. The percentage of hereditary ovarian cancer may be even higher since the number of its variants remain unknown.

Patients known to carry any of the above mutations (BRCA1 and BRCA2) or any other of the 43 genes associated with Hereditary Breast and Ovarian Cancer (HBOC) syndrome should be closely monitored. This also applies to patients who do not know their genetic status but have a strong family history of breast cancer at a young age or ovarian cancer at any age,” points out Mr. Pleuris.

Preventive interventions

Preventive procedures such as removing both fallopian tubes and ovaries could reduce the chance of ovarian cancer by up to 98%. This option should always be discussed with a gynecologist and clinical geneticist.

Robotic surgery and ovarian cancer

The surgical treatment of ovarian cancer in the vast majority of patients involves laparotomy, i.e. open surgery.

“If the best prevention of that particular cancer for you is removal, special care must be taken to remove the ovaries whole and intact. Multiple cases have been reported where debris remained, for various reasons, in the abdomen after both ovaries and fallopian tubes were removed.

Robotic surgery contributes to the successful completion of such surgeries by avoiding ovarian remnants due to increased adhesions or poor visibility of the surgical field,” concludes Mr. Pleuris.