Epithelial ovarian tumors
Which are the symptoms?
To date, there is no screening for early detection of ovarian cancer. For this reason, in the majority of cases (60-70%) it is diagnosed in an advanced phase. In the early stages, there are no specific symptoms except for the presence of a mono- and/or bilateral pelvic adnexal mass usually found during a routine gynecologic and/or abdominal checkup. In advanced stages, the most frequent symptom is the presence of ascites (accumulation of fluid in the peritoneal cavity). The spread of ovarian carcinoma is essentially intra-abdominal with involvement of the peritoneum, omentum and sometimes the intestine.
- pelvic mass
- increased abdominal circumference
- abdominal pain
- bowel obstruction
- breathing difficulty
How is it diagnosed?
Diagnosis is made by gynecologic examination and transvaginal or transabdominal ultrasonography. Hematochemical tests useful in the diagnosis of epithelial ovarian cancer include tumor markers (CA125, HE4, CA19-9, CEA). If there is a suspicion of ovarian cancer, a CT scan of the chest and abdomen is also requested and, in the presence of ascites or pleural effusion, a cytological examination of the drained fluid may be performed. Diagnosis must be confirmed by diagnostic laparoscopy and definitive histologic examination, which allow for adequate surgical staging. The stage of disease at the time of diagnosis making is the major prognostic factor in ovarian cancer and is what directs the appropriate treatment.
To date, ovarian cancer is classified according to the FIGO classification into 4 different stages:
- Stage I: Tumor limited to ovaries.
- Stage II: Tumor involving one or both ovaries and/or tubes with pelvic extension.
- Stage III: Tumor involving peritoneum outside the pelvis and/or metastasis to retroperitoneal lymph nodes.
- Stage IV: Distant metastasis.
How is it treated?
It is essential that the treatment of ovarian cancer is performed in centers of reference for this pathology. Treatment of ovarian cancer is primarily surgical and chemotherapeutic. The goal of surgery is to remove all macroscopically visible disease to achieve optimal cytoreduction. In fact, it has been shown that one of the main prognostic factors is residual tumor after surgery performed at diagnosis: the prognosis is more favorable in patients who perform an optimal cytoreduction. If the distribution of disease or the patient's condition does not allow the removal of all localizations, it is possible to perform a chemotherapy treatment in the first instance (neoadjuvant chemotherapy) and proceed to surgery after at least 3 cycles of chemotherapy. Typically, surgery involves removal of the genital tract, omentum, and all peritoneal and lymph node metastases. In order to achieve optimal cytoreduction, more or less extensive bowel resections, splenectomy and peritonectomies may be indispensable. Surgical treatment, however adequate, always requires completion with chemotherapyThe only exception is correctly determined stage I A G1-G2 of ovarian tumors. Chemotherapy is indicated in selected cases based on stage, grading and tumor histotype. In the early stages, there is the possibility of conservative surgery in the case of fertility preservation in young women with possible radicalization after pregnancy. The chemotherapy drugs of choice in the treatment of ovarian cancer in the first instance are Taxol and Carboplatin. Peculiarity of ovarian carcinoma is the tendency to recur: the characteristics of recurrence allow evaluating a surgical or chemotherapeutic route. The chemosensitivity and the wide choice of chemotherapeutic drugs has made ovarian cancer a chronic disease that can live with the patient even for very long periods of time with a good quality of life. Research for this type of tumor is very active and this has led in recent years to the approval of new "smart" drugs, including bevacizumab and PARP inhibitors used in the treatment and as maintenance therapy allowing for improving the survival of patients even in advanced stages.