What is ovarian cancer
Ovarian cancer is the second most common gynecologic malignancy in women, second only to cervical cancer.
It is the seventh most common cancer in women worldwide, affecting more than 300,000 new patients per year.
According to data from the Ministry of Health for the year 2023 in Brazil, it ranks eighth among the most incident neoplasms in females (excluding non-melanoma skin tumors). According to the INCA (National Cancer Institute), for the triennium 2023 to 2025, the estimated number of new cases in the country is above 7,000 per year.
The vast majority of ovarian neoplasms—95%—are derived from epithelial cells, that is, those that line the ovary. The other 5% come from germ cells (those that form the eggs) and stromal cells (those that produce most of the female hormones).
Subtypes of ovarian cancer
There are several subtypes of ovarian cancer, classified based on the type of cells where they originate. This result can be confirmed through the biopsy report.
The three main groups are:
- Epithelial Ovarian Tumors – Begin on the outer surface of the ovary (the epithelium) and are the most common subtype. Fallopian tube cancer and primary peritoneal cancer are included in this group. This subtype is further divided into high-grade serous (90%), endometrioid (10%), clear cell, mucinous, and low-grade.
- Germ Cell Ovarian Tumors – Originate in the reproductive cells of the ovaries, i.e., those that give rise to the eggs;
- Stromal Cell Ovarian Tumors – Form in the cells of the connective tissue, which is the portion responsible for supporting and nourishing the organ;
Symptoms of ovarian cancer
Ovarian cancer is a silent disease, and in its early stages, it usually does not present specific symptoms. As the tumor grows, it can cause:
- Swelling in the abdomen;
- Abdominal pain;
- Pain in the pelvic region, back, or legs;
- Nausea;
- Indigestion;
- Gas;
- Abnormal bowel function (constipation or diarrhea);
- Constant fatigue;
- Loss of appetite and weight without apparent reason;
- Abnormal vaginal bleeding, especially after menopause;
- Increased frequency and/or urgency of urination.
Diagnosis of ovarian cancer
There is no specific screening test for ovarian cancer, such as the Pap smear for cervical cancer or mammography for breast cancer. Due to the lack of an effective screening test and the fact that ovarian cancer symptoms can be easily confused with other less serious health conditions, the diagnosis is often made in the advanced stages of the disease.
The main symptoms of ovarian cancer that alert specialists are abdominal swelling and pain, constant fatigue, and weight loss. In this scenario, a physical and gynecological examination, as well as laboratory and imaging tests, will be performed.
Abdominal imaging tests help identify the presence of nodules, cysts, or masses in the ovaries, as well as the presence of ascites (fluid accumulation in the abdomen). This is important for evaluating the existence and extent of the disease.
It is essential to note that most ovarian cysts are benign but should be investigated when they are larger than 10 cm. If ovarian cancer is suspected, a surgical evaluation with a specialized team is performed.
A chest imaging test, such as an X-ray or computed tomography, should also be performed to detect pleural effusion (fluid accumulation in the lungs) or the presence of lung metastases.
Treatment for ovarian cancer:
The treatment for ovarian cancer may include surgery and intravenous chemotherapy based on a drug called platinum.
The choice depends on the medical evaluation by the clinical oncologist, who considers the type of tumor, the staging (extent of the disease), whether it is an initial or recurrent tumor, as well as the age and clinical conditions of the patient.
For early stages, the approach is surgical combined or not with chemotherapy. Advanced stages can be treated with surgery followed by chemotherapy, chemotherapy followed by surgery, or exclusive chemotherapy.
Prevention of ovarian cancer:
To prevent or increase the chance of diagnosing ovarian cancer at an early stage, women should have regular check-ups with their gynecologist, be aware of symptoms (especially if several occur at the same time), and be mindful of risk factors, particularly from the age of 50 onwards.
Risk factors for ovarian cancer:
- Age – The older a woman is, the higher the incidence of epithelial ovarian carcinoma;
- Reproductive factors – Women who have never had children tend to have an increased risk of ovarian cancer. On the other hand, those who use oral contraceptives (birth control pills) tend to have a reduced risk;
- Hormonal factors – Early menarche (first menstruation before age 12) and late menopause (after age 52) may be associated with a higher risk of ovarian cancer;
- Family history – Presence of family members, especially first-degree relatives, with ovarian, colorectal, and breast cancers;
- Genetic factors – Presence of mutations in genes, mainly the BRCA1 and BRCA2 genes;
- Obesity.
