Ovarian cancer: what it is and how many women it affects in Italy

“Silent” is one of the adjectives that occurs most often when it comes to ovarian cancer. Because it is a sneaky neoplasm, which initially shows no signs of itself. And the symptoms, when they appear, are so generic that they are often confused with gastrointestinal disorders or something else. In fact, in most cases, ovarian cancer is discovered by chance during routine gynecological checkups. Unfortunately, to date there are no effective tools for screening or early diagnosis, and this explains the late diagnoses and high mortality.

The numbers of ovarian cancer

In Italy, more than 5,000 cases of ovarian cancer are recorded every year, and 75-80% of these are discovered in an advanced stage: that is, the disease is already locally advanced (stage III, present in one or both ovaries, in the abdominal peritoneum and/or nearby lymph nodes) or metastatic (stage IV, in which it has spread to distant organs such as the lung and liver). Only one in 10 cases is detected when the cancer is still confined to the ovaries (stage I) or the pelvis (stage II).

Currently, about 50,000 women live in our country who have been diagnosed with ovarian cancer in their lifetime. Survival varies greatly according to the stage in which the disease is discovered and to some characteristics of the neoplasm, including genetic and molecular ones, but on average it is 43% 5 years after diagnosis. For 2021, 3,200 deaths from this cancer have been estimated.

Ovarian health, dialogue on new treatments and prevention: the Health initiative

04 May 2023

The different types of ovarian cancer

It is vital to remember that not all ovarian cancers are created equal. First of all, tumors that develop from an ovary, from the fallopian tubes (which connect the ovaries to the uterus) and from the peritoneum (the tissue that covers the abdominal organs) are grouped under this name. Depending on the cells from which they originate, they are classified into three categories: epithelial tumors, which represent about 60% of ovarian tumors and affect women both in reproductive age and in menopause; germinal ones (derive from the cells that give rise to ovules), which represent 15-20% of cases, but only 5% is malignant and more typical of very young women (40-60% of the time it is found under 20 years of age ); the stromal ones (from the support structures of the ovary), more rare.

Within each group there are other classifications. Among epithelial tumours, for example, the most frequent (70%) are those of “high-grade serous”. Recognizing these differences is important because the choice of treatment and prognosis depend on them. Half of the patients with this type of tumor, in fact, have genetic deficits that alter the repair mechanisms of DNA damage: this implies that it can be treated with targeted drugs and that the disease is more sensitive to some chemotherapy.

Symptoms

As already mentioned, this neoplasm does not give specific symptoms. The most frequent are abdominal swelling and pain, lack of appetite, early satiety or even without eating, the need to urinate frequently, vaginal bleeding, frequent constipation or diarrhea. In these cases it is important to carry out a gynecological examination which includes transvaginal ultrasound.

The risk and protective factors

One of the main risk factors is genetic, linked to the presence of some hereditary mutations – including those of the BRCA 1 and BRCA2 genes – responsible for the alteration of the DNA repair mechanisms. Regardless of this, family history is also very important: in fact, the risk increases for women who have history of tumors among first-degree relatives (in particular, but not only, ovarian, endometrial and breast cancer). Among the factors that increase the likelihood of getting sick there are some conditions that affect the hormonal balance, in particular nulliparity, infertility or a first pregnancy over the age of 35 linked to ovarian stimulation, an early menarche or a late menopause. A strongly protective factor, on the other hand, is the intake of the contraceptive pill for at least 4 years.

How to cure

In patients with early stage cancer, surgery is curative in 70% of cases. In the others, however, it gives relapses and for this reason a chemotherapy treatment is always proposed. Even in the advanced stage (stages III and IV), surgery, when radical, is the treatment of choice, always followed by medical therapy. However, despite the best surgical treatment and chemotherapy, currently about 70% of patients with advanced ovarian cancer recur within the first two years. For those with BRCA mutations and other mutations that cause deficits in homologous recombination of DNA, a big change has taken place with the arrival of new drugs with a molecular target called Parp-inhibitors.