70% of patients are diagnosed with advanced stage. Gynecological oncology experts remind that ovarian cancer is becoming younger and you should be cautious if you have these symptoms.

According to the latest cancer statistics in 2022, there are about 61,100 new cases of ovarian cancer in China each year. Although the incidence rate ranks third among gynecological malignancies, because the ovaries grow in the pelvic and abdominal cavity, there are no obvious symptoms in the early stage, and many patients are already in the late stage when they are discovered. Therefore, ovarian cancer is also called the "silent killer."

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"70% of patients are diagnosed in the late stage, 70% relapse within 3 years, and 70% have a survival rate of less than 5 years. Ovarian cancer has become one of the most common malignant tumors in women with the highest mortality rate." Zou Dongling, director of the Gynecological Oncology Center of the Affiliated Cancer Hospital of Chongqing University, introduced that although the survival rate of patients with advanced ovarian cancer is low, the five-year survival rate can be significantly improved to more than 60% through standardized diagnosis and treatment and long-term follow-up management. Therefore, standardized diagnosis and treatment throughout the process is very important.

Ovarian cancer is difficult to detect in its early stages

The trend of "younger" is obvious

The ovaries are important female reproductive organs, located deep in the pelvic cavity, existing in pairs, and have the function of regulating endocrine and helping fertility. Due to their hidden location and small size, if cancer occurs, it is not easy to be detected.

Ms. Jiang, 32 years old this year, is a white-collar worker in a foreign company. Due to her busy work, she often stays up late to work overtime and has an irregular diet. Two years ago, she suddenly felt dull pain in her lower abdomen, loss of appetite, and lost 10 pounds in half a year. She thought it was because she was too tired from work and did not pay attention to it. At the end of the year, when the company organized a physical examination, an ultrasound examination showed that there was a cystic solid mass in the ovary. So she went to the Affiliated Tumor Hospital of Chongqing University to complete relevant examinations. Pelvic MRI and chest and abdominal enhanced CT showed: an irregular mass on the right side of the pelvis, considering malignant tumor lesions. After laparoscopic exploration, the intraoperative frozen pathology confirmed ovarian cancer, because it was accompanied by multiple peritoneal metastatic lesions.

After joint consultation and evaluation of the condition by ovarian cancer experts and full communication with the family, Ms. Jiang was successfully given ovarian cancer tumor reduction surgery. After the operation, she underwent intraperitoneal hyperthermic perfusion chemotherapy and was diagnosed with high-grade ovarian serous adenocarcinoma stage IIIA. After completing 6 courses of chemotherapy, Ms. Jiang began oral targeted drugs for maintenance treatment and underwent regular checkups. Currently, 2 years have passed, and Ms. Jiang's condition is stable and her physical condition has recovered well.

The incidence of ovarian cancer increases with age and is common in menopausal and postmenopausal women. The age of onset is 40-60 years old, but the age of onset of different histological types of tumors varies. "According to clinical data, ovarian cancer has a clear trend of becoming younger in recent years." Director Zou Dongling introduced that among the ovarian cancer patients she has treated, there are many young women in their twenties, and even worse, teenage girls have also become targets of ovarian cancer.

The cause of ovarian cancer remains unclear

Gene mutations can double risk

The lifetime risk of ovarian cancer in the general female population is 1.3%, while women with a family history of breast cancer or ovarian cancer and BRCA gene mutations have a significantly increased lifetime risk of ovarian cancer. Women with germline BRCA1 gene mutations have a lifetime risk of ovarian cancer of up to 54%, and women with BRCA2 gene mutations have a lifetime risk of ovarian cancer of 23%. American Hollywood actress Angelina Jolie had her ovaries and fallopian tubes removed preventively at the age of 39 after she was diagnosed with a germline BRCA1 gene mutation.

"Genetic and family factors are high-risk factors for ovarian cancer. About 15% of ovarian cancer patients are related to genetics." Han Mei, attending physician at the Gynecological Oncology Center, said that women with a family history of ovarian cancer and breast cancer should pay special attention. The risk of ovarian cancer before the age of 60 is significantly higher than that of the general population. In addition, women who take exogenous non-contraceptive estrogen, marry and have children late, and infertile women have an increased risk of ovarian cancer.

"Smoking also increases the risk of ovarian cancer." Han Mei said that the ovaries are very sensitive to tobacco. Long-term excessive smoking will increase the accumulation of carcinogens in tobacco in the body, which will not only cause premature menopause, but also promote ovarian cancer. At the same time, frequent contact with paint, talcum powder, asbestos, and frequent consumption of high-calorie, high-fat and pickled foods will also increase the risk of ovarian cancer.

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"Mental factors have a certain impact on the occurrence of ovarian cancer." Han Mei emphasized that impatience, excessive stress, mental tension, depression, inferiority, self-blame, and tense interpersonal relationships can damage the body's immune system and then induce tumor growth. People with cheerful and optimistic personalities are at the lowest risk. Negative emotions can inhibit the function of the immune system and weaken the body's own anti-cancer ability.

These "red flags" appear

Beware of ovarian cancer

The ovaries themselves are very small and located deep in the pelvic cavity. Unlike cervical cancer, they cannot be screened at an early stage. Therefore, only when the tumor slowly invades from deep inside and metastasizes to other parts of the abdominal cavity will there be some typical symptoms, including ascites, abdominal distension, and weight loss. Therefore, it is usually diagnosed in the late stage. The following abnormalities should be noted:

1. Abdominal distension: Abdominal distension is a "red card" warning for ovarian cancer. It is often the first symptom of ovarian cancer patients and can occur before the lower abdominal mass is felt. The reason is that the tumor itself compresses and pulls the surrounding ligaments in the abdominal cavity. In addition, ovarian cancer is often accompanied by ascites, which makes patients often feel abdominal distension. Therefore, if there is unexplained abdominal distension (especially in menopause), a gynecological examination should be done in time.

2. Menstrual disorders: Most ovarian cancer patients do not have menstrual changes. If the normal ovarian tissues are destroyed by cancer cells, the hormone levels change, and the patient's general condition is poor, oligomenorrhea or amenorrhea may occur. The pathological types of ovarian cancer are complex and varied. Ovarian granulosa cell tumors can secrete estrogen. Excessive estrogen production can cause precocious puberty, menstrual disorders, or postmenopausal vaginal bleeding. For example, Sertoli-Leydig cell tumors can produce too much androgen, causing women to show signs of masculinization.

3. Abdominal pain and back pain: Ovarian cancer infiltrates the surrounding tissues, or adheres to adjacent tissues, compressing the nerves and causing abdominal pain and back pain, which usually ranges from dull pain to dull pain, or even more severe pain.

4. Edema of the lower limbs and vulva: Ovarian cancer tumors gradually grow in the pelvic cavity, which can compress the pelvic veins and affect lymphatic return. Therefore, if patients experience edema of the lower limbs and vulva, they should consider that ovarian cancer may be the cause.

5. Unexplained weight loss or intestinal obstruction: The ovarian mass gradually grows larger, and ascites forms, which can mechanically compress the gastrointestinal tract, causing the patient to lose appetite and indigestion, or even intestinal obstruction. In addition, the growth and reproduction of cancer cells consumes a lot of nutrients, causing the patient to become increasingly thin, anemic, weak, and pale.

Source: Chongqing University Cancer Hospital

Review expert: Zou Dongling, Director of the Gynecologic Oncology Center of the Affiliated Cancer Hospital of Chongqing University

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