[Fat Bear Science] Why is ovarian cancer diagnosed in the late stage? These symptoms may be your ovaries asking for help~

The ovary is one of the important organs of women, which has the function of regulating endocrine and helping fertility. Ovarian cancer is called "the king of gynecological cancer" and is one of the malignant tumors that seriously threaten women's health. About 70% of ovarian cancers are already in the advanced stage when they are discovered; 70% of ovarian cancer patients relapse within 3 years after standardized treatment; 70% of epithelial ovarian cancer patients survive less than 5 years.

Why is ovarian cancer diagnosed in the late stage? What are the high-risk factors? What symptoms should be alerted? Today, experts from the Gynecological Tumor Center of the Affiliated Tumor Hospital of Chongqing University will take you to the "King of Gynecological Cancer"~

Ovarian cancer

Is the incidence rate high?

At present, the annual incidence of ovarian cancer in my country ranks third among female reproductive system tumors. In 2020, there were approximately 55,242 new cases of ovarian cancer in China, and 37,519 deaths. According to the latest data from the National Cancer Center, the incidence of ovarian cancer has been increasing year by year from 2000 to 2016.

Women's lifetime risk of ovarian cancer

How big is the 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.

Why Ovarian Cancer

Difficult to detect early?

First, because the ovaries are hidden, early symptoms are not obvious, and some women may not even have symptoms at all. If you do not have annual physical examinations and do ovarian cancer screening programs, it is difficult to detect in the early stages.

Second, ovarian cancer can easily be confused with other diseases in the early stages, causing symptoms such as abdominal distension, abdominal pain, and indigestion, which may be mistaken for gastrointestinal problems.

Third, not enough attention is paid after the symptoms appear. Menstrual irregularities, abnormal leucorrhea, abdominal distension, etc. are very common gynecological diseases in women. Many women do not take them seriously, which delays the best time for treatment.

Ovarian cancer

What are the high-risk factors?

● Genetic and familial factors

About 15% of ovarian cancer patients are related to heredity. Hereditary ovarian cancer patients are often caused by BRCA1/BRCA2 gene mutations, which are passed on to the next generation. Women carrying BRCA1/BRCA2 gene mutations have a significantly higher risk of ovarian cancer before the age of 60 than the general population.

● Endocrine factors

Patients with breast cancer or endometrial cancer are about twice as likely to develop ovarian cancer as the general population. Taking exogenous non-contraceptive estrogen can increase the risk of ovarian cancer, while anovulation during pregnancy, long-term use of contraceptives, multiple births, and breastfeeding can reduce the incidence of ovarian cancer.

● Chemical carcinogens

The ovaries are very sensitive to tobacco. Long-term excessive smoking will increase the accumulation of carcinogens in the body, which will not only cause premature menopause but also promote ovarian cancer. In addition, women who are frequently exposed to paint, talcum powder, and asbestos are more likely to develop ovarian cancer.

● Environmental and lifestyle factors

Due to the increasing environmental pollution in industrialized countries, the incidence of ovarian cancer is also increasing. The incidence of ovarian cancer is also related to diet. Pickled meat products, kimchi, and spoiled vegetables all contain a large amount of nitrite, which can react with amino acids to produce nitrosamines with strong carcinogenicity. In addition, a high-calorie, high-fat diet leads to an increase in estrogen levels in the body, stimulating the proliferation and malignant transformation of the ovarian epithelium, thereby increasing the risk of ovarian cancer.

● Marriage and childbearing

Women who marry and have children late or who are infertile have an increased risk of ovarian cancer.

● Age

The incidence of ovarian cancer increases with age, but the age range of different histological types of tumors varies. Germ cell tumors are most common in women under 20 years old, borderline tumors often occur in women aged 30-40 years old, and epithelial ovarian cancer mostly occurs in postmenopausal women. Therefore, as the average life expectancy increases, the incidence of ovarian cancer is also increasing.

● Psychological factors

An irritable personality, excessive stress, mental tension, depression, inferiority, self-blame, and strained interpersonal relationships can damage the body's immune system and subsequently induce tumor growth. People with cheerful and optimistic personalities are at the lowest risk, as negative emotions can inhibit the immune system and weaken the body's own anti-cancer ability.

The following symptoms occur

Beware of ovarian cancer

There are no specific symptoms in the early stages of ovarian cancer, but the following abnormalities should be a cause for concern.

● Abdominal distension

Abdominal distension is a "red card" warning of ovarian cancer. It is often the first symptom of ovarian cancer patients and can occur before a mass is felt in the lower abdomen. 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 bloated. Therefore, if there is unexplained bloating (especially in menopause), a gynecological examination should be done in time.

● Menstrual disorders

Most ovarian cancer patients do not have menstrual changes. If the normal ovarian tissues are destroyed by cancer cells, hormone levels change, and the patient's overall 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.

● Abdominal pain, back pain

Ovarian cancer infiltrates the surrounding tissues or forms adhesions with 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.

● Edema of lower limbs and vulva

Ovarian cancer tumors gradually grow in the pelvic cavity, compressing the pelvic veins and affecting lymphatic drainage. Therefore, if patients experience edema in the lower limbs and vulva, they should consider that ovarian cancer may be at work.

● Unexplained weight loss

The ovarian mass gradually grows larger, and ascites forms, which can mechanically compress the gastrointestinal tract, causing the patient to lose appetite and suffer from indigestion. 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.

Suspected ovarian cancer?

Early diagnosis and treatment are the key

Although ovarian cancer is hidden in the early stages, and has a high recurrence rate and mortality rate, early diagnosis and treatment are of great help to the prognosis of the disease. Once you suspect you have ovarian cancer, it is best to go to a specialized oncology hospital for diagnosis and treatment in a timely manner.

(1) Imaging examination

● Ultrasound examination: It is an important method for diagnosing ovarian tumors. It can determine the size, location, texture, relationship with the uterus and pelvic organs, and the presence or absence of ascites.

● CT and MRI examinations: determine the size and texture of the tumor, the relationship between the tumor and the pelvic organs, especially the enlargement of the pelvic and para-aortic lymph nodes, and the presence or absence of liver and spleen metastasis, which are of certain value in determining the surgical method.

● Gastroscopy and colonoscopy: to find out whether there is primary gastrointestinal cancer.

● Chest and abdominal X-rays: They are of diagnostic significance in determining the presence of pleural effusion, lung metastasis, and intestinal obstruction.

● PET-CT examination: It can distinguish benign and malignant tissues by using the difference in metabolic activity, which helps to characterize and diagnose existing ovarian tumors and rule out distant metastasis.

(2) Laparoscopy

Laparoscopic examination can help confirm the diagnosis of patients with suspected ovarian malignancy due to pelvic masses, ascites, abdominal distension, etc.; laparoscopic observation can assess the severity of the disease and determine the treatment plan; laparoscopic scoring can determine the feasibility of radical tumor reduction surgery.

(3) Ascites cytology examination

Patients with ascites should undergo abdominal puncture. If the ascites is small, the posterior fornix can be punctured. The obtained ascites can be concentrated by centrifugation and smeared for cytological examination, which will help further clarify the diagnosis.

(4) Tumor marker determination

Ovarian tumor markers can be detected in serum, tissues, body fluids and excrement. They can be used to assist in diagnosis, monitor the efficacy of tumor treatment, and judge prognosis. They are of great significance for the diagnosis and treatment of tumors.

Ovarian cancer

Can it be prevented?

In terms of genetics, if your immediate family members have ovarian cancer, breast cancer, endometrial cancer or colorectal cancer, and it has occurred multiple times in a family, you can go to a specialized oncology hospital for genetic counseling or related gene testing to find out whether there are related gene mutations, such as breast cancer-related oncogenes (BRCA genes) and Lynch genes. For BRCA1 gene mutation carriers, it is recommended to undergo preventive fallopian tube and oophorectomy after completing childbearing at the age of 35-40. The age of diagnosis of BRCA2 gene-related ovarian cancer is usually 8-10 years later than that of BRCA1 gene-related ovarian cancer, so BRCA2 gene mutation carriers can consider delaying preventive adnexectomy until the age of 40-45.

Secondly, for young childless women, oral contraceptives can reduce the risk of ovarian cancer. For the general population, it is recommended to have regular gynecological examinations every year, including gynecological ultrasound, tumor marker testing (CA125 or HE4), etc., which can detect some hidden lesions in advance and achieve early detection and early treatment.

Finally, developing good living habits, strengthening exercise, improving physical fitness and immunity are also helpful in preventing ovarian cancer.

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Zou Dongling

Director of the Gynecologic Oncology Center of the Affiliated Cancer Hospital of Chongqing University, associate chief physician, master's supervisor, and doctor of medicine.

She is good at open, minimally invasive, single-port and robotic surgery for gynecological tumors, surgical treatment and comprehensive treatment of cervical cancer, ovarian cancer, endometrial cancer, etc., and individualized treatment of recurrent gynecological malignancies.

Clinic hours: Monday morning

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Li Lin

Attending physician at the Gynecological Oncology Center of the Affiliated Cancer Hospital of Chongqing University, Doctor of Medicine, Postdoctoral Fellow.

He is good at standardized treatment of common gynecological malignant tumors and individualized treatment of advanced and recurrent gynecological malignant tumors.

Text/Fat Bear

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