Frequently Asked Questions about Ovarian Cancer

Most of the ovarian tumours detected via ultrasound are not malignant, especially in young people. The ultrasound characteristics of the tumour and other criteria help the doctor decide whether it is benign or malignant. In case of doubt, you can ask for other diagnostic tests (tumour marker analysis or an MRI, among others). Sometimes, even if the tumour appears to be benign, it is preferable to remove it, This may involve removing only the diseased part, for example an ovarian cyst, or the entire ovary. In any case, the definitive diagnosis is obtained only after a histological (microscopic) study made by a pathologist. 

Conservative surgery, in case of borderline tumours, is considered safe. There is an increased risk of cancer appearing in the other ovary (approximately 15-20%), in the form of a new borderline tumour, which can be safely resected.  

The risk of dying from the disease does not increase and the ovary and uterus can still be preserved after having a baby. On the other hand, removing the other ovary means becoming menopausal and increasing the risk of cardiovascular disease and osteoporosis. 

It is understandable for you to think that surgery should be the first option and that the doctors should "take out as much as they can". But this isn't always the best option. In ovarian cancer, both therapies, surgery and chemotherapy, go hand in hand. At some point in the process, there must be no visible disease left in the pelvis and abdomen after surgery. We know that, if you have major surgery, but the disease is left inside the abdomen (in other words, the surgeon was not able to remove all the disease), the operation was not very helpful and the prognosis is not good. In addition, extensive operations can have complications and a long postoperative period. This can lead to the chemotherapy being delayed. 

Although complementary imaging tests can provide guidance on resectability (the ability to completely remove all the tumour masses), sometimes, in cases of doubt, there is no choice but to surgically explore the abdominal cavity to decide whether or not it is worth attempting an operation. Laparoscopy is a minimally invasive technique, which facilitates this surgical exploration. 

If the therapy team decides to start with chemotherapy, they will monitor the patient to check for tumour shrinkage, and then indicate surgery at the optimal time (often after 3 or 4 cycles of chemotherapy). 

Indeed, the risk of developing ovarian cancer is high, as is the risk of breast cancer. The problem with ovarian cancer is that, despite close monitoring, an ovarian tumour can develop very quickly and reach an advanced stage of the disease (e.g., stage III) by the time it is diagnosed. You should remember that the prognosis in these advanced stages is not good. This is different from the situation in breast cancer.  

Another aspect to consider is that when studying the ovaries of women who have undergone preventive adnexectomy (removal of the ovary and fallopian tube on the left side) because they are BRCA carriers, in a significant proportion of cases a hidden carcinoma is actually found inside the ovary. In addition, you should know that an adnexectomy also reduces the risk of breast cancer. 

In any case, the decision is up to the patient. If you decide to opt for controls rather than surgery, you should discuss your monitoring, which should be done with ultrasound and tumour markers every six months. You should also discuss other protective measures, such as taking oral contraceptives. 

Although there appears to be no disease from imaging techniques and surgical exploration, this does not exclude the possibility of microscopic disease at the frequent sites of tumour spread. This disease must be actively looked for and ruled out by the pathologist. To do this, a number of structures must be surgically removed. This operation is known as surgical staging. This conditions the prognosis and, in your specific case, also the indication for further chemotherapy. In fact, up to one-third of tumours supposedly confined to the ovary present extra-ovarian disease when surgical staging procedures are performed. The procedure involves: surgical exploration of the pelvic-abdominal cavity, washing of the abdomen with serum for a cytological study, removal of the uterus and the other appendages (tube and ovary), biopsies of various peritoneal surfaces and removal of the lymph nodes (lymphadenectomy) from the pelvic and aortic regions. All these procedures can be done laparoscopically.  

Normally, the vagina is not affected in ovarian cancer. The gynaecological part of the surgery is limited to removing the uterus and ovaries, not the vagina. The vaginal cavity is preserved, so you can still have satisfying sex. Often, however, there may be an altered sexual response, involving a lack of desire, dissatisfaction or pain, caused by multiple factors. If this is the case, do not hesitate to consult your therapy team, because they will certainly be able to help you. 

No. Ovarian cancer cannot be transmitted to a partner, sexually or otherwise. So you can have a full sex life without worrying about this. 

This treatment pattern is called neoadjuvant chemotherapy with interval surgery. Indeed, when we think that surgery at the outset will not succeed in eliminating all the disease we opt for this approach. The best time for surgery is when the therapy team has observed a fairly significant decrease in tumour mass and they think surgery will be feasible. Often this is achieved after three cycles, as in your case. What we do know, however, is that the longer it takes to operate, the worse the prognosis for the disease. For this reason, if the operation can be performed after the third cycle, it should not be put off until after the fourth or fifth cycle. 

Hereditary ovarian cancer accounts for about 16-20% of all ovarian cancers. These are patients who have a specific mutation, in all the cells in their body, of one of the genes involved. The most frequent of these are BRCA1 and BRCA2. These women also have an increased risk of developing breast and other cancers. Male relatives who carry one of these mutations are also at increased risk of developing prostate, breast, and other cancers, so it is recommended that they also undergo a study. The only way to determine whether or not a mutation exists is through a blood test and a specific genetic study. 

No, not always. Although the CA-125 blood test can be a useful tool for diagnosing and monitoring ovarian cancer, it is not uncommon for it to become elevated in benign situations, including uterine fibroids, liver inflammation, or other inflammatory processes. The CA-125 test is more accurate in postmenopausal women who have a pelvic tumour.   

Ovarian cancer is usually diagnosed in the advanced stages of the disease because there are no symptoms or the symptoms are non-specific and could therefore be the result of other common and mild conditions. In addition, there are no early-diagnosis tests, unlike for breast cancer, where regular mammographies give an early warning. It is only effective to perform controls through pelvic examinations, blood tests and gynaecological ultrasound in women who have a high risk of developing ovarian cancer (family history of breast and/or ovarian cancer). When ovarian cancer is suspected, tests are performed to confirm the diagnosis, which may include an analysis, a CT or PET scan, as well as others. 

Research is constantly being conducted into new drugs that may be useful in curing diseases such as cancer. Clinical trials are designed to prove their safety and efficacy. There are different types of trials depending on the objectives to be investigated. The tests are carried out under strict conditions and must be approved by the competent authorities that regulate them. The aim is often to compare the efficacy of the new substance with another effective drug for the disease being studied, or with a placebo (a substance that has no therapeutic effect) if no useful drugs are available. Often, the patient (and also the doctor) does not know which drug (or placebo) they are taking, that is, the traditional drug or the new drug being studied.