What there is to know

“Ovarian cancer” actually includes many diseases that are very different in their expression and prognosis.

Schematically we distinguish:

1 - Malignant epithelial tumors. These are the most common cancers, those generally referred to as “ovarian cancer”. They are developed from the cells that cover the surface of the ovary or from the cells of the fallopian tube (and more rarely the peritoneum).

2 - Rare tumours. These cancers represent less than 20% of all ovarian cancers. There are 2 categories: malignant germ cell tumors and tumors of the stroma and sex cords.

3 - Finally, borderline tumours, which are not strictly speaking cancers but whose aspects and management are often close to those of neoplastic lesions.

Ovarian cancer most often corresponds to a high-grade serous carcinoma, but you should know that there are other cell types (endometrioid cancer, carcinosarcoma, etc.). The peculiarity of this disease lies in its mode of extension. The tumor is in fact directly in contact with the pelvic organs (uterus, bladder, sigmoid and rectum). In addition, the cells released by the tumor will be able to follow the abdominal fluid and be grafted, in the form of deposits (implants), on all the tissues and organs of the abdomen (peritoneum, colon, intestine, small intestine, omentum). We thus quickly pass from a disease localized to the ovary or the fallopian tube to a diffuse disease in the pelvis and the abdomen. Conversely, intravisceral metastases in the liver or lung are rare in this disease.

This cancer gives no or very few symptoms at the beginning of the disease. These are generally non-specific (abdominal discomfort, heaviness, variable constipation, bleeding). Later, bulky adnexal masses (of the ovary and/or fallopian tube) and ascites responsible for a rapid increase in the volume of the abdomen are observed. There is no effective screening test capable of finding the disease at an early stage. The diagnosis is therefore made in the majority of cases at a so-called advanced stage when there are neoplastic tissue grafts on the surface of the peritoneum and multiple organs.

LOvarian cancer requires complex care involving multiple specialists: surgeons, medical oncologists, pathologists, radiologists, nutritionists, geneticists, etc. Their training in the management of the disease and their training in working together improves results. The management is complex because it is necessary to make a precise diagnosis of the type of cancer, its extension, the general condition of the patient, the biological characteristics of the tumor, etc. The effectiveness of these treatments is linked to the training of the team (number of cases treated, participation or initiation of clinical or biological research protocols). Finally, treatments are increasingly personalized, depending on the precise type of tumor and its biological characteristics. For example, for serous cancers, a distinction is made between high-grade cancers (the most frequent) and low-grade cancers. In high-grade cancers, a distinction is made between those linked to a mutation of a BRCA gene (about 20% of cases), those falling within the framework of the HRD syndrome and the others.

The treatment of “ovarian cancer” therefore requires a precise pathological and biological diagnosis before any treatment decision. The treatment must take into account the subtype in question and the patient (general condition, history, co-morbidity). It must be proposed by a CPR expert in ovarian pathology and take into account current standards. These are available online on the website of the National Cancer Institute (INCa)(www.e-cancer.fr), on the GINECO group website (so-called “St Paul de Vence” repositories, www.arcagy.org