Ovarian Cancer Center
Opened in September 2008, this centre is a unique example of a multidisciplinary approach to patients with ovarian cancer.
The Centre’s specific aims are:
Patient Care
Diagnosis: ultrasound and radiology specialists are available to patients with ovarian cancer using the most modern diagnostic tools.
Surgery: a strong collaboration between Gynaecological Surgeons, General Surgeons, Anaesthetists and Pathologists provides the best surgical treatment to patients with ovarian cancer. Different approaches are performed, tailoring the most appropriate surgery for each patient: from minimally invasive fertility-sparing surgery for young patients with early disease, to the most aggressive surgical debulking for patients with advanced disease. More than 450 patients are treated surgically for primary/recurrent ovarian cancer.
Chemotherapy: Gynaecological Oncologists offer the most innovative treatments, also allowing patients to participate in both National and International Trials. More than 2500 chemotherapies are administered yearly to patients with ovarian cancer.
Supportive Therapy: psychological, nutritional support and palliative care are offered to all patients by dedicated physicians and nurses.
Research
Many collaborative trials and clinical/translational research projects are ongoing in order to improve the outcome of patients with ovarian cancer.
Education
ESGO fellowships for young Gynecologists and the ESAGON School (European School of Abdominal/Pelvic Surgery) are part of the Ovarian Cancer Centre programme with the aim of training new generations of Gynaecological Oncologists and offering better care to patients with ovarian cancer.
Ovarian cancer is a gynaecological cancer that originates from the surface of the ovaries. Benign ovarian tumours do not cause metastasis, while the malignant ones can metastasise to other parts of the body. Malignant ovarian tumours are mainly divided into cancer and stromal tumours; epithelial carcinomas account for 90% of malignant ovarian tumours. It has recently been shown that epithelial ovarian carcinoma is not a single disease, but combines different diseases with different biological behaviour. A specific consideration is deserved for borderline tumours, for which conservative surgery is always indicated.
Ovarian cancer is the leading cause of death from gynaecological cancer and it is fifth most common cancer in the female population in developed countries. Each year, it is estimated that 65,000 cases are diagnosed in Europe, including almost 5,000 in Italy. Despite the relatively low incidence of ovarian cancer, it is burdened by high mortality. Ovarian cancer affects all ages with greater frequency between 50 and 65 years.
About 5% of women diagnosed with ovarian cancer present a genetic mutation (BRCA1, BRCA2, Lynch syndrome) of hereditary/family nature, which increases the risk of this and other types of cancer.
It is important to know that...
- one out of ten cancers is family-based and can be prevented
- the contraceptive pill can prevent up to 60% of ovarian tumours
- yearly gynaecological examination is not useful for the purposes of early diagnosis, while the transvaginal ultrasound, despite being the best diagnostic tool of ovarian cancers, cannot reduce mortality
- ovarian cancer is a silent disease, but even the slightest nuanced symptoms can raise suspicion and hasten diagnosis
- the quality of the first surgery impacts on survival.
Risk factors for ovarian cancers
Epidemiological studies have identified the following risk factors for ovarian cancer:
- Nulliparity
- First pregnancy after age of 35
- Hormone therapy
- Early menarche
- Late menopause
- Persistent inflammation of the pelvis (pelvic inflammatory disease)
- Ovarian stimulation for in vitro fertilisation (especially for "borderline" cancers)
- Breast cancer diagnosed at a young age
- Endometriosis (1)
- BRCA1, BRCA2
- Lynch syndrome type II.
Protecting factors for ovarian cancers
- 25 years or less at first pregnancy
- High number of pregnancies
- Use of oral contraceptives
- Breastfeeding (2).
Classification of ovarian cancers
Ovarian tumours can be classified into the following categories according to the cells they are derived from.
Epithelial tumours
Epithelial cancers derive from epithelial cells lining the ovary. They represent about 90% of malignant tumours. They can be divided into two types - type 1, low-grade serous tumours, mucinous, endometrial tumours and clear cell tumours, and type 2, high-grade serous tumours that represent the most common ovarian cancer, often diagnosed at an advanced stage.
Germ cell tumors
These represent about 5% of ovarian cancers and arise from the cells the ova derive from. Eighty percent of cases occur before the age of 30. They include teratomas, dysgerminomas, endodermal sinus tumours and choriocarcinomas.
Stromal or sex cord tumours
These are rare, originate from the connective structures, and produce oestrogen and progesterone. On average they occur during the sixth decade of life and metastasise in the latter stages. The main ones are granulosa tumours, granulosa-theca tumours, and Sertoli-Leydig tumours.
Borderline cancers
These tumours have a low degree of malignancy, with little tendency to metastasise, and in the majority of cases, it is possible to totally remove only the lesion while preserving a large amount of ovarian tissue. They are often diagnosed at a young age and generally have a good prognosis, but may give rise to type 1 epithelial tumours. This type of tumour tends to recur, but young patients can still benefit from a conservative approach. As emerged from a study conducted at our institution, relapses grow by an average of 1 mm per month, allowing the patients to be followed up for long periods without any need for timely surgical intervention.
Primary peritoneal cancers
These are rare, arise from serous cells lining the pelvis and abdomen, and can occur even in women who have undergone annexectomy.
Ovarian cancer symptoms
The vast majority of women with ovarian cancer have non-specific symptoms, with large differences among individuals. The most common symptoms are abdominal discomfort or pain, bloating, indigestion, feeling of pressure, cramps, difficulty eating or feeling full quickly even after a light meal, nausea, diarrhoea, constipation, increased urinary frequency and/or urgency, unexplained weight loss or gain, loss of appetite, abnormal vaginal bleeding.
These symptoms do not indicate the presence of an ovarian cancer, but it is good practice to require in-depth investigations, particularly in case of new-onset symptoms - less than six months - that last for more than three months and occur more than 12 times per month. A gynaecological evaluation with TVS and CA125 assay is recommended if at least two symptoms with the above-described characteristics occur. Using these symptoms for screening purposes is neither sensitive nor specific, in particular for identifying the early stage disease.
(1) Endometriosis is a disease characterised by the cells lining the uterus (endometrium) that forms outside of this organ. It can be found mainly in the pelvis (ovaries, bowel or bladder) and more rarely in other organs (skin, lungs), where the cells continue to be stimulated by sex hormones and periodically undergo proliferation and exfoliation, resulting in bleeding. In recent years, the association between endometrial clear cell ovarian cancer and endometriosis has been demonstrated. The transformation of endometriosis into cancer is a rare event. Neoplastic degeneration occurs in 0.4-1% of cases and typically occurs in the third to fourth decade of life. In 80% of cases the ovary is involved, but the neoplastic process may affect any other part of endometrium. It is important that women with endometriosis undergo periodic inspections, particularly above the age of 35.
(2) Other protective or risk factors are related to eating habits.
a) According to the National Cancer Institute being overweight/obesity increase the risk of ovarian cancer by 80% in the age between 50 and 70.
b) Low fat diet reduces the risk of cancer in general, according to the study Women's Health Initiative Dietary Modification. After 4 years, women who reduce fat intake show a 40% lower risk of developing ovarian cancer.
c) Use of tea. A study conducted by the University of Washington on 2,000 women revealed that women who drink at least one cup of green tea every day have a 54% lower risk of ovarian cancer. A study by the National Institute of Environmental Medicine in Stockholm showed that a cup of black tea a day reduced the risk by 50%.