Ovarian cancer

The ovaries are two small, almond-shaped organs located on either side of the uterus in the pelvic region. They play a dual role in the female body: the production of eggs for reproduction and the secretion of sex hormones, principally oestrogen and progesterone.

There are three main cell types in the ovaries: the epithelial cells that cover the outer surface of the organ, the germ cells that produce the eggs, and the stromal cells that structure the ovary and produce hormones. Each of these cell lineages can give rise to different types of tumour

In its early stages, ovarian cancer rarely causes specific symptoms. When they do appear, they are often trivial and attributed to other conditions, which frequently delays diagnosis. Commonly reported clinical signs include

• Persistent pelvic or abdominal pain
• A feeling of bloating or an increase in the size of the abdomen
• Loss of appetite or early satiety
• Digestive problems such as constipation or diarrhoea
• Frequent or urgent urination
• Unexplained tiredness
• Pain during sexual intercourse or bleeding outside the period or after the menopause.

These symptoms can also occur with benign illnesses. However, if they persist or worsen, you should seek medical advice immediately.

The exact cause of ovarian cancer remains unknown to this day. However, specific genetic mutations and certain biological mechanisms are frequently implicated in the transformation of normal cells into malignant cells. One of the most widely accepted hypotheses suggests that cancer does not systematically begin in the ovary itself, but in the cells at the end of the fallopian tubes. These cells can migrate to the ovary, implant themselves there and form tumours.

This process is often associated with alterations in the genetic material. When these genes are defective, genetic errors accumulate, promoting carcinogenesis.

Cancer progression also depends on the ability of cancer cells to detach from the primary tumour, invade neighbouring tissues and then colonise other areas via the lymphatic or blood system.

Several factors have been identified as increasing the likelihood of developing ovarian cancer. They fall into two categories: non-modifiable factors and lifestyle factors.

Non-modifiable factors include:

• Age: the risk increases with age, particularly after the age of 50
• Family history: the presence of cases of ovarian, breast or colon cancer in the family is an indicator of increased risk, particularly in the case of hereditary syndromes such as Lynch syndrome or BRCA1 and BRCA2 mutations
• Personal history of gynaecological or digestive cancer

Lifestyle or biological factors:

• No pregnancy or a late first pregnancy
• Being overweight or obese
• Endometriosis, a condition in which uterine tissue develops outside the uterus
• Prolonged use of hormone replacement therapy after the menopause.

On the other hand, certain factors appear to reduce the risk of ovarian cancer: the use of oral contraceptives, multiple pregnancies and prolonged breastfeeding have all been shown to have a protective effect.

Diagnosis of ovarian cancer is complex, as there is currently no mass screening test that can reliably identify it at an early stage.

Diagnosis is based on a combination of clinical, biological and imaging tests. It often begins with a consultation prompted by persistent symptoms. A pelvic examination may reveal a mass. This is then explored by pelvic ultrasound, often followed by a CT scan, MRI or PET scan to assess the extent of the disease.

A blood test may be prescribed to measure the level of CA-125, a tumour marker that is often elevated in ovarian cancer. However, this marker lacks specificity: it may be normal in the presence of cancer or elevated for other benign reasons, such as endometriosis.

A definite diagnosis is made after exploratory surgery, which allows a biopsy to be taken and the stage of the disease to be accurately assessed. This stage is crucial for adapting treatment, particularly in the case of epithelial cancers, which are the most common.

Treatment of ovarian cancer is generally based on a combination of surgery and chemotherapy, adapted to the histological type of tumour and the stage of the disease at diagnosis. The therapeutic approach is multidisciplinary, involving gynaecological surgeons, oncologists, radiologists and pathologists.

Surgery is the first stage of treatment. It is used both to confirm the diagnosis by biopsy and to reduce the tumour mass. This procedure, known as cytoreduction, aims to remove the uterus, ovaries, fallopian tubes, omentum and sometimes other affected tissues. In the presence of metastases, the aim is to remove as much tumour tissue as possible, which improves the response to adjuvant treatment.

Chemotherapy is indicated in the majority of cases, particularly in the advanced stages. It is generally administered after surgery, but may also precede surgery in some cases to reduce the size of the tumour (neoadjuvant chemotherapy).

Some patients may benefit from targeted therapies or PARP inhibitors, particularly if they have a BRCA gene mutation. These treatments target mechanisms specific to cancer cells, limiting the effects on healthy cells.

Radiotherapy is rarely used, except in cases of localised recurrence or specific metastases.

The course of ovarian cancer is strongly influenced by the stage at diagnosis. When the disease is detected early (stage I), 5 year survival rates can exceed 90%. On the other hand, for cancers diagnosed at an advanced stage (stage III or IV), survival falls significantly, with a median of around 47.4% at 5 years.

Complications may arise from the progression of the disease itself or from treatment. In the long term, the risk of relapse remains high, particularly for high-grade cancers. Recurrence often requires successive lines of chemotherapy, which can lead to cumulative toxicity and reduced quality of life.

Psychological complications such as anxiety, depression and post-traumatic syndrome can also occur. Psycho-oncological care is therefore recommended to support patients throughout their treatment.

There is currently no absolute method of preventing ovarian cancer. However, several measures can help to reduce the risk:

Prolonged use of oral contraceptives is associated with a significant reduction in risk. This protection appears to be proportional to the duration of use.

Tubal ligation and prophylactic salpingectomy (preventive removal of the fallopian tubes) can also reduce the risk, particularly in women with a BRCA mutation.

In women at high risk (BRCA mutation, family history), preventive surgery involving removal of the ovaries and fallopian tubes (bilateral oophorectomy) may be considered. This operation drastically reduces the risk of developing cancer, but leads to an early menopause, which requires special support.

Systematic screening tests such as pelvic ultrasound or CA-125 assays are not recommended for the general population, due to their lack of sensitivity and specificity. They may, however, be considered as part of targeted surveillance in high-risk patients.

It is recommended that you seek medical advice immediately if any persistent symptoms appear. These may include unusual abdominal distension, recurrent pelvic pain, unexplained loss of appetite or recent urinary problems. Their trivial nature can lead to them being overlooked or attributed to benign conditions, thereby delaying diagnosis.

Women with a family history of gynaecological cancer or known carriers of genetic mutations such as BRCA1 or BRCA2 should be particularly vigilant. These women should report any such history to their doctor.

Finally, any pelvic mass detected during a gynaecological examination requires further investigation.

At Hôpital de La Tour, ovarian cancer treatment is part of a personalised medicine approach. Thanks to close coordination between the gynaecology, surgery, medical oncology, advanced imaging and support care teams, each patient benefits from a tailor-made treatment plan.

Finally, special attention is paid to quality of life, with psychological, nutritional and physiotherapeutic support. The care pathway is structured to offer patients comprehensive support, from the diagnostic phase through to post-treatment follow-up.

How common is ovarian cancer?
Although relatively rare, ovarian cancer remains the most lethal gynaecological tumour, because it is often diagnosed late.

Is ovarian cancer hereditary?
In 10-15% of cases, ovarian cancer is associated with an inherited genetic mutation, such as BRCA1, BRCA2 or Lynch syndrome.

Can ovarian cancer be detected?
No. No systematic screening test has yet proved effective. Targeted surveillance is reserved for women at high risk.

What are the most common symptoms?
Bloating, abdominal or pelvic pain, digestive problems, feeling full quickly, tiredness and frequent urination are among the most commonly reported signs.

What is the standard treatment?
Excisional surgery followed by chemotherapy is the most common treatment regimen. Other options, such as targeted therapies, may be considered on a case-by-case basis.

Do oral contraceptives protect against ovarian cancer?
Yes. Regular use reduces the risk of developing ovarian cancer, particularly in low-risk women.

Does the menopause influence the risk?
Yes. The risk increases after the menopause, particularly after the age of 60. Ovarian cancer is rare before the age of 40.