Ovarian Cancer

Ovarian cancer develops from the various cells that make up the ovaries. There are two main types of ovarian cancer:

• Ovarian adenocarcinoma (90% of cases), in which the tumor affects the cells on the outer surface (epithelial cells) of the organ.

• Non-epithelial ovarian tumors (10% of cases), which are rare malignant ovarian tumors (RMOT). These tumors affect the stromal or germ cells of the ovary and include the following conditions:

  • Sex cord tumors.

  • Germ cell tumors.

  • Clear cell adenocarcinomas.

  • Mucinous adenocarcinomas of the ovary.

  • Borderline or low-grade malignant tumors.

  • Small-cell carcinoma.

  • Ovarian and uterine carcinosarcomas.

  • Low-grade serous tumors.

Ovarian carcinoma is the eighth leading cause of cancer in women in France, with approximately 5,200 new cases per year. The median age of patients at diagnosis is 62 years, according to data from the National Cancer Institute. 

Non-epithelial tumors, or rare malignant ovarian tumors (RMOTs), affect young women, including adolescents and even children. Nevertheless, they are generally detected at an early stage and are often chemotherapy-sensitive, which means that many have a good prognosis when properly treated.

ROMTs must be treated at expert centers accredited by the National Cancer Institute (INCa), such as Gustave Roussy (a national expert center).

The main risk factor for developing ovarian cancer is a mutation in the BRCA1 or BRCA2 genes. Hereditary genetic abnormalities are thus implicated in 15 to 20 percent of high-grade ovarian cancers.

Other factors have been identified as increasing the risk of developing ovarian cancer:

• Age, with a diagnosis typically made at an average age of 65.

• Being overweight or obese.

• Early onset of menstruation.

• Late menopause.

• Never having been pregnant.

Ovarian cancer can be asymptomatic for a long time. That is why, unfortunately, it is often diagnosed at an advanced stage, when the cancer cells have spread to other nearby organs and tissues. However, certain symptoms may be indicative of the disease, such as abdominal discomfort, abdominal swelling, urinary problems, or pelvic or back pain.

Gustave Roussy provides diagnosis and management of suspected ovarian masses or peritoneal carcinomatosis, as well as treatment for ovarian cancer. The Institute also treats patients who have already received a diagnosis.

During the initial consultation, the patient is interviewed to learn more about her personal and family medical history. In particular, the doctor will inquire about other cases of cancer in the patient’s family. This helps identify any potential hereditary predispositions to developing cancer (15% of ovarian carcinomas are linked to a gene that predisposes individuals to ovarian cancer).

A general physical, gynecological, and abdominal examination is then performed to check for any unusual masses.

Depending on the suspected condition, its stage, and its aggressiveness, various tests may be recommended: a thoraco-abdominal-pelvic CT scan, an ultrasound, a CT scan, or a pelvic MRI.

A diagnostic laparoscopy is often performed prior to surgical resection to refine the diagnosis and assess the extent of the disease.

Decisions regarding cancer treatment plans are made during weekly multidisciplinary team meetings (MDTs). These meetings involve several physicians from different specialties—medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists—in collaboration with primary care physicians. For each major decision, a recommendation is issued.

Various treatments can be used to treat ovarian cancer. 

Treatment for gynecologic cancer can often lead to infertility, particularly as a result of surgery. That is why the teams at Gustave Roussy pay special attention to preserving patients’ fertility and have been working to improve treatment practices for the past two decades.

In certain situations where the tumor is localized or particularly sensitive to chemotherapy (especially for germ cell tumors in young women), fertility-sparing treatment may be considered. This requires specific expertise in pathology—such as that offered at Gustave Roussy (review of slides or case management at the Institute)—as well as surgical expertise (surgery, comprehensive care, review of slides, etc.).

This fertility preservation is systematically discussed whenever it can be safely offered to the patient in conjunction with treatment. It may combine procedures to preserve the uterus and at least part of one ovary during surgery, as well as procedures to retrieve oocytes or ovarian cortex prior to surgery. We raise this issue during the initial consultation and support patients throughout their fertility preservation journey until it is completed.

Depending on the characteristics and stage of the cancer, doctors at Gustave Roussy may offer patients the opportunity to participate in clinical research trials. If appropriate, referral to a clinical trial will be discussed with patients during their care with their referring oncologist, allowing them to access innovative treatments.

→ View ongoing clinical trials for gynecologic cancers [notes: link to be added]