What is ovarian cancer?
Ovarian cancer develops from the various cells that make up the ovary. There are two main types of ovarian cancer:
- Ovarian adenocarcinoma (90% of cases) when the tumour affects the (epithelial) cells on the outer surface of the organ.
- Non-epithelial ovarian tumours (10% of cases), which are rare ovarian malignant tumours (ROMT). These tumours affect the stromal or germ cells of the ovary and include the following conditions:
- Sex cord tumours
- Germ cell tumours
- Clear cell adenocarcinomas
- Ovarian mucinous adenocarcinomas
- Borderline or attenuated malignant tumour
- Small cell carcinoma
- Ovarian and uterine carcinosarcomas
- Low-grade serous tumours
Ovarian carcinoma is the 8th most common cancer in women in France with approximately 5,200 new cases diagnosed each year*. The median age of the patient at diagnosis is 62 years.
Ovarian cancer can be asymptomatic for a long time – hence it is unfortunately often diagnosed at an advanced stage, when the cancer cells have spread to other adjacent organs. Nevertheless, certain symptoms can be revealing, such as abdominal discomfort, urinary problems or pelvic or back pain.
Non-epithelial tumours or rare ovarian malignant tumours (ROMTs) affect young women, even adolescents or children. Nevertheless, they are usually discovered at an early stage and are often chemo-sensitive, which gives them a good prognosis when managed efficiently.
ROMTs must be managed in expert centres, approved by the French National Cancer Institute (INCa), such as Gustave Roussy (national expert centre).
Diagnosis of ovarian cancer
Gustave Roussy is involved in the diagnosis and management of suspect ovarian masses or peritoneal carcinosis and in the treatment of ovarian cancer. The Institute also manages patients whose diagnosis has been confirmed.
During the initial consultation, patients are asked about their personal and family medical history. The doctor will document any other family cases of cancer in order to highlight any hereditary predisposition to disease onset (15% of ovarian carcinomas are linked to a predisposition gene for ovarian cancer).
General physical, gynaecological and abdominal examinations are then performed to look for unusual masses.
Depending on the suspected disease, its stage and degree of aggressiveness, various examinations may be recommended including chest, abdominal and pelvic scans, an ultrasound scan, a CT scan or pelvic MRI.
A diagnostic laparoscopy is often performed prior to surgical excision to further investigate the diagnosis and assess the extent of the disease.
Decisions on cancer treatment pathways are taken during weekly multidisciplinary meetings. These meetings involve several doctors from different disciplines including medical oncologists, surgeons, radiotherapy oncologists, radiologists and anatomo-pathologists who work in conjunction with community doctors. Every major decision is discussed and an opinion is given.
Ovarian Cancer Treatments
Various treatments can be implemented to treat ovarian cancer:
Surgery is a major step in the management of ovarian cancer. It is performed in order to completely remove the tumour lesions. As the disease often spreads, ovarian cancer surgery requires the expertise of specialised surgeons.
Chemotherapy is often an essential additional treatment for aggressive or advanced-stage ovarian cancer. It is recommended as an adjuvant to surgery if complete removal of the tumour is not possible or prior to surgery if the latter is not initially feasible, in order to facilitate complete removal of the tumour. This treatment is based on the administration of anti-cancer drugs that act systemically (throughout the body).
Maintenance treatments after chemotherapy
Depending on the type of histology, molecular tumour anomalies and disease spread, venous or oral maintenance therapy may be considered following chemotherapy to consolidate earlier treatment.
They treatments will be decided in a multidisciplinary meeting focusing on histopathological results and disease spread.
The treatment of gynaecological cancer can often lead to sterility, particularly following surgery. This is why the Gustave Roussy teams focus on preserving patient fertility and have been involved in improving practices over the last two decades.
In some situations where the tumour is limited or particularly chemo-sensitive (particularly for germ cell tumours in young women), a fertility-preserving treatment may be considered. Specific pathological expertise such as that available at Gustave Roussy (slide review or management) and surgical expertise is required to this end (surgery, overall management, slide review, etc.).
Preservation is routinely discussed when it can be offered safely alongside treatment. It may combine procedures preserving the uterus and at least part of an ovary during surgery, as well as procedures to collect oocytes or ovarian cortex prior to surgery. We raise this issue during the first consultation and accompany our patients throughout their fertility preservation journey.
Clinical trials and advanced therapy medicinal products
Depending on the characteristics and stage of the cancer, Gustave Roussy doctors may invite patients to participate in clinical trials. If appropriate, clinical trial participation will be discussed during treatment by the referring oncologist. The patient will then be given access to advanced therapy medicinal products.
▶ View ongoing clinical trials for gynaecological cancers.
* 2018 figures from the French National Cancer Institute