(Cristina Nabuco)
He has a reputation for silent killer. Although corresponds to a maximum of 4% of the malignant tumors that affect women - well below the incidence of breast cancer - ovarian cancer causes more damage. It is a major cause of death in industrialized countries female (the fourth Britain, fifth Canada) because in 80% of cases, the diagnosis is done on very advanced stage, where the malignant cells have spread the abdominal cavity and the chances of cure are smaller. Survival rates could jump from 30 to 90% with early detection of this evil. Therefore, scientists are looking for a screening test equivalent to mammography, which identifies the breast tumor in early stages. The good news is that researchers see a light at the end of the tunnel: the symptoms of ovarian cancer can be perceived earlier than previously thought.
The work of Barbara Goff, director of gynecologic oncology at the University of Washington, U.S., challenge the thesis that the signs appear only later. In January, she published an article on the subject in the journal CANCER, which led to a new approach in the medical field. On June 25, organizations led by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Society of can cer formalized an updated consensus about the disease.
The document highlights that four symptoms can lead women to search for the presence of ovarian cancer: bloating or increased abdominal size, pelvic or abdominal pain, difficulty eating or feeling of fullness quickly and urinary disorders, such as frequent or urgent need go to the bathroom. Introduce them almost daily for more than three weeks warrants a trip to the doctor, especially when to signal change in usual state of health. "I do not want to scare people," said Barbara Goff in an interview with THE NEW YORK TIMES. These symptoms can have other causes, including benign, but she warns: Ovarian cancer is a hypothesis to be considered. "
Precisely therein lies the problem. "Doctors do not always appreciate the complaints and miss opportunities to anticipate the discovery of the tumor," she says. By studying 1700 patients with ovarian cancer, Barbara found that 36% had an initial diagnosis wrong, attributed to stress or depression, among other problems. Worse, 12% had not heard anything wrong and that the source of his discomfort was psychological. "The expectation is that the agreement signed in June raise the suspicion of cancer through these complaints, generally placed in the background," says Agliberto Barbosa de Oliveira, president of the Brazilian Society of Gynecology Oncology (Sobragon). "This should encourage referral to the gynecologist oncology specialist better able to recognize and treat the tumor, and allows a greater number of early diagnoses."
It is too early to know whether the list of symptoms able to reduce mortality from ovarian cancer or, at the other end, will lead to a barrage of tests and unnecessary surgery, assesses Jesus Paula Carvalho, professor of medicine and chief of the USP group of Gynecological Cancer Hospital das Clinicas in Sao Paulo, "but it is a valid method while we have no better option, as a test to detect ovarian cancer at an earlier stage: before any symptoms manifest."
Know the enemy:
The term ovarian cancer is a kind of umbrella under which to shelter several diseases. The most frequent of them, ovarian carcinoma, is also one of the most aggressive: arises after menopause, but begins to develop years before. The germ cell tumors primarily affecting teenagers and younger women. Since the strands of sexual and borderline (low malignant potential or borderline) can appear at any age. The predictions are best for the borderline, which end cured in over 90% of cases.
How is it diagnosed?
At gynecological examination, abdominal palpation and vaginal examination, using images taken by ultrasound if possible endovaginal three-dimensional and Doppler (which shows the flow of blood at the site, which provides clues for doctors), and the marker CA 125 tumor, blood test dosa that a protein produced by cancer. But, while useful for monitoring tumor, the marker is not very reliable for initial diagnosis, warns Agliberto Oliveira.
Ovarian cysts can turn into cancer?
Fortunately not, because one in three women of reproductive age so these "bags" filled with fluid. Over 80% of accidents are inconsequential route, so are called functional cysts. However, it is not always easy to distinguish a harmless cyst from a malignant tumor.
Certain features spotted on ultrasound increase the suspicion of cancer, the doctor informs Jesus Oak: solid and liquid content, the presence of multiple cavities and formation of a network of vessels on site. Confirmation requires a biopsy, i.e., microscopic examination of samples of the cysts.
You can punch or a non-invasive surgery to collect this material?
In suspected cases of ovarian cancer, both puncture (content aspiration needle) and laparoscopic surgery should be discarded. There is danger of spreading malignant cells, facilitating the emergence of new foci of tumor. If the signs are strong, it is recommended exploratory surgery.
How is it treated?
The main surgery to remove tissue that will be more or less depending on the size and radical tumor aggressiveness. It takes also into account the patient's age. If she has no children, seeks to preserve the uterus and other ovary, provided there is no risk of life. Otherwise, you can freeze eggs or ovarian fragments healthy for future use in assisted fertilization, suggests Agliberto Oliveira. The treatment also involves chemotherapy, use of drugs against tumor cells. Can be done after surgery before (if the intention is to reduce the size of the tumor to apply a technique more conservative) or during. Intraoperative Chemotherapy is an experimental method in which drugs are injected in the abdomen, normal or elevated temperature to destroy malignant cells.
What are the risk factors?
Personal history of breast cancer (the two tumors may originate from the same genetic mutation) and family history (who presents cases in the family can inherit a predisposition to the disease).
But beware, only 10% of tumors are of genetic origin. The others are related to exposure to toxic agents (cigarette, pesticides and regular use of talc in genital) and lifestyle, such as dietary changes and especially in reproductive habits. It is worth remembering that in the early 20th century, the woman menstruated only 50 times in my life, because married early, had children and spent many long periods breastfeeding. Now menstruate over 350 times because delays pregnancy, have fewer children and breastfeed less. "Ovarian cancer is related to the excessive number of ovulations," explains Jesus Carvalho.
Birth control pill prevents tumor?
It is considered that it has a protective effect because it suppresses ovulation. The use of the pill for more than five years makes the incidence of ovarian cancer dropped 60%. The HRT has the same protective effect? No, because at that stage the ovaries have shut down the activity. What works is to inhibit ovulation. It is suspected that HRT causes some rarer tumor types. Drugs to induce ovulation can cause cancer? Clomiphene citrate, used in assisted fertilization treatments, was put in the dock by hiperestimular ovaries and also because several cases were observed among users. However, recent work suggests that the ovary of these women was already more prone to cancer before they even make contact with the drug. What to do when a woman knows she is at risk for being a carrier of genetic mutations? The likelihood of having ovarian cancer reaches 60% for those with mutations in the BRCA 1 and BRCA 2. One can contemplate a strict monitoring, use of oral contraceptives or a more drastic measure: a preventive withdrawal of the ovaries. Studies have detected the cancer in 2.5% of apparently healthy and asymptomatic ovaries removed as a precaution, Jesus tells Carvalho.
Caution is warranted, since ovarian cancer is one of the most devastating. Hence, one understands why the appearance of a small light at the end of the tunnel was sufficient to mobilize many organizations.