The prevalence of ovarian cancer is increasing - MK

Ovarian cancer is one of the most difficult types of cancer to diagnose and one of the most difficult to treat. Despite the advances of modern science, ovarian cancer remains one of the most common cancers and the eighth most common cause of cancer death among women in the world. At the same time, its prevalence is growing, and given the lack of specific methods for early diagnosis and symptoms in the early stages, the situation seems very sad.

In 2020, more than 314 thousand patients with ovarian cancer were officially diagnosed worldwide, as well as more than 207 thousand deaths from this disease. An increase in the number of new cases has been recorded for several years, and according to expert forecasts, by 2040 the increase will be 42%. That is, we will have more than 445 thousand new cases and 314 thousand deaths per year. In Russia, as the chemotherapist and oncologist at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after. V.I. Kulakova, Professor of the Department of Oncology and Palliative Medicine of the Russian Medical Academy of Postgraduate Education Svetlana Khokhlova, in 2020, 11 thousand new patients with this diagnosis were identified, and in 2023 - already 13 thousand.

Unfortunately, in most cases the disease is detected at advanced, 3rd or 4th stages - in two thirds of patients, ovarian cancer is diagnosed when the process is already widespread, rapidly progressing and worsening the quality of life, despite treatment. Unfortunately, 50-70% of patients with advanced cancer die within 5 years. “Unfortunately, no early screening programs for ovarian cancer work; Today, the early stages of the disease cannot be detected either by ultrasound or tumor markers. There are proven risk factors: benign ovarian diseases, primarily endometriosis; few pregnancies and childbirths; history of infertility; estrogen therapy. Sporadic (random) cancers, unfortunately, make up the majority, 80%, and their origin is completely unknown. Genetically determined - only about 10%. The symptoms of the disease are vague (abdominal pain, general malaise, dyspepsia), but even they appear only at stages 3-4. Patients with such symptoms go to a gastroenterologist, hepatologist, therapist, but not to a gynecologist. The diagnosis can actually only be made morphologically,” notes Professor Khokhlova.

If we talk about genetic predisposition, it is now known that mutations in the BRCA1 and BRCA2 genes contribute to the development of the disease, which also increases the risk of developing breast and ovarian cancer. It is also known that age affects the incidence: the risk of developing ovarian cancer increases significantly in women over 50 years of age. However, in recent years, ovarian cancer has become younger: stress leads to the disease being detected earlier and earlier.

Endocrine factors such as early menstruation and late menopause may contribute to the development of the disease due to prolonged exposure to estrogen. In addition, lack of pregnancy and breastfeeding, as well as the use of hormone replacement therapy, are additional risk factors.

Therefore, doctors recommend that if you have risk factors, especially hereditary syndromes, you should visit a gynecologist every six months. If there are no risk factors, it is enough to visit a gynecologist annually.

Surgery remains one of the main methods of treatment. Chemotherapy and targeted therapy are also used. Experts place great hopes on conjugate therapy, combining cytostatics with antibodies. Immune therapy methods are still in the research stage. A therapeutic vaccine for ovarian cancer is also in development.

American standards provide for preventive removal of the uterus and appendages when mutations in the BRCA1 and BRCA2 genes are detected - this reduces the risk of developing the disease by up to 90%. At one time, the famous actress Angelina Jolie underwent such an operation. And yet, after such an intervention, the woman goes into artificial menopause, which significantly increases the risks of osteoporosis and cardiovascular diseases. “Today we began to practice a new experience: first remove the appendages, and remove the ovaries only after menopause. This direction is actively developing in Europe, and this tactic will be considered correct in the near future,” says Svetlana Khokhlova.

In Russia, as the doctor says, there are now many young patients who, having already had children, undergo preventive removal of organs of the reproductive system, seeing the experience of mothers and grandmothers. However, such operations are permitted only for those carriers of genetic mutations who have already been diagnosed with breast cancer. And even then only if the mammary gland has already been removed.

Of course, early detection of any cancer significantly improves a patient's prognosis, so doctors believe it is very important to increase women's awareness of symptoms and risk factors, which, in turn, can encourage earlier treatment. The discovery of advanced ovarian cancer is always a shock for a woman, causing fear, non-acceptance of the disease, and withdrawal. “Such women often do not want to go to the doctor, do nothing or listen to their girlfriends. Or they trust information on the Internet. And when they come, it’s already difficult to do anything. Now there is an urgent need to raise awareness among women about this disease,” says Svetlana Khokhlova.

In connection with this, the medical community initiated the educational project “Choreography of Life”, the ambassador of which was the famous dancer, choreographer, actress and ballerina Alla Sigalova. The project aims to raise awareness of the burden of ovarian cancer, as well as provide information assistance to patients with this disease and their loved ones. “It is important not only to provide patients with the necessary medications and modern treatment methods, but also to create an atmosphere of support and understanding around them. Even in the most difficult times, it is possible to find hope and light,” says Irina Borovova, a member of the Russian Presidential Council for the Development of Civil Society and Human Rights.