Ovarian Cancer Early Diagnosis: Improving Cure Rates

Felipe Salustino
Reporter

Rio Grande do Norte should record 130 new cases of ovarian cancer per year in the triennium started in 2023 and ending in 2025, according to the projection of the National Cancer Institute (Inca). Of the total, 40 cases are foreseen each year in the same cut for the capital. Ovarian cancer is considered one of the most challenging malignant neoplasms in early diagnosis, which makes the chances of healing difficult. The Brazilian Federation of Gynecology and Obstetrics Associations points out that about 65% of patients receive the diagnosis when the disease is already in advance, making this type one of the most lethal among all carcinomas.

Gynecologist Maria da Guia de Medeiros Garcia, from Maternity School Januario Cicco (MEJC), a unit linked to UFRN and the EBSERH network, explains that ovary cancer mainly affects elderly women, a factor that usually causes confusion regarding the identification of symptoms. “The ovary is located in the pelvis. As they are usually elderly women, it is common to associate signs with stomach or intestine problems, for example. Precisely for this reason, the diagnosis is almost always late. In addition, clarifications are lacking and the disease ends up being underestimated,” explains the doctor.

The most common symptoms are increased abdominal volume, flatulence, appetite changes and changes in intestinal functioning (alternating constipation with diarrhea). “The woman attributes abdominal growth to a weight gain that she considers natural or thinks that constipation comes from the fact that she consumes little water and ends up not giving due attention,” reports Maria da Guia. Quick diagnosis is also compromised, according to the doctor, because specific examinations for the detection of the disease are lacking.

“There are no preventive tests against ovarian cancer. If we could say that there is something able to identify the disease earlier, this procedure would be ultrasound. But considering the world population of women, it is impossible to do an ultra every two years. Therefore, this protocol is not advocated in medical literature, which means a great limiter,” points out the gynecologist.

The diagnosis, in fact, is usually made from the patient’s complaint. “Only when the complaint is there an image exam (simple ultrasound, tomography or resonance). There is suspected cancer, an ovary biopsy is done. Blood tests, called tumor markers, are also included in the investigation.” But it is biopsy who allows the closed diagnosis and who will say the most suitable treatment for each type of tumor, “says the doctor.

Ivete Matias, director of the Rio Grande do Norte Gynecology and Obstetrics Association (Sagorn), states that the lack of screening results in the statistics on the disease. She argues that there is a greater offer of information about the disease. “Of every four cases of ovarian cancer, three are identified at an advanced stage. Awareness and periodic consultations with the gynecologist, so they are crucial. Sagorn has acted a lot to bring this awareness,” he says.

Young women are also affected

Despite mainly reaching older women – from the age of 50 – cases in young patients are not unlikely. Lawyer Gabriella Medeiros discovered ovarian cancer in 2019 at the age of 24 in a routine consultation with the gynecologist. Initially, she and the doctor imagined that she was a cyst. Since the tumor was already three times larger than the uterus, Gabriella was referred to surgery. After the procedure, she says that the gynecologist realized that she was a tumor, which a biopsy detected as malignant.

“I sought a follow -up with the gynecologist because I wanted to have a child. Apart from the growth of the alleged cyst, which generated an abdominal swelling and some gas similar discomfort, the situation was quiet. After the biopsy result, I was referred to the alloy against cancer, where I underwent a new surgery to remove the left ovary. Then I had treatment with chemotherapy,” he says. Today, Gabriella is fine, celebrating a new moment with her son, a year and four months.

Earlier this month, she underwent new exams, as she has done since 2020. “Thank God, in the result nothing has appeared. The treatment of the disease was very difficult. I am a person who likes to control things. Not controlling my health was very distressing. I had anxiety crises that even affected my mother, who accompanied me in chemotherapy sessions, also suffered a lot,” the lawyer, with 30 years.

Gynecologist Maria da Guia de Medeiros Garcia, from MEJC, explains that the treatment depends on the type of tumor. “The existing options to treat ovary cancer are surgery, radiotherapy, chemotherapy or through medicines, so -called immunosuppressants,” he says. The chances of healing vary according to the time of discovery of the disease. “We prefer to call remission, because it is not uncommon for the disease to come back in five years or even a little more. And in the case of elderly women, there is usually no very long survival after the diagnosis, but this also has to do with our life expectancy,” says the doctor.

Oncologist Sulene Cunha said that if discovered in the early stages (1 and 2), the chances of cure ovary cancer are around 95%. Late identification (stage 3 and 4), however, reduces these chances to about 40%. “Stages 3 and 4 indicate that the disease is at a very high risk. But there are chances of healing – that we prefer to use the term ‘without evidence of the disease’, since, in cure, theoretically the disease does not return – especially with the advances of current treatments,” he explains.

Treatment is also done via SUS

In Rio Grande do Norte, cancer treatment and follow -up is offered via the Unified Health System (SUS) in the Cancer League in Natal. Sulene Cunha, coordinator of the unit’s clinical oncology, details that the service can be started through online or face-to-face screening. In the first case, a copy should be sent with the result of tests that point to the suspicion of the disease, and information such as name, address and SUS card of the patient, on the League page on the Internet (triagem.liga.org.br).

For face-to-face screening, the patient needs to move from Monday to Friday, from 6am, to Luiz Antônio Hospital, where a doctor will evaluate the exam. After screening, the League professional will continue the investigation. “He can request tests such as resonance, tomography, laboratory and gynecological examinations, tumor markers and others. Then program biopsy to, if cancer is confirmed, apply treatment,” says Sulene Cunha. The service protocols are the same for any type of neoplasia.

When surgery is required, the procedure is scheduled by the unit itself as long as possible. For chemotherapy cases, Sulene says that the League offers a multidisciplinary team, which involves accompanying with a nurse, nutritionist and psychologist before reaching oncology. According to her, 70 new cases of ovary cancer are recorded on average in the unit. Throughout the country, 7,310 new cases are projected for each year of the 2023-2025 triennium. Factors such as stress, food and quality of life contribute to increasing the chances of the disease.

Prevention can be done by combating risk factors. In addition, genetic issues can also influence. “About 20% of the patients we receive carry genes related to ovarian cancer, that is, there is a hereditary factor as well. In these cases, we have an oncogeneticist who evaluates the relatives of this woman to act in prevention,” says Sulene.