Of all gynecological cancers, ovarian cancer “has the highest mortality rate in Portugal,” says Lucia Correa, a gynecologic oncologist at the Portuguese Institute of Oncology in Lisbon and a member of the Portuguese Society of Gynecology. According to the specialist, this event “comes from the fact that the majority of cases (70-80%) are diagnosed in advanced stages (third and fourth), with the disease spreading outside the pelvis.”
Preparation Globocan 2022 For Portugal, it indicates that there were 682 new cases of ovarian cancer that year, one of the deadliest types of cancer in women.
The symptoms, which are “non-specific and very malignant,” as Lucia Correa explains, may be one of the reasons for late diagnosis. Moreover, symptoms can easily be related to other causes, such as pelvic or abdominal pain, increased abdominal size, feeling of fullness, easy fatigue, digestive or urinary disorders, weight loss, and vaginal bleeding, among others. In rare cases, patients may be “asymptomatic and the diagnosis may be made after examinations or surgeries for another reason,” says Monica Pires, also a member of the Portuguese Society of Gynecology.
According to this specialist, “Among all known risk factors, genetic mutations are responsible for 20-25% of ovarian cancer cases, and mutations in the BRCA 1 and 2 genes are considered the most dangerous.” But he adds: “Having a BRCA mutation does not mean you have cancer.” “There are multiple genetic, environmental and individual factors that influence cancer risk, which means that many carriers do not develop the disease. Women who carry a BRCA mutation can choose risk-reducing strategies, either through early and intensive breast cancer screening, or through surgical procedures.” To reduce risks such as prophylactic mastectomy or prophylactic salpingo-oophorectomy (removal of the ovaries and tubes) after completion of her reproductive project. For women diagnosed with cancer, especially ovarian cancer, knowing the presence of a BRCA mutation allows the multidisciplinary team to tailor treatment.
As for ovarian cancer, the main reason for the lack of an effective screening program is related to the biological and natural history of the disease. In light of current knowledge, the described precursor lesions cannot be detected by various imaging methods or biochemical markers. When malignant transformation appears, its development and spread, especially within the abdomen, are early and have few symptoms, which is why the majority (>75%) of ovarian cancers are detected at advanced stages.
Monica Pires also highlights that the lack of regular gynecological surveillance in Portugal is also a reality. “Seeking emergency care has been shown to be an alternative, often justified by the rapid progression of the disease, which often results in abdominal bloating or pain.”
To improve early diagnosis, this specialist advocates the need for “health literacy and education for prevention and the importance of assessing certain signs or symptoms.” Lucia Correa agrees, stressing that “women who belong to risk groups, such as those with genetic mutations, should be monitored in specific units.”
Advisory/Communication Team
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