Ovarian carcinoma is called the “silent killer” because it has no early symptoms. Prevention is the only way to its early diagnosis. We talk about ovarian cancer with Dr. Rositsa Krasteva. She is the head of the Oncology Center at Uni Hospital Medical Center in Panagyurishte. He has two specialties – internal medicine (2001) and oncology (2005). She specialized in the university hospitals of Turin, Basel, Athens and Munich. Dr. Krasteva has participated in a number of national and European congresses. She is an active member of the European Society of Medical Oncology (ESMO), the Bulgarian Medical Union, the Bulgarian Association of Medical Oncology (BAMO), the European Radiation Therapy Community (ESTRO). He is a member of the management board of BINO – Balkan Investigational Network of Oncology and of the “Experts Against Cancer” Foundation. He is the chairman of the Young Oncologist Club. He is a laureate of the St. Ivan Rilski Foundation’s prestigious annual award for contribution to healthcare for 2017 in the Oncology category. He is the winner of the “Doctor of the Year” prize of the “Uni Hospital” Medical Center for 2018. – What disease is ovarian cancer and what is its frequency in Bulgaria? Ovarian cancer is one of the socially significant malignant diseases. Although in recent years we have seen success in the treatment of cancer and reported a decrease in the death rate from this disease, according to a June 9, 2020 publication by colleagues from the National Cancer Center in the United States, the treatment of ovarian cancer cannot boast of great success. In Bulgaria, according to data from the National Cancer Registry for 2017, ovarian cancer is in fifth place in frequency among women and, in fact, represents 5.5% of all malignant diseases, and as a cause of death it is in 6th place. It is not for nothing that they say that ovarian cancer is the silent killer. If we are to compare the incidence of ovarian carcinoma with the incidence of other malignancies, it is indeed a less common disease, but because it is usually diagnosed at a more advanced stage, the mortality rate is still high. According to data for Europe for 2012, 65,000 new cases were reported, and according to data for the world, about 240,000 new patients are diagnosed each year, with 150,000 deaths, i.e. is about 4% of all women on earth. – What are the risk factors for the development of ovarian cancer? It is very good to know which factors cause ovarian cancer, but, unfortunately, they are not always clear. In more than 20% of cases, this disease is hereditary, and in families in which there are cases of ovarian carcinoma in the female direct line, it is good to do genetic tests and determine the probability and risk of the occurrence of ovarian carcinoma. For example, we can take the case of Angelina Jolie, who had a higher risk of ovarian and breast malignancy. The remaining risk factors are divided into several groups – high-risk, medium-risk and low-risk. High-risk factors include BRCA1 and BRCA2 gene mutations.These mutations are also a risk factor for breast cancer, so the two diseases are relatively common together. The phenomenon is known as hereditary breast carcinoma and ovarian carcinoma. With a history of breast cancer, we also have a high risk of ovarian cancer, as well as with hereditary non-polyposis colon cancer (Lynch syndrome). The group of medium- and low-risk factors includes early onset of first menstruation or late menopause, a history of endometriosis, polycystic ovary syndrome, and pelvic inflammatory disease. In nulliparous women, the risk of ovarian cancer is higher than in nulliparous women. Obesity, sedentary lifestyle, smoking and excessive alcohol consumption also contribute to the development of this disease. – What are the symptoms of this disease? As I mentioned earlier, ovarian carcinoma is called the silent killer. As with all cancers, symptoms appear late. The most common in this type of cancer are heaviness and discomfort in the small pelvis, problems with the menstrual cycle, less often pain. Ascites is definitely a late symptom. It is important for doctors to be able to recognize the symptoms of ovarian cancer. Unlike breast cancer, in this case, feeling and palpation cannot be the first method that prompts a woman to seek consultation with a specialist. All these symptoms appear at a later stage of disease development. In order to detect ovarian cancer early, it is necessary to have a gynecological examination at least once a year. – How is ovarian cancer diagnosed? One of the fastest methods is the ultrasound examination and gynecological examination. If the presence of a finding in the pelvis is confirmed, a scan, nuclear magnetic resonance can be planned and, of course, the tumor marker Ca 125 and the ROMA index should be investigated. After that, a histological confirmation must be done. When the disease is advanced, cytoreductive surgery is initiated, removing the tumor mass when possible, or a biopsy is taken and surgical treatment is discussed after 6 courses of chemotherapy. – What stages does ovarian cancer go through? If you expect me to tell you how ovarian carcinoma originates, I couldn’t explain it, because it’s too complicated a matter and we still don’t know what causes it. But if we talk about the staging of this disease, as is known, malignant diseases can be divided into 4 main stages. This is the international classification known as TNM, where T is the tumor, N is the lymph basin, M is the distant metastases. Determining the stage of the disease according to the TNM classification is extremely specific and aimed at doctors and specialists who understand malignant diseases. The goal is to know what will be the most adequate and correct treatment in each specific case.- What are the treatment options? Can we talk about a cure for ovarian cancer? We have good news and not so good news in this regard. In the early stages of all cancers, treatment is extremely successful. Even with this insidious disease, today we have a treatment option and early-stage patients can be cured, and more advanced-stage patients can be brought into complete remission. Today we also have targeted therapy for the treatment of ovarian carcinoma. The possibilities today are decidedly better. The administration of chemotherapy is the gold standard in advanced disease, but we can now have a much more personalized approach in these cases in patients where we have a proven pathologic mutation. – Is there any prevention? There should be, but whether there is an organized one in Bulgaria, I cannot say. In my opinion, I would say that it is rather not. Here is the time to emphasize that every woman over 45 should visit a gynecologist once a year. Because of ovarian carcinoma, because of cervical carcinoma, because of the physiological changes that occur. This type of preventive examinations is aimed at detecting the malignant disease at an early stage. One should maintain a high level of health culture and know what could be prevented with regular preventive examinations. If we think about prevention against cancer in general, it is a much more global campaign and at this stage it would be very difficult for us to talk about this topic. – Can we give some advice to patients with this disease that they can follow in their daily life? The first main tip is: if you have been diagnosed with ovarian cancer, talk to your surgeon first if you have had surgery. Patients should be aware of how radical the surgery is and what they need to do after it – whether they will be monitored, what their treatment plan will be, whether it is okay to be tested for genetic mutations. Finally, patients should be able to lead fulfilling lives without being a burden to others. Published with the support of AstraZenecaHere is the time to emphasize that every woman over 45 should visit a gynecologist once a year. Because of ovarian carcinoma, because of cervical carcinoma, because of the physiological changes that occur. This type of preventive examinations is aimed at detecting the malignant disease at an early stage. One should maintain a high level of health culture and know what could be prevented with regular preventive examinations. If we think about prevention against cancer in general, it is a much more global campaign and at this stage it would be very difficult for us to talk about this topic. – Can we give some advice to patients with this disease that they can follow in their daily life? The first main tip is: if you have been diagnosed with ovarian cancer, talk to your surgeon first if you have had surgery. Patients should be aware of how radical the surgery is and what they need to do after it – whether they will be monitored, what their treatment plan will be, whether it is okay to be tested for genetic mutations. Finally, patients should be able to lead fulfilling lives without being a burden to others. Published with the support of AstraZenecaHere is the time to emphasize that every woman over 45 should visit a gynecologist once a year. Because of ovarian carcinoma, because of cervical carcinoma, because of the physiological changes that occur. This type of preventive examinations is aimed at detecting the malignant disease at an early stage. One should maintain a high level of health culture and know what could be prevented with regular preventive examinations. If we think about prevention against cancer in general, it is a much more global campaign and at this stage it would be very difficult for us to talk about this topic. – Can we give some advice to patients with this disease that they can follow in their daily life? The first main tip is: if you have been diagnosed with ovarian cancer, talk to your surgeon first if you have had surgery. Patients should be aware of how radical the surgery is and what they need to do after it – whether they will be monitored, what their treatment plan will be, whether it is okay to be tested for genetic mutations. Finally, patients should be able to lead fulfilling lives without being a burden to others. Published with the support of AstraZeneca