Among all gynecological cancers, ovarian cancer "has the highest mortality rate in Portugal," confirms Lúcia Correia, a gynecological oncologist at the Portuguese Institute of Oncology in Lisbon and a member of the Portuguese Society of Gynecology, in a statement. In her view, this reality "arises from the fact that the majority (70-80%) of cases are diagnosed in advanced stages (III and IV), with disseminated disease outside the pelvis". 

That is why the alert is issued on the occasion of World Ovarian Cancer Day, which is celebrated this Wednesday, May 8, for the commitment to early diagnosis. "Rapid diagnosis and prompt referral to the oncological treatment center are fundamental factors in the success of treatment," says Mónica Pires, a gynecological oncologist at IPO-Porto and a member of the Portuguese Society of Gynecology, quoted in the same press release.

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The GLOBOCAN 2022 figures for Portugal indicate the existence of 682 new cases of ovarian cancer in that year, one of the most lethal cancers in women. One of the reasons for the late diagnosis may have to do with the symptoms, which are "very nonspecific and insidious," as Lúcia Correia explains. Patients may report pelvic or abdominal pain, increased abdominal volume, feeling of fullness, easy fatigue, gastrointestinal or urinary complaints, weight loss, vaginal bleeding, among others - all symptoms easily attributable to other causes. "More rarely, patients may be asymptomatic and the diagnosis may be made following examinations or surgeries for another reason."

According to this specialist, "among all known risk factors, genetic mutations are responsible for 20-25% of cases of ovarian cancer, with mutations in the BRCA 1 and 2 genes being the highest risk".

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But, adds Mónica Pires, "having a BRCA mutation does not mean having cancer. There are multiple genetic, environmental and individual factors that influence the risk of developing cancer, so many carriers do not develop the disease. Women who carry a BRCA mutation can opt for risk reduction strategies, either by earlier and more intensive screening for breast cancer, or by risk-reducing surgeries such as prophylactic mastectomy or prophylactic salpingo-oophorectomy (removal of ovaries and fallopian tubes) after completing their reproductive project. In women already diagnosed with cancer, namely ovarian cancer, the knowledge of the existence of a BRCA mutation allows the multidisciplinary team to adapt the treatment."

In ovarian cancer, the main reason for the lack of an effective screening program is related to the biology and natural history of this disease. In light of what is known, the precursor lesions described are not detectable by different imaging methods or by biochemical markers. When malignant transformation occurs, its evolution and metastasis, particularly intra-abdominal, are early and poorly symptomatic, which is why the majority (>75%) of ovarian cancers are detected in advanced stages.

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In Portugal, the lack of regular gynecological follow-up is also a reality, according to Mónica Pires. "The use of emergency services ends up being an alternative, often justified by the rapid progression of the disease, which often results in abdominal distension or pain."

To improve early diagnosis, this specialist advocates the need for "health literacy, education for prevention and the importance of valuing certain signs or symptoms".

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Lúcia Correia agrees, reinforcing that "women who belong to high-risk groups, such as carriers of genetic mutations, should be followed up in specific units".

An alert also given by the saBer mais ContA project, an initiative supported by Careca Power, Evita, Europacolon, Gynecological Oncology Movement, Portuguese Society of Human Genetics, Portuguese Society of Gynecology, Portuguese Society of Oncology, Portuguese Society of Senology and AstraZeneca.

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