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Cancer de l’ovaire

 


Une tumeur enlevée chirurgicalement

Epidémiologie des cancers de l’ovaire :

Qui ? Une femme sur 70 développe un cancer de l’ovaire dans sa vie ; si elle est porteuse d’un gène de prédisposition héréditaire (5% des femmes), c’est 1 femme sur 2 qui est atteinte.

Fréquence ? Le cancer ovarien est le 4° cancer de la femme, il est 6 fois moins fréquent que le cancer du sein.
Il est plus fréquent dans les populations blanches. Les femmes asiatiques présentent beaucoup moins de cancers ovariens que les femmes américaines, et les descendantes de femmes asiatiques nées aux Etats-Unis gardent cette protection.

Age ? L’âge moyen de survenue est de 59 ans ; en cas de prédisposition héréditaire, il est de 49 ans. C’est aussi un cancer de la femme jeune.

Facteurs de risque ? :
- l’ovulation est un risque majeur : toute situation qui accumule les ovulations est facteur de risque : - croissance avec l’âge, - et les inducteurs de l’ovulation chez les multipares.
- les facteurs nutritionnels : l’association de graisses et de protéines animales, la surcharge pondérale, et l’augmentation de la taille.
- une récente (Sept 2005) étude suédoise précise "l'évidence que l'absorption de produits laitiers, en particulier le lait, augmente le risque de tumeur séreuse de l'ovaire".

Facteurs protecteurs ? :
- toute situation diminuant l’ovulation est protectrice (femmes multipares, alimentation au sein, prise de contraceptifs oraux);
- une alimentation riche en végétaux (en particulier beta-carotènes).

Diagnostic du cancer ovarien :
L’ovaire est un organe profond, la dissémination intrapéritonéale est souvent asymptomatique : on assiste donc souvent à un diagnostic tardif : 75% de ces cancers sont diagnostiqués à un stade avancé, au pronostic sombre : ce cancer est redoutable. Une prévention efficace doit donc être engagée tôt dans la vie, avant tout signe clinique.
Les signes entrainant la consultation chez le médecin : douleurs abdomino-pelviennes, augmentation du volume abdominal, métrorragies.
Les cancers ovariens sont très souvent associés à d’autres cancers, qu’il faudra donc dépister simultanément : sein, colon, endomètre, col de l’utérus.
Les moyens utilisés pour le diagnostic :
1) l’échographie : sus-pubienne, et endovaginale ; échographie Doppler.
2) l’IRM : sa sensibilité tissulaire permet une parfaite délimitation anatomique des tumeurs et leur situation par rapport à la vessie et au rectum, et aux parois du pelvis.
3) les Marqueurs Tumoraux (par prise de sang):
- le CA125 : la valeur-seuil retenue est de 35 U/l ; sa concentration est fonction du volume tumoral et du stade de la maladie.
- l’AFP et la BHCG : ont un intérèt dans les tumeurs ovariennes germinales.
- le CA19-9, l’ACE : utilisables dans les tumeurs mucineuses, quand le CA125 n’est pas exprimé.
4) la chirurgie : coelioscopie exploratrice, laparatomie exploratrice.

Traitement des cancers ovariens :
1) Chirurgie : élément capital pour le diagnostic (évaluation du stade, et de l’extension péritonéale), et pour la réduction tumorale optimale.
2) Chimiothérapie : la chimiothérapie initiale est une polychimiothérapie.
3) Radiothérapie : non indiquée sur ce type de cancers. La combinaison radiothérapie-chimiothérapie, très utile sur d’autres cancers, ne l’est pas sur les cancers ovariens.
4) Surveillance : elle a pour but la détection précoce d’une récidive chez les femmes en rémission complète apparente, et l’évaluation de l’efficacité des traitements utilisés. Le dosage du CA125 est extrêmement important : après intervention pour exérèse d’une tumeur de l’ovaire, il est primordial de doser le CA125 à partir du 5° jour, délai qui semble correspondre à la demi-vie du marqueur. La non-normalisation doit faire craindre une tumeur résiduelle, même si la normalisation ne permet pas d’exclure la persistance d’un tissu tumoral : selon les centres, environ 15% des malades doivent être réopérées après une chirurgie initiale imparfaite.
L’augmentation au décours de la récidive est très précoce, et précède le diagnostic clinique de plusieurs mois : il est souhaitable de doser le CA125 tous les 3 mois la première année, puis tous les 6 mois..
Une augmentation du CA125 impose de mettre en évidence la récidive, par échographie, et immunoscintigraphie.

En pratique, dépistage du cancer ovarien :
le dépistage précoce de ces tumeurs augmente la survie des malades.
-toutes les femmes (risque de 1,4%) doivent bénéficier d’un examen gynécologique tous les ans;
-en cas de syndrome de cancer ovarien héréditaire (risque de 40%), chaque année on doit effectuer l’examen clinique, le dosage des marqueurs tumoraux et l’échographie pelvienne.
et l’utilisation des marqueurs tumoraux, progrès indispensable pour détection des cancers ovariens et de leurs récidives :
pour les cancers de l’ovaire, on doit utiliser OBLIGATOIREMENT le CA125, couplé à l’ACE, et, mieux, aux CA 19-9, AFP et BHCG.
La stratégie la plus efficace comprend:
1) ultrafast EBT body scanner, l'EBT étant supérieure au spiral CT scanner à cause de sa dose très faible de radiations, telle que pratiquée par nos partenaires :
-"Colorado Heart & Body Imaging", CO, Denver, USA, www.coloradoheart.com,
-"Lifescore", CA, San Diego, USA, www.lifescore.com,
-and the "Monaco Life Check Center", Monaco, www.monacolifecheck.com, l'EBT combinant faibles rayonnements, rapidité très élevée, haute résolution permettant d'obtenir des clichés uniques de tête, cou, poitrine et abdomen;
2) et examen sanguin : cancer check-up Cancersafe®test.


Un témoignage éloquent... :

THIS IS A MUST TO READ TO THE END P L E A S E!
An Eye Opener on Ovarian Cancer
I hope you all take the time to read this and pass it on to all you
can. Send this to the women in your life that you care about.
Years ago, Gilda Radner died of ovarian cancer. Her symptoms were
inconclusive, and she was treated for everything under the sun until it
was too late. This blood test finally identified her illness but alas,
too late. She wrote a book to heighten awareness Gene Wilder is her widower.

KATHY'S STORY: this is the story of Kathy West
As all of you know, I have Primary Peritoneal Cancer. This cancer has
only recently been identified as its OWN type of cancer, but it is
essentially Ovarian Cancer.
Both types of cancer are diagnosed in the same way, with the "tumor
marker" CA-125 BLOOD TEST, and they are treated in the same way -
surgery to remove the primary tumor and then chemotherapy with Taxol and
Carboplatin.
Having gone through this ordeal, I want to save others from the same
fate. That is why I am sending this message to you and hope you will
print it and give it or send it via E-mail to everybody you know.
One thing I have learned is that each of us must take TOTAL
responsibility for our own health care. I thought I had done that
because I always had an annual physical and PAP smear, did a monthly
Self-Breast Exam, went to the dentist at least twice a year, etc. I even
insisted on a sigmoidoscopy and a bone density test last year. When I
had a total hysterectomy in 1993, I thought that I did not have to worry
about getting any of the female reproductive organ cancers.
LITTLE DID I KNOW. I don't have ovaries (and they were HEALTHY when
they were removed), but I have what is essentially ovarian cancer.
Strange, isn't it?
These are just SOME of the things our Doctors never tell us: ONE out of
every 55 women will get OVARIAN or PRIMARY PERITONEAL CANCER.
The "CLASSIC" symptoms are an ABDOMEN that rather SUDDENLY ENLARGES and
CONSTIPATION and/or DIARRHEA.
I had these classic symptoms and went to the doctor. Because these
symptoms seemed to be "abdominal", I went to a gastroenterologist. He
ran tests that were designed to determine whether there was a bacteria
infection; these tests were negative, and I was diagnosed with
"Irritable Bowel Syndrome". I guess I would have accepted this diagnosis
had it not been for my enlarged abdomen. I swear to you, it looked like
I was 4-5 months pregnant! I therefore insisted on more tests.
They took an X-ray of my abdomen; it was negative. I was again assured
that I had Irritable Bowel Syndrome and was encouraged to go on my
scheduled month-long trip to Europe. I couldn't wear any of my slacks
or shorts because I couldn't get them buttoned, and I KNEW something was
radically wrong. I INSISTED on more tests, and they reluctantly)
scheduled me for a CT-Scan (just to shut me up, I think). This is what I
mean by "taking charge of our own health care."
The CT-Scan showed a lot of fluid in my abdomen (NOT normal). Needless
to say, I had to cancel my trip and have FIVE POUNDS OF FLUID DRAINED
OFF (I assure you), but NOTHING compared to what was ahead of me.
Tests revealed cancer cells in the fluid. Finally, finally, finally,
the doctor ran a CA-125 blood test, and I was properly diagnosed.
I HAD THE CLASSIC SYMPTOMS FOR OVARIAN CANCER, AND YET THIS SIMPLE
CA-125 BLOOD TEST HAD NEVER BEEN RUN ON ME, not as part of my annual
physical exam and not when I was symptomatic. This Is an inexpensive and
simple blood test!
PLEASE, PLEASE TELL ALL YOUR FEMALE FRIENDS AND RELATIVES TO INSIST ON
A CA-125 BLOOD TEST EVERY YEAR AS PART OF THEIR ANNUAL PHYSICAL EXAMS.
Be forewarned that their doctors might try to talk them out of it,
saying, IT ISN'T NECESSARY." Believe me, had I known then what I know
now, we would have caught my cancer much earlier (before it was a stage
3 cancer). Insist on the CA-125 BLOOD TEST; DO NOT take "NO" for an
answer!
The normal range for a CA-125 BLOOD TEST is between zero and 35. MINE
WAS 754. (That's right, 754!). If the number is slightly above 35, you
can have another done in three or six months and keep a close eye on
it, just as women do when they have fibroid tumors or when men have a
slightly elevated PSA test (Prostatic Specific Antigens) that helps
diagnose prostate cancer.
Having the CA-125 test done annually can alert you early, and that's
the goal in diagnosing any type of cancer - catching it early.
Do you know 55 women? If so, at least one of them will have this VERY
AGGRESSIVE cancer. Please, go to your doctor and insist on a CA-125 test
and have one EVERY YEAR for the rest of your life.
And forward this message to every woman you know, and tell all of your
female family members and friends. Though the median age for this cancer
is 56, (and, guess what, I'm exactly 56), women as young as 22 have it.
Age is no factor.

A NOTE FROM THE RN:

Well, after reading this, I made some calls. I found that the CA-125
test is an ovarian screening test equivalent to a man's PSA test
prostate screen (which my husband's doctor automatically gives him in
his physical each year and insurance pays for it). I called the general
practitioner's office about having the test done. The nurse had never
heard of it She told me that she doubted that insurance would pay for
it. So I called Prudential Insurance Co., and got the same response.
Never heard of it - it won't be covered.
I explained that it was the same as the PSA test they had paid for my
husband for years. After conferring with whomever they confer with, she
told me that the CA-125 would be covered.
It is $75 in a GP's office and $125 at the GYN's. This is a screening
test that should be required just like a PAP smear (a PAP smear cannot
detect problems with your ovaries). And you must insist that your
insurance company pay for it.
Gene Wilder and Pierce Brosnan (his wife had it, too) are lobbying for
women's health issues, saying that this test should be required in our
physicals, just like the PAP and the mammogram.

PLEASE TAKE A MOMENT TO SEND THIS OUT TO ALL THOSE YOU CAN. BE IT MALE
OR FEMALE, IT SHOULD NOT MATTER, AS THEY CAN FORWARD IT ALSO TO THOSE
LOVED ONES THEY KNOW.
IF YOU HAVE A PROBLEM WITH FORWARDING SOMETHING AS IMPORTANT AS THIS,
HERE'S A LITTLE HINT THAT MAY ASSIST YOU WITH YOUR DECISION ~ JUST
PRETEND THAT THIS IS A JOKE, WHICH IT CERTAINLY IS NOT, AND SEND IT OUT
TO ALL THE FOLKS YOU WOULD IF IT WAS. THANKS

Marie Potter
Director of Special Programs
Continuing Education
"Brunswick Community College"



Les marqueurs tumoraux mentionnés ci-dessus font partie du panel de Cancersafe®test, il est hautement recommandé d’ effectuer régulièrement ce test, une fois par an.

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