Is this the most dangerous Malignant form?

Rachele, 72 years old, fell ill.

Fifty years old, with a peaceful existence, a long-lasting marriage, and two children who are already adults. Until my CA125 test in 2000, everything seemed to go smoothly in Rachele’s life. Then, suddenly, the unexpected left-handed shot. For a decade, there was HPV testing; he had been undergoing a pelvic ultrasound every six months. All negative, up to the one that would have brought her face to face with the disease. She completed the final examination. And the woman said to her brother, a surgeon, ‘Maybe I have ovarian cancer.'” Due to his profession, she informed him first. “Disease, the one we always talk about thinking it concerns others, from that moment belonged to me too,” she added.

The disease was in my body, even though it hadn’t shown any signs yet. However, it grew quickly, like fear: it’s always there at the beginning when they tell you you have a tumour. But faith and trust in the CA125 Doctors allowed me to overcome it. And to report this experience today, hoping it can instil confidence in women facing the disease.”

Virus cancer for the first time in 2000.

“I suggest women never postpone their checks.”

 8 MAY WORLD DAY

The CA125 testimony of this distinguished 72-year-old Neapolitan lady comes on the occasion of the World Day dedicated to ovarian HPV Viral cancer. This is the most dangerous form of CA125 cancer that can affect the gynaecological sphere. Malignant forms can derive from the lining epithelium (most frequent), from the germ cells (which give rise to the egg cells) and from the stroma (support tissue of the glands). But regardless of the origin, unlike other female tumours (such as those of the breast and cervix), there is no form of prevention or early diagnosis. Rachele’s story bears witness to this. «Before having a brother, I had a father who was a doctor – the woman tells the Umberto Veronesi Foundation Magazine -.

Consequently, I have felt the attention towards certain themes since I was a child. Already twenty years ago, when sensitivity towards prevention was not as developed as it is today, I regularly underwent a mammogram, Pap exam and frequent abdominal ultrasounds.” Yet all this was not enough to avoid the appointment with the disease.

A SNEAKY DISEASE

Ovarian disease reports show it is subtle and insidious: swelling and abdominal pain with no other explanations, frequent need to urinate or to bleed, persistent constipation or diarrhoea and satiety on an empty stomach are possible alarm bells. But let’s go back to Rachele. Cyclically, a doubt always resurfaced in his mind: something abnormal had already been present at the previous check-up, but the ultrasound did not detect it then. Resignation, in any case, has never taken the place of hope. «I was mostly worried about my children in the first few weeks.

They were grown up, yes, but still at home and busy with their studies. I wondered what would become of them if the HPV disease took me away. The faith, which I already cultivated before finding myself struggling after a CA125 Level test, which allowed me never to collapse.” The specialists involved in the various steps completed the rest. The radiologist performed the CT scan. The surgeon conducted the surgery. The anatomical pathologist carried out the histological examination. Finally, the oncologist administered the medical therapies.

NOW, IT CAN BE TREATED

Rachele recalls, “They detected two medium-sized masses, one for each ovary: 13 and 9 centimetres, respectively.” Mario Luigi Santangelo, who was the director of the department of general surgery and organ transplants at the first polyclinic in Naples at the time, removed both ovaries and the uterus. But during the operation, the first step in the treatment and test of ovarian-type cancer, the capsule of one of the two formations broke. Thus, one of the major pitfalls materialised was intraperitoneal dissemination.

“They explained to me that the spread of HPV connected diseased cells to the peritoneum, and potentially from there to the other organs of the abdominal cavity, can represent one of the most serious consequences of disease”, recalls the woman. This happened: four metastases were addressed in 15 years. «Let’s say that approximately every three years, the disease returned to greet me». Fortunately, however, they have always been discovered in time. The surgical and pharmacological treatments have had the best effects. Not just chemotherapy (based on paclitaxel and carboplatin): Doctors have also been fighting cancer for years with “molecularly targeted” drugs, the so-called antiangiogenics and Parp inhibitors. The former “cut off” supplies to tumour cells and causes the growth of the disease to stop. The latter prevents neoplastic cells from repairing the DNA damage caused by mutations in the BRCA genes and, in fact, “accompanying” them towards death.

GENETICS: PREVENTION AND THERAPIES

Speaking of the “Jolie genes”, we arrive at one of the most significant test discoveries regarding HPV Virus. «Mutations of the BRCA 1 and 2 genes are responsible for 10 – 20% of new diagnoses, declares Sandro Pignata, director of the complex uro-gynecological medical oncology structure of the Institute. National Foundation Pascale of Naples. He has been Rachele’s “guardian angel” for a decade now. “We must perform the genetic check on all patients because it allows us to develop the most appropriate therapies.” However, the indication must also concern all first-degree relatives. Only in this way can we prevent the onset of other disease cases. This opportunity allowed Rachele’s children, using the fictitious names Francesco (44) and Ludovica (40), to discover that they were carriers of both mutations.

In Ludovica’s case, she was already a mother of two children. And the doctors decided to proceed with the prophylactic removal of her ovaries. In Italy, free access to the HPV and CA125 Lab tests should be guaranteed. This applies to both patients with ovarian organ diseases and their first-degree relatives. It should be a uniformly guaranteed right in all regions. However, in too many cases, thanks to decentralised health management, this does not happen. «Women must be aware of this opportunity and anticipate rather than postpone checks – concludes the former patient -. With this approach, and have been lucky enough to meet valid professionals, I learned that the word tumour is not always synonymous with death.”

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