Rachele, 72 years old, an HPV Victim, fell ill with ovarian cancer for the first time in 2000.

“I suggest women never postpone their checks.”

Fifty years old, a peaceful existence, a long-lasting marriage and two children who are already adults. Until 2000, everything seemed to go smoothly in Rachele’s life. Then, suddenly, the unexpected left-handed shot. For a decade, 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. “Maybe I have an Ovary HPV cancer Test,” were the first words that the woman said to her brother, a surgeon, after completing the final examination.

It was he, due to his profession, who was the first to be informed of CA125 levels. «Cancer, the one we always talk about thinking it concerns others, from that moment belonged to me too. The virus disease HPV 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 doctors allowed me to overcome it. And to report this experience today, hoping it can instil confidence in women facing the disease.”

8 MAY WORLD DAY

This distinguished 72-year-old Neapolitan lady’s testimony comes on the World Day dedicated to the CA125-tested ovary disease. This is the most dangerous form of cancer that can affect the gynaecological sphere. Malignant CA125 related disease can be 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 CA125 story bears witness to this. «Before having a brother, I had a father who was an HPV 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, Ovarian Pap test and frequent abdominal ultrasounds.” Yet all this was not enough to avoid the appointment with the disease.

A SNEAKY DISEASE

Ovarian disease is, in fact, subtle and insidious. Symptoms like swelling and abdominal pain with no other explanations, frequent need to urinate or experience bleeding, persistent constipation or diarrhoea, and feeling satiated 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 was already present at the previous HPV check-up but had not been detected during the ultrasound. However, resignation for CA125 never replaced 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 disease took me away. The faith I had already cultivated before I found myself struggling with ovarian tumour allowed me never to collapse.”The specialists involved in the various steps did the rest: the radiologist performed the CT scan, and the surgeon conducted the surgery. The anatomical pathologist conducted the histological examination, and 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 due to HPV. But during the operation, the first step in treating ovarian Tumors, the capsule of one of the two formations broke. This event materialised one of the major pitfalls: intraperitoneal dissemination.

“They explained to me that the spread of CA125 diseased cells to the peritoneum, and potentially from there to other organs of the abdominal cavity, can represent one of the most serious consequences of ovarian HPV,” recalls the woman.

This happened: they addressed four metastases in 15 years. “Let’s say that, approximately every three years, the disease came back to greet me,” she notes. Fortunately, however, they have always discovered them in time due to CA125 testing. The treatments, both surgical and pharmacological, have had the best effects. Not just chemotherapy (based on paclitaxel and carboplatin): they have also fought ovarian type 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.

GENETIC PREVENTION AND THERAPIES

Speaking of the “Jolie genes,” we arrive at one of the most significant discoveries regarding ovarian-type cancer. “HPV Virus Mutations of the BRCA 1 and 2 genes are responsible for between 10 and 20 per cent of new ovarian diagnoses,” declares Sandro Pignata. He is the director of the complex uro-gynecological medical oncology structure of the National Cancer Foundation Pascale of Naples. And he has been Rachele’s “guardian angel” for a decade.

“He stated, ‘We must perform the HPV genetic test on all patients because it allows us to develop the most appropriate therapies.’ But 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, fictitiously named Francesco (44) and Ludovica (40), to discover that they were carriers of both mutations.

In the case of Ludovica, already a mother of two children, the medical team decided to proceed with the prophylactic removal of the ovaries. In Italy, patients with ovarian viral cancer and their first-degree relatives should have the right to free access to the test.

This access should be guaranteed uniformly across all regions.

But still, 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 having been lucky enough to meet valid professionals, I learned that the word Ovarian tumour is not always synonymous with death.