Every year, thousands of women and their loved ones around the world face the diagnosis of ovarian cancer, a disease that represents one of the main challenges for gynecologists, medical oncologists, surgical oncologists and researchers. In Spain alone, around 3,500 new cases are detected annually, and globally, the figure exceeds 200,000 diagnoses. Historically, this tumor has been one of the most difficult to detect in time, which has influenced its mortality rate.
Thanks to scientific advances, today we are talking about more effective and personalized treatments that are improving the quality of life and life expectancy of many patients.
What is ovarian cancer and why is it complex to treat?
Ovarian cancer originates when ovarian cells begin to multiply in an uncontrolled manner. Its complexity lies not only in its biology, but also in its clinical behavior: in most cases, up to 60% of patients are diagnosed in advanced stages, which limits the therapeutic options and reduces the probability of cure.
Types of ovarian cancer
Ovarian cancer is not a single disease, but a heterogeneous group of tumors with very different characteristics:
- Epithelial cancer: represents approximately 90% of cases. It originates in the outer layer of the ovary and is usually diagnosed in advanced stages.
- Stromal tumors: less frequent, they arise in the tissue that supports the ovary and produce hormones.
- Germ cell tumors: mainly affect young women and have a more favorable prognosis.
Diagnostic and treatment challenges
One of the major obstacles remains late diagnosis, as the symptoms (abdominal bloating, pelvic pain, changes in bowel rhythm) are nonspecific and can be confused with other pathologies. In addition, there is a high recurrence rate, even in patients who have initially responded to treatment. This makes a personalized and multidisciplinary approach, adapted to the molecular and clinical profile of each patient, essential.
Recent advances in the treatment of ovarian cancer.
Research has opened up new therapeutic avenues that allow for more precise, less invasive and better tolerated treatments.
More precise and conservative surgery
Surgery remains the cornerstone of treatment. Today, minimally invasive techniques are used, such as laparoscopy or robotic surgery, which allow for faster recovery and fewer complications.
For its part, cytoreductive surgery is key to radical removal of the visible tumor, a determining factor in improving prognosis.
Likewise, intraperitoneal chemotherapy techniques in advanced and/or metastatic cases have represented a paradigm shift.
Hyperthermic intraperitoneal chemotherapy (HIPEC) consists of administering chemotherapy directly into the abdominal cavity at high temperature at the end of surgery. The heat enhances the effect of the drugs and makes it possible to better reach microscopic tumor cells that may remain after surgery. Recent studies have shown that HIPEC can prolong disease-free survival in selected patients, especially in cases of interval surgery (after neoadjuvant chemotherapy) and for patients with platinum-sensitive relapse (i.e. relapse at least 6 months after completion of chemotherapy treatment).
On the other hand, in situations where cytoreductive surgery is not possible due to the extent of the disease and with insufficient response to systemic treatments, one option is to combine systemic treatments with cycles of pressurized intraperitoneal aerosol chemotherapy (PIPAC). This minimally invasive technique allows chemotherapy to be delivered as an aerosol during laparoscopy, using pressure to improve its penetration into the tumor tissues. It is a very well tolerated technique that requires only one night’s stay.
Personalized and more effective chemotherapy
Neoadjuvant chemotherapy, administered before surgery, reduces tumor size and facilitates a more effective intervention. Thanks to the analysis of the genetic and molecular profile of the tumor, doses and drug combinations are adjusted to enhance efficacy and reduce adverse effects.
Targeted therapies: a revolution in oncology.
Targeted therapies mark a turning point. They are treatments designed to act on specific alterations of the tumor:
- PARP inhibitors, especially effective in patients with mutations in the BRCA1 and BRCA2 genes, prevent tumor cells from repairing their DNA and promote their destruction, such as olaparib, niraparib and rucaparib.
- Antiangiogenic therapies, such as bevacizumab, block the formation of new blood vessels that feed the tumor.
- The use of biomarkers makes it possible to select the most appropriate therapy for each patient, improving response and reducing toxicity.
- Conjugated antibodies directed against the folate-alpha receptor, a novel way to target therapy against this receptor that is overexpressed in most ovarian tumors.
Immunotherapy in research
Although not yet part of standard treatment, immunotherapy is emerging as a promising tool. Ongoing clinical trials aim to boost the immune system’s response against tumor cells, with encouraging results in specific patient subgroups.
Recent data show promising results for the combination of PARP inhibitors, bevacizumab and immunotherapy, especially for patients without BCRA mutations or homologous recombination deficits.
Precision medicine and multidisciplinary approach
Genetic and molecular analysis of the tumor.
Precision medicine is based on an in-depth understanding of the genetic alterations in the tumor. Using genomic tests, oncologists identify key mutations and choose the most effective and least aggressive treatments. This strategy not only improves outcomes, but also allows more informed decisions to be made.
Importance of a specialized oncology team
The treatment of ovarian cancer requires close coordination between gynecologists, medical oncologists, surgical oncologists, radiation oncologists, pathologists, geneticists and psycho-oncologists. This integrated approach guarantees personalized care, both physically and emotionally, offering patients and their families continuous and humane support.
What do these advances mean for patients and their families?
Improvement in survival and quality of life
Advances have allowed many patients to experience prolonged remissions and even cures in some cases. At the same time, current treatments generate fewer side effects, which translates into a better quality of life during and after treatment.
More options, more hope
The possibility of accessing specialized centers and clinical trials opens up new opportunities for patients. Being well-informed, actively participating in therapeutic decisions and having the support of expert professionals is fundamental for going through this process with greater security and hope.
Thanks to scientific advances, therapeutic tools are now more effective, precise and humane. The combination of cutting-edge surgery, targeted therapies, personalized medicine and immunotherapy marks the beginning of a new era in the treatment of ovarian cancer.
In this path of innovation and personalized approach, IVOQA, the multidisciplinary approach unit for cancer and advanced cancer at the Viamed Santa Elena University Hospital, is a leading center in the comprehensive care of ovarian cancer. Not only do they offer access to the latest medical and surgical developments, including treatments such as HIPEC, targeted therapies and immunotherapy, but they also guarantee a rigorous assessment of each case by a multidisciplinary tumor committee.
This committee is composed of specialists in both early stage and metastatic ovarian cancer, which allows the design of therapeutic strategies tailored to the specific needs of each patient. With a scientific, human and coordinated approach, IVOQA contributes to transform the prognosis of this disease and to accompany patients with rigor and hope.
