"The approach to ovarian cancer requires highly specialized multidisciplinary care".
DR. ANTONIO GONZÁLEZ
DIRECTOR. MEDICAL ONCOLOGY DEPARTMENT
Ovarian cancer is the third most common gynecologic tumor worldwide but remains the leading cause of death in gynecologic cancer as it is usually diagnosed in advanced stages.
It usually appears after menopause, although it can arise in young women with a family history of breast or ovarian cancer as a consequence of a mutation in the BRCA gene and in other genes such as BRIP1, RAD51C and RAD51D.
These mutations also make the tumor itself more fragile and are allowing us to treat it with newer targeted drugs that destroy it more easily.
The objective of the Gynecologic Cancer Area of the Cancer Center Clínica Universidad de Navarra is to offer our patients individualized attention. To this end, we have a group of highly specialized professionals: medical oncologists, gynecologic oncologists, radiation oncologists, pathologists, radiologists, nuclear physicians, geneticists and specialized nurses.
This multidisciplinary approach allows us to personalize the treatment of each patient in a consensual manner, seeking excellence and innovation.
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What are the symptoms of ovarian cancer?
There are no specific symptoms, and the disease is often confused with symptoms of the digestive system and bladder, particularly if symptoms are persistent.
The most common symptoms include abdominal swelling, bloating, poor digestion, constipation or diarrhea, as well as a frequent urge to urinate.
There may also be loss of appetite or weight for no apparent reason. Sometimes genital symptoms appear, such as menstrual disorders, post-menopausal bleeding or pain during sexual intercourse.
The most common symptoms of ovarian tumors are:
- Abdominal pain or discomfort.
- Sensation of fullness.
- Abdominal distention.
- Gastrointestinal transit disturbance.
Do you have any of these symptoms?
You may have ovarian cancer
What are the causes?
90% of ovarian cancers develop from epithelial cells (located in the ovary and fallopian tubes), which are divided into 5 types: high-grade serous, low-grade serous, endometrioid, clear cell and mucinous.
The other tumors have different biological behavior and treatment.
The exact cause of ovarian tumors is still unknown, although among the various theories it is accepted that incessant ovulation with the consequent scarring phenomena on the surface of the ovary may have something to do with it.
The possible relationship with chronic inflammatory processes or a certain hormonal environment, such as androgens in polycystic ovary or the elevation of gonadotropins in menopause, has also been admitted.
What are the risk factors?
The main risk factors are:
- Inheritance of mutated genes such as BCRA1 and 2, which is also related to the risk of developing ovarian cancer. Hereditary nonpolyposis colorectal cancer syndrome.
- Family history: sometimes ovarian cancer can develop in more than one family member, but this is not related to known hereditary factors.
- Patient medical history of breast cancer.
- Age: occurs more frequently following menopause.
- Fertility: not having had children. Having undergone ovulation-inducing treatments, although this seems more related to the context of sterility itself than to the medication.
- Estrogen-only hormone replacement therapy.
- Obesity or a high-fat diet.
How is ovarian cancer diagnosed?
Working in collaboration with Radiodiagnostics, Nuclear Medicine, Anatomic Pathology and Genomic Medicine allows us to make a precise diagnosis in a short period of time.
Ovarian cancer is diagnosed via:
- Clinical examination.
- Transvaginal or transrectal ultrasound—a test with extremely high diagnostic accuracy.
- Tumor markers in the blood, especially CA-125.
- Imaging tests: CT, abdominal ultrasound or MRI.
- Surgical exploration to confirm and treat the disease in the abdomen.
How is ovarian cancer treated?
Molecular studies have proven to be of great importance in the selection of the most appropriate treatment for patients, which is why we perform them in all cases.
The golden rule in the treatment of ovarian cancer is the complete removal (exeresis) of the visible disease, or at least the possibility of leaving a maximum of less than 1cm of residual disease.
We have gynecologic oncologists with high surgical specialization in cytoreduction. The aim of this technique is to remove all visible tumor to increase patient survival.
Sometimes, this surgery is performed in collaboration with experts in thoracic surgery or liver surgery to eliminate the locations of the disease that may appear in the thorax or liver.
This approach has been shown, in conjunction with effective chemotherapy, to significantly improve the curability of patients suffering from this disease.
We administer intraoperative radiotherapy, a high-precision technique that is administered in a single fraction during the surgical procedure on the tumor bed or microscopic tumor residue. This direct application of the treatment respects the surrounding healthy tissues and avoids unnecessary radiation.
For some years now, it has been recommended that the postoperative chemotherapy treatment should also include hyperthermic intraperitoneal chemoperfusion in cases where optimal surgical approaches have been possible from the outset. Recent studies have shown that this strategy, combined with the complete removal of the disease as mentioned above, achieves the best results.
Our center has over twenty years of experience in the administration of hyperthermic intraperitoneal chemoperfusion.
Currently, and based on the same principles, hyperthermic intraperitoneal chemoperfusion (HIPEC) is applied during surgery following resection of diseased tissue: this technique is becoming widespread among some reference centers for treating this disease.
We perform the most innovative chemotherapy treatments such as anti-angiogenic therapies and PARP inhibitors.
Sometimes, given the areas affected by the disease, it does not seem possible to achieve the ideal goal of what is termed “optimal cytoreduction,” i.e. leaving no residual disease behind.
This assessment is based on the findings of imaging tests (CT, PET–CT) and direct information obtained through laparoscopy, making it possible to easily obtain better information about the extent of the disease and to take the necessary biopsies to determine the tumor type (sometimes it may not be of ovarian origin and might require another approach).
Compared with laparotomy, where a large incision is made in the abdomen, this technique allows treatment with neoadjuvant chemotherapy (NAC), which is associated with new antiangiogenic treatment to be started within a few days if the possibility of optimal surgery is ruled out.
NAC is used to reduce the tumor volume, usually after three or four cycles, so that the desired surgical treatment can be carried out (interval surgery), which has the same goal as in primary surgery: to leave no visible disease behind.
Naturally, where necessary, this requires the same strategy for technical procedures and the use of the same surgical equipment as for the initial surgery. After this surgery, the patient completes treatment with a few more cycles of chemotherapy.
Some ovarian cancer patients may experience a relapse. In this case, depending on the time elapsed since the end of chemotherapy until the relapse diagnosis and the location and extent of the disease (in the liver, spleen, pelvic bone metastases or exclusively intestinal, etc.), these patients would once again be candidates for surgical treatment to pursue the same goal, i.e. to not leave any visible residual disease.
This would require a strategy similar to the treatment of the disease when it first appeared: appropriate surgery followed by chemotherapy.
Proton therapy for cancer
Proton therapy is the most precise external radiotherapy modality, providing better distribution of radiation dose and therefore less irradiation of healthy tissues.
The Proton Therapy Unit of the Cancer Center Clínica Universidad de Navarra in its Madrid headquarters is the most advanced in Europe and the first in a Cancer Center, with all its healthcare, academic and research support.
Where do we treat it?
IN NAVARRE AND MADRID
The Gynecologic Cancer Area
of the Cancer Center Clínica Universidad de Navarra
The Gynecologic Cancer Area is a multidisciplinary unit focused on the treatment and research of tumors of the female genital tract.
We have professionals of recognized national and international prestige, considered opinion leaders in their field, who over the years have formed a team that places the patient at the center of its activity.
What diseases do we treat?
Why at the Clinica?
- High surgical specialization.
- Focused on the patient.
- State-of-the-art diagnostic and therapeutic technology.
- Research and clinical trials to offer the most innovative treatments.