Ovarian Cancer
"The approach to ovarian cancer requires highly specialized multidisciplinary care".
DR. ANTONIO GONZÁLEZ
DIRECTOR. MEDICAL ONCOLOGY DEPARTMENT
Ovarian cancer is the third most common gynaecological tumour worldwide, but remains the leading cause of gynaecological cancer mortality, as it is often diagnosed at advanced stages.
Although it commonly occurs after menopause, it can also affect younger women, especially those with a family history of breast or ovarian cancer, due to mutations in genes such as BRCA, BRIP1, RAD51C and RAD51D.
These genetic alterations not only increase the risk of developing the disease, but also weaken the tumour, allowing it to be treated with more advanced drugs that act more effectively. At the Gynaecological Cancer Department of the Clínica Universidad de Navarra Cancer Centre, our aim is to provide personalised, cutting-edge care for each patient.
To this end, we have a multidisciplinary team of highly qualified professionals, including medical oncologists, gynaecological oncologists, radiation oncologists, pathologists, radiologists, nuclear medicine doctors, geneticists and specialised nursing staff.
This comprehensive and collaborative approach allows us to design treatments tailored to the needs of each patient, always striving for excellence and innovation.
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What are the symptoms of anal cancer?
In almost two thirds of cases, lung cancer produces no symptoms or very non-specific symptoms. Therefore, in most cases, it is diagnosed in advanced stages.
There is no specific symptomatology and it is usually confused with that which can be produced by the digestive tract and bladder, especially if the symptomatology is persistent.
Common symptoms include:
- Abdominal bloating
- Feeling of fullness
- Feeling of gas
- Poor digestion
- Gastrointestinal transit disturbance
- Frequent urination
- Loss of appetite or weight loss without apparent cause
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes of ovarian cancer?
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 tumours have different biological behaviour and treatment. The exact cause of ovarian tumours is still unknown, although among the various theories it is accepted that incessant ovulation with the resulting scarring phenomena on the surface of the ovary may play a role.
A possible link with chronic inflammatory processes or a certain hormonal environment, such as androgens in polycystic ovary or elevated gonadotrophins in menopause, has also been accepted.
Risk factors for ovarian cancer
The main risk factors are:
- Inheritance of mutated genes such as BCRA1 and 2 which is also associated with the risk of developing ovarian cancer.
- Hereditary non-polyposis colorectal cancer syndrome (HNPCC).
- Family history: sometimes ovarian cancer can occur in more than one family member, with no known hereditary factors.
- Personal history of breast cancer.
- Age: more frequent in the post-menopause.
- Fertility: not having had children.
- Having undergone ovulation-inducing treatments, although this seems to be more related to the context of infertility itself than to the medication.
- Hormone replacement therapy with oestrogen alone.
- Obesity or high-fat diet.
How is ovarian cancer diagnosed?
The collaborative work of the Radiodiagnostic, Nuclear Medicine, Pathological Anatomy and Genomic Medicine services allows a precise diagnosis to be made in a short space of time.
The chances of survival when this type of tumour appears are closely related to whether or not it has spread outside the ovary.
It is diagnosed through:
- Clinical examination.
- Transvaginal or transrectal ultrasound.
- It has a very high diagnostic accuracy.
- Tumour markers in blood, especially CA-125.
- Imaging tests: CT scan, abdominal ultrasound or MRI.
- Surgical exploration: to confirm and treat the disease located in the abdomen.
How is ovarian cancer treated?
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.
What clinical trials do we have on Ovarian cancer?
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 NAVARRA 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?
- Ovarian cancer
- Uterine or endometrial cancer
- Uterine cervical cancer
- Vaginal tumors
- Vulvar tumors
- Gestational trophoblastic disease
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.
Our team of ovarian cancer experts
