Ovarian cancer is the fifth most common tumor diagnosed in women and the most lethal gynecologic cancer. It affects 1 in 70 women and is most frequent between 45-75 years of age. In Spain around 3500 cases are diagnosed each year, representing 5.1% of cancers among women, behind breast, colorectal and uterine cancer. Its high mortality rate (about 1900 cases per year) is due to the fact that up to 70% are diagnosed at an advanced stage.
What types of ovarian cancer are there?
It is currently known that there are at least four histological subtypes (serous, mucinous, clear cell and endometrioid), each with different molecular alterations that lead to a different evolution and, therefore, a different response to treatment.
What factors increase the risk of ovarian cancer?
There are certain factors that can increase the risk of ovarian cancer, including: nulliparity, endometriosis, early menarche and late menopause, as well as genetic factors. Between 10-15% of ovarian cancers are of hereditary origin, triggered by two pathologies: Lynch Syndrome and Hereditary Breast and Ovarian Cancer Syndrome.
What are the symptoms of ovarian cancer?
In the early stages it does not usually produce any symptoms and the diagnosis is usually a chance finding in a gynecological check-up. In advanced stages of the disease, the symptoms are non-specific; abdominal pain and distension, dyspepsia, heartburn, increased frequency of urination… The clear symptoms that can make us suspect ovarian cancer are: presence of ascites, adnexal mass, sensation of rapid gastric fullness and the existence of a palpable abdominal mass. Screening for early diagnosis of ovarian cancer has not proven to be effective.
What is the best treatment for ovarian cancer?
For advanced stage ovarian cancer the standard treatment is optimal cytoreductive surgery with zero gross residual disease followed by adjuvant chemotherapy with carboplatin + paclitaxel every 21 days for six cycles with or without bevacizumab followed by maintenance bevacizumab in patients at high risk of relapse.
The advent of new therapeutic targets such as PARP inhibitors is changing the landscape of women with ovarian cancer, so it is now necessary to know the BRCA status of these women at the time of diagnosis.
Treatment studies combining PARP inhibitors with antiangiogenics and even immunotherapy are currently being developed.