Ovarian cancer: symptoms, diagnosis and complete treatment

Ovarian cancer is a malignant tumour that starts in the ovaries. The most common type is high-grade serous epithelial carcinoma, which accounts for about 70-80% of cases. It tends to spread early through the abdominal cavity, forming peritoneal carcinomatosis.

The most relevant risk factors are mutations in the BRCA1 and BRCA2 genes (lifetime risk of 40-60%), a family history of ovarian or breast cancer, older age, nulliparity, endometriosis (2-3 times higher risk) and Lynch syndrome. The menopause and long-term hormone replacement therapy also increase the risk.

Because in the early stages it causes hardly any specific symptoms and there is no effective population screening programme. 70% of cases are detected at stage III or IV, when the disease has already spread to the peritoneum or distant organs.

The diagnostic process includes transvaginal ultrasound, the tumour marker CA-125 (raised in 80% of advanced cancers), chest, abdominal and pelvic CT to assess extent, MRI and, in selected cases, PET-CT or diagnostic laparoscopy. BRCA genetic testing is recommended in all high-grade serous epithelial carcinomas.

The FIGO classification sets out four stages: stage I (confined to the ovary, 5-year survival above 90%), stage II (pelvic extension, 70-80%), stage III (peritoneal spread, 30-60% depending on the quality of surgery) and stage IV (distant metastases, 15-30%). Stage III is the most common at diagnosis.

Cytoreductive surgery aims to remove all visible tumour (goal CC-0 or R0). Depending on the extent, it can include bilateral oophorectomy, hysterectomy, omentectomy, peritonectomies and resections of the bowel, liver or diaphragm. It is the most decisive prognostic factor: specialised centres achieve optimal cytoreduction rates above 80-85%, compared with 40-50% in general hospitals.

HIPEC (hyperthermic intraperitoneal chemotherapy) involves delivering heated chemotherapy (41-43°C) directly into the abdominal cavity for 60-90 minutes after complete cytoreductive surgery. It is used in selected cases with peritoneal spread of ovarian origin and can increase median survival by 12-18 months compared with systemic chemotherapy alone.

The standard regimen is carboplatin plus paclitaxel for 6 cycles. It can be given as adjuvant treatment (after surgery), neoadjuvant treatment (before surgery to make resection easier, a strategy known as "interval debulking") or as maintenance to extend the disease-free time.

PARP inhibitors (olaparib, niraparib, rucaparib) are targeted therapies that have changed maintenance treatment in ovarian cancer, especially in patients with BRCA1/BRCA2 mutations. They significantly improve progression-free survival and are available both in first line and in platinum-sensitive recurrences.

BRCA1/BRCA2 mutation carriers have risk-reducing options: intensive surveillance with CA-125 and ultrasound every 6 months, and bilateral prophylactic salpingo-oophorectomy from the age of 35-40 or once they no longer wish to have children. This surgery reduces the risk of ovarian cancer by 80-95%.

Yes, especially when complex surgery is being considered or there is peritoneal spread. The quality of the first operation is the modifiable prognostic factor with the greatest impact. Our team offers a specialist assessment to review the diagnosis, the surgical plan and access to advanced therapies such as HIPEC or PARP inhibitors.

Patients treated at high-volume centres by specialised teams have better oncological outcomes, a higher rate of complete cytoreduction and lower postoperative morbidity. Access to weekly multidisciplinary committees, molecular diagnosis and clinical trials also influences the course of the disease.