Key facts about ovarian cancer in this infographic

Ovarian cancer: key data

Ovarian cancer is one of the most serious gynecologic tumors. It is often diagnosed at advanced stages because at first it does not cause specific symptoms.

Here we summarize the incidence and mortality figures, the risk factors, the warning symptoms, the diagnostic tests and the treatment options we offer at Quenet Torrent Institute.

Epidemiology and risk factors

Incidence: Ovarian cancer accounts for 3-4% of all cancers in women, with approximately 3,300 new cases diagnosed each year in Spain. It is the fifth most common cancer in women and the most lethal of the gynecologic tumors.

Age at presentation: The average age at diagnosis is 63, and it is uncommon before 40. The risk increases steadily with age, especially after menopause.

Main risk factors:

• Genetics: Mutations in the BRCA1 and BRCA2 genes increase the risk to as much as 40-60%. Lynch syndrome also increases the risk.

• Family history: Having first-degree relatives (mother, sister, daughter) with ovarian cancer doubles or triples the risk.

• Nulliparity: Not having had children is associated with a higher risk, while each full-term pregnancy reduces the risk by about 10%.

• Older age: More than 50% of cases occur in women over 65.

• Endometriosis: Women with endometriosis have a 2-3 times higher risk of developing certain subtypes of ovarian cancer.

• Long-term hormone replacement therapy: Long-term use (more than 5-10 years) may slightly increase the risk.

Protective factors: Using oral contraceptives for 5+ years reduces the risk by up to 50%. Prolonged breastfeeding and tubal ligation also offer some protection.

Symptoms and warning signs

Ovarian cancer is known as the "silent killer" because in its early stages it rarely causes symptoms. However, when symptoms are present, the most common include:

Abdominal and pelvic symptoms:

• Persistent abdominal bloating: A feeling of swelling that does not improve with changes in diet or usual medication

• Chronic pelvic or abdominal pain: Constant or intermittent discomfort in the lower abdomen or pelvis

• Early satiety: Feeling full quickly when eating or finding it hard to eat normal amounts

• Changes in bowel habits: New constipation or diarrhea with no apparent cause

Other possible symptoms:

• Changes in the menstrual pattern or postmenopausal bleeding

• Increased urinary urgency or needing to urinate more often

• Unexplained fatigue and unintentional weight loss

• Pain during sex

• An increase in waist size without weight gain elsewhere

Important: If you have any of these symptoms persistently (more than 12-15 days a month) for more than 2-3 weeks, see your gynecologist for a complete evaluation, especially if you have risk factors.

Diagnosis: tests and biomarkers

Physical and gynecologic examination: A pelvic exam can detect ovarian masses, but it has limitations for diagnosing early cancer. That is why it is completed with imaging tests.

Transvaginal ultrasound: The first imaging test. It shows the ovaries and allows assessment of size, the characteristics of masses (solid, cystic, mixed) and blood flow using Doppler. Sensitivity of 80-90% in expert hands.

CA-125 tumor marker: A protein that is raised in about 80% of advanced epithelial ovarian cancers. However, it can be normal in early stages and rise in benign conditions (endometriosis, fibroids, pelvic inflammation).

Contrast-enhanced chest and abdominal CT: Assesses the extent of the disease, the presence of ascites, peritoneal implants, involvement of neighboring organs and lymph nodes. It is used to plan surgery.

Pelvic MRI: Provides more anatomical detail than CT to characterize complex ovarian masses and plan complex surgery.

PET-CT: Useful in selected cases to detect hidden disease, especially in recurrences or to assess response to treatment.

Diagnostic laparoscopy: In doubtful cases, it allows direct visualization of the ovaries, biopsy and accurate surgical staging.

BRCA genetic test: Recommended for all patients with high-grade serous epithelial ovarian cancer, regardless of family history, because it determines treatment options (PARP inhibitors) and allows genetic counseling for the family.

Stages of ovarian cancer

The FIGO classification (International Federation of Gynecology and Obstetrics) divides ovarian cancer into four stages:

Stage I: Tumor limited to one or both ovaries. 5-year survival: 85-95%

Stage II: Extension to other pelvic organs (uterus, tubes, bladder, rectum). 5-year survival: 70-80%

Stage III: Peritoneal spread outside the pelvis and/or involvement of retroperitoneal lymph nodes. It is the most common stage at diagnosis (60-70% of cases). 5-year survival: 30-50%

Stage IV: Distant metastases (liver, lung, pleura). 5-year survival: 15-30%

70% of cases are diagnosed at advanced stages (III-IV), which explains the high mortality of this disease.

Treatment: a multidisciplinary approach

Cytoreductive surgery: The basis of treatment. The goal is optimal cytoreduction (R0), that is, leaving no visible residual tumor. Achieving it improves survival considerably.

Surgery can include: bilateral oophorectomy, hysterectomy, omentectomy, peritonectomies, bowel resections, splenectomy and liver resections, depending on the extent of the disease.

HIPEC (Hyperthermic Intraperitoneal Chemotherapy): At Quenet Torrent Institute we use this technique. After complete cytoreductive surgery, heated chemotherapy (41-43°C) is delivered directly into the abdominal cavity for 60-90 minutes, eliminating residual microscopic tumor cells.

In selected patients with advanced or recurrent ovarian cancer, HIPEC can improve survival.

Systemic chemotherapy: Usually with carboplatin and paclitaxel. It can be given as neoadjuvant treatment (before surgery to shrink the tumor), adjuvant treatment (after surgery) or palliative treatment in advanced inoperable disease.

Targeted therapies: PARP inhibitors (olaparib, niraparib, rucaparib) for patients with BRCA mutations or homologous recombination deficiency. Bevacizumab (anti-angiogenic) combined with chemotherapy and as maintenance.

Immunotherapy: PD-1/PD-L1 inhibitors under investigation for specific subgroups with high microsatellite instability.

Prognosis and follow-up

Overall survival: 5-year survival varies widely depending on the stage at diagnosis and the quality of cytoreductive surgery:

• Stage I: 85-95%

• Stage II: 70-80%

• Stage III with optimal cytoreduction: 40-60%

• Stage III with suboptimal cytoreduction: 20-30%

• Stage IV: 15-30%

Favorable prognostic factors: Diagnosis at early stages, low-grade histology, complete cytoreduction (R0), good response to chemotherapy; a BRCA mutation paradoxically confers a better prognosis.

Follow-up: After treatment is completed, follow-up visits take place every 3 months for 2 years, every 4 months up to 5 years, and every 6-12 months after that. They include a physical exam, CA-125 and imaging tests as clinically needed.

Prevention and early detection

Genetic counseling: Women with a significant family history should consider genetic testing for BRCA mutations. Carriers may benefit from:

• Intensive surveillance with CA-125 and ultrasound every 6 months (although evidence of benefit is limited)

• Bilateral prophylactic salpingo-oophorectomy from the age of 35-40 or once they no longer wish to have children (reduces the risk by 80-95%)

Oral contraceptives: Using them for 5+ years reduces the risk by up to 50%, a benefit that persists for decades after stopping them.

Attention to symptoms: There is currently no effective population screening. What helps most to detect it earlier is paying attention to persistent symptoms and seeing a gynecologist early.

Why choose Quenet Torrent Institute?

At Quenet Torrent Institute we focus on complex gynecologic oncological surgery. Our team has trained at international centers and takes part in clinical research.

We offer:

• Complete cytoreductive surgery by surgeons experienced in advanced ovarian cancer

• HIPEC with validated protocols and internationally published results

• A multidisciplinary approach with weekly oncology committees

• Access to clinical trials

• Personalized care throughout treatment