As with most tumors, the risk of developingovarian cancer increases with age, being more frequently diagnosed in women over 63 years old and rarely detected in patients under 40 years of age. Despite representing only 3% of all female tumors, this cancer is ranked as the fifth cause of death for cancer in women. It is estimated that in 2024 more than 3,716 women will be diagnosed with this disease. Of them, about 300 in the Valencian Community.
Although ovarian cancer is not one of the most common tumors, it represents the leading cause of mortality from gynecological cancer, so detecting it in early stages, when its cure rate is around 90%, is one of the main challenges facing oncology. However, and as explained by Dr. Josep Sanchis, clinical head of the Gynecology Service of theValencian Institute of Oncology Foundation (IVO), Unlike other types of tumors, currently “there is no effective method for the early detection of ovarian cancer, which explains that 70-80% of cases are diagnosed at an advanced stage.”
Likewise, the non-specific nature of its symptoms, which can be confused with other ailments, such as digestive ailments, is another of the great difficulties that arise when it comes to diagnosing it in time. He Dr. Ignacio Romero, assistant doctor of the Medical Oncology Service of the IVO reviews some of the symptoms that you should be alert for, such as “abdominal bloating due to the accumulation of fluids, the feeling of ‘fullness’ with light meals, which can be accompanied by discomfort in the pelvic area, changes in intestinal rhythm and, in rare cases, the appearance of vaginal bleeding between menstrual cycles or in menopausal women. With any of them, experts advise going to a specialist to perform the relevant tests.
“Cases detected in early stages have a good prognosis and around 90% of patients will be cured. To this end, routine gynecological check-ups through pelvic examination and vaginal ultrasound play a fundamental role,” the IVO points out.
It represents the leading cause of mortality from gynecological cancer, so detecting it in early stages, when its cure rate is around 90%, is one of the main challenges faced by oncology.
Risk factor’s
In addition to the symptoms, it is also important to know what other risk factors can predispose to ovarian cancer: “Age, lack of pregnancy, postmenopausal estrogen consumption, or genetic inheritance” are some of the risk factors. risk associated with the development of this tumor,” states the Dr. Ignacio Romerowho explains that as soon as a family or genetic burden is identified, early detection programs and even prophylactic surgeries are developed.
For your part the use of contraceptives In periods longer than five years, breastfeeding, pregnancy, or healthy eating, “are some factors that can help reduce the risk of suffering from it.”
Multidisciplinary approach
An international reference center in the diagnosis and treatment of cancer, the IVO was a pioneer more than 45 years ago in offering a comprehensive approach in Spain through its Tumor Committees, as Dr. Romero explains: “The complexity of This disease makes it essential to individualize the treatment of each patient and this is possible thanks to multidisciplinary committees where specialists such as gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, molecular biologists, psychologists and nuclear doctors participate, who examine the patient’s history. patient and make joint decisions.” An organization that is “key for offering a very complete vision of each patient,” the IVO emphasizes.
Advances and new lines of research
The identification of the different ovarian tumors, the genetic causes and the search for predictive biomarkers of response to drugs have focused research in recent years on this disease. “The most important advances in cancer treatment come through the progress in the identification of different ovarian tumors at a deep level, with substantial improvements at the molecular level. This has allowed us to have tools to know better in each case the prognosis and the treatments that are going to be applied,” says the Dr. Ignacio Romero, which highlights that advances go hand in hand with the identification of genetic causes such as, among others, the BRCA1 and BRCA2 genes. “Nowadays, screening for cases of genetic predisposition in practically all ovarian malignant tumors is routinely carried out, in conjunction with the Genetic Counseling units and the Molecular Biology laboratory. And this, together with the development of targeted treatments such as PARP enzyme inhibitors, in whose clinical development we have participated, allows us to use them on a daily basis.”
In this sense, Raquel López Reig, researcher at the service Molecular Biology of the IVO, assures that ovarian cancer constitutes one of the priority lines of research of its laboratory and they are focused on searching for predictive biomarkers of response to drugs. There are two main lines of research in the IVO LBM. On the one hand, the study of genomic instability as a biomarker of response to PARP inhibitors. To do this, and based on previous studies by the group, a technology called low coverage sequencing. “This new approach allows us to obtain higher throughput from sequencing data. Thus, through this novel technique we will not only obtain the genomic instability status of the tumor, but also the different available genomic markers, such as tumor mutational burden (TMB) or mutational signatures.”
The other main line of the laboratory is focused on the search for biomarkers and response models to immunotherapy based on the transcriptomic and metagenomic analysis of the tumor and its microenvironment, through the use of techniques of Machine Learning.
How is ovarian cancer treated?
As explained by Dr. Josep Sanchis, “surgery continues to be the fundamental pillar of the treatment of these patients, although new biological therapies known as target therapies have been developed in recent years, and have provided encouraging results.” Dr. Sanchís also highlights the evolution of surgery thanks to technological advances. “Although some techniques such as laparoscopy have allowed greater precision and better organ conservation, great surgical advances have come hand in hand with robotic surgery. This surgical procedure allows the most complicated gynecological interventions to be performed, in specific situations, with a higher success rate. Currently, robotic or minimally invasive surgery can be safely applied in most early cases of ovarian cancer and specifically in some selected cases of advanced stages.”
Thus, the treatment consists of a primary cytoreduction surgery to resect as much tumor tissue as possible followed by platinum-based chemotherapy. In early-stage cases, surgery will consist of removing the tumor for diagnosis and taking biopsies to rule out the presence of hidden metastases. In the advanced stages, the objective will be the complete elimination of the tumor, which will require a set of surgical procedures at the gynecological, urological, intestinal and/or thoracic level.
After surgery, in most cases adjuvant systemic treatment with conventional intravenous chemotherapy is necessary followed by other targeted maintenance drugs that help reduce the risk of relapse. “Radiotherapy is effective in gynecological tumors in limited volumes such as the pelvis, but ovarian cancer can spread throughout the abdomen, so irradiation is not part of the initial postoperative treatment, and it is chemotherapy that is capable of eliminating microscopic residual disease after surgery,” comments Dr. José Luis Guinot, clinical head of the Brachytherapy Unit, of theIVO Radiation Oncology service.
For its part, radiotherapy can help control the disease in cases of relapse in lymph nodes or in areas that relapse again after a second surgery in limited areas. “If possible, stereotactic body radiotherapy or SBRT is used, which allows high doses to be given in very small areas, avoiding nearby risk organs such as the intestine, rectum, bladder or kidneys. Irradiation of metastases in bones, lung or brain is also useful, reducing tumor growth and improving symptoms. In these cases, radiotherapy is administered in one or two weeks, with minimal side effects.”
The importance of collaboration
In addition, they are developing a collection of primary cell lines, established from patient tumor tissue, which will be used as a screening platform for available treatments and those in development, with the aim of selecting the drug that best adapts to the characteristics of the tumor. analyzed. “In this way we are able to better understand the biology of tumors and design and choose personalized therapies,” says the researcher. Raquel López Reigwhich highlights that the development of this type of projects is possible thanks to national and international collaborations with other research groups specialized in the field.
A collaboration that Dr. Ignacio Romero also emphasizes: “It is in our DNA, with participation in international clinical trials, many of them in collaboration with GEICO, the Spanish gynecological cancer research group. There is work to be done to identify new vulnerabilities of ovarian cancer and this involves looking beyond what we do today and developing new strategies. That is why going hand in hand with basic knowledge is key, integrating and participating in the development of new drugs such as new antibodies with chemotherapy attached.”