Treatment of ovarian cancer

Ovarian cancer is a malignant neoplasm that develops in the tissues of the ovaries. It is considered one of the most aggressive gynecologic cancers, as it is often diagnosed at advanced stages due to the absence of specific symptoms in the early course of the disease. Treatment of ovarian cancer includes surgery, chemotherapy, and, in selected cases, targeted therapy. The treatment strategy depends on the stage of the disease, tumor histology, the patient’s general condition, and other clinical factors.

Stages of ovarian cancer

1. Stage I — the tumor is confined to one or both ovaries.
2. Stage II — the tumor has spread to pelvic tissues (for example, the uterus or fallopian tubes).
3. Stage III — the tumor has spread to regional lymph nodes or the peritoneal cavity.
4. Stage IV — distant metastases are present, most commonly in the liver or lungs.

Methods of ovarian cancer treatment

Treatment of ovarian cancer usually involves a combination of modalities, selected individually according to disease stage and patient-specific factors.

Surgical treatment

Surgery is the cornerstone of ovarian cancer management. The extent of surgical intervention depends on the stage of the disease.

• Cytoreductive surgery (debulking surgery). The goal is to remove as much visible tumor tissue as possible. This may include removal of the ovaries, uterus, fallopian tubes, omentum, and affected lymph nodes. Optimal cytoreduction significantly improves the effectiveness of subsequent chemotherapy.
• Bilateral salpingo-oophorectomy. Removal of both ovaries and fallopian tubes, typically performed in advanced stages or in patients at high risk of recurrence.
• Hysterectomy. Removal of the uterus, often performed together with bilateral salpingo-oophorectomy when the tumor involves adjacent reproductive organs.
• Omentectomy. Removal of the omentum, which is frequently involved by metastatic spread in ovarian cancer.

Chemotherapy

Chemotherapy is a systemic treatment using cytotoxic drugs to destroy or inhibit the growth of cancer cells. It may be administered before surgery, after surgery, or as the main treatment in advanced disease.

• Neoadjuvant chemotherapy. Administered prior to surgery to reduce tumor burden and facilitate optimal cytoreduction.
• Adjuvant chemotherapy. Given after surgery to eradicate residual microscopic disease and reduce the risk of recurrence.
• Platinum-based chemotherapy. Platinum compounds such as carboplatin and cisplatin form the backbone of ovarian cancer chemotherapy and are highly effective in most epithelial ovarian cancers.

Chemotherapy is commonly combined with agents such as paclitaxel. Treatment is usually delivered in multiple cycles at 3–4 week intervals.

Targeted therapy

Targeted therapy acts on specific molecular pathways involved in tumor growth and survival, with limited impact on normal cells. In ovarian cancer, the following targeted agents are commonly used:

• Anti-angiogenic therapy (bevacizumab). These agents inhibit the formation of new blood vessels supplying the tumor, thereby slowing tumor growth and dissemination.
• PARP inhibitors. Drugs such as olaparib and rucaparib are used in patients with BRCA1 or BRCA2 mutations. They inhibit DNA repair mechanisms in cancer cells, leading to tumor cell death.

Immunotherapy

Immunotherapy aims to stimulate the patient’s immune system to recognize and destroy cancer cells. In ovarian cancer, immunotherapy is not yet a standard treatment but remains an active area of clinical research.

Radiation therapy

Radiation therapy is rarely used in ovarian cancer because these tumors are generally less sensitive to radiation. However, it may be applied in selected cases for palliation, such as relief of pain caused by localized metastases.

Prognosis

The prognosis of ovarian cancer depends on the stage at diagnosis, patient age, tumor biology, and overall health status. Early-stage ovarian cancer is often highly treatable, with many patients achieving long-term remission. In advanced stages, recurrence is common, highlighting the importance of long-term follow-up and regular monitoring.

Prevention of ovarian cancer

Preventive strategies include:

1. Genetic testing for BRCA1 and BRCA2 mutations. Women with these mutations have a significantly increased risk of ovarian cancer. Risk-reducing strategies, including prophylactic salpingo-oophorectomy, may substantially lower this risk.
2. Regular gynecologic examinations. Routine pelvic examinations and transvaginal ultrasound can aid in early detection of gynecologic pathology.
3. Healthy lifestyle. Maintaining a healthy body weight, regular physical activity, and smoking cessation may reduce the risk of several cancers, including ovarian cancer.

Modern treatment of ovarian cancer is based on a multidisciplinary and individualized approach combining surgery, chemotherapy, targeted therapy, and emerging treatment options. Early diagnosis, regular medical follow-up, and personalized treatment planning are key factors in achieving optimal outcomes and improving survival.