Ovarian cancer is a rare tumor that is difficult to detect

As with most tumors, The risk of developing ovarian cancer increases with age. Its diagnosis is more common in women over 63 years of age and is rarely detected in patients under 40 years of age. Although this cancer accounts for only 3% of all female tumors, it is considered fifth cause of cancer death in women. It is expected that in 2024 more This disease will be diagnosed in 3,716 women. Of these, about 300 are in the Valencian Community.

Early detection faces many challenges, including the lack of effective screening tests and the nonspecific nature of symptoms.

Although ovarian cancer is not one of the most common tumors, it is leading cause of death from gynecological cancer, so discover it in the early stages, when the cure rate is about 90%, This is one of the main problems facing oncology. However, as explained by Dr. Josep Sanchis, clinical director of the gynecology service of the Valencia Institute of Oncology Foundation (IVO), unlike other types of tumors, there is currently “no effective method for early detection of ovarian cancer, which explains why In 70-80% of cases, the diagnosis is made in late stages.“

Besides, the nonspecific nature of your symptoms, which can be confused with other ailments, such as digestive ones, represents another of the great difficulties encountered in its timely diagnosis. He Dr. Ignacio Romerojunior doctor on the IVO Medical Oncology Service, looks at some of the symptoms you should look out for, such as “bloating due to fluid build-up, feeling of being full of light foodwhich may be accompanied discomfort in the pelvic area, changes in bowel rhythm and, less commonly, the appearance of vaginal bleeding between menstrual cycles or in women during menopause. For any of them, experts advise contacting a specialist to conduct appropriate tests.

“Cases detected at early stages have a good prognosis and About 90% of patients will be cured. For this purpose, routine gynecological examinations are carried out through a gynecological examination and “Vaginal ultrasound plays a fundamental role” they indicate from IVO.

Risk factors

In addition to symptoms, it is also important to know what other risk factors may predispose you to ovarian cancer: “Age, lack of pregnancy, postmenopausal estrogen intake“or genetic inheritance” are some of the risk factors associated with the development of this tumor,” says Dr. Ignacio Romero, who explains that when a familial or genetic burden is identified, early detection programs and even preventive surgeries are developed. .

From my side, using contraception for more than five years, breastfeeding, pregnancy or a healthy diet, “These are some factors that can help reduce your risk of getting this disease.”

Multidisciplinary approach

International Reference Center for the Diagnosis and Treatment of Cancer, IVO was a pioneer more than 45 years ago. offering a comprehensive approach in Spain through its oncology committees, as Dr. Romero explains: “The complexity of this disease makes it necessary 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 scientists participate, review the patient’s medical history and make joint decisions. The organization, which is “the key to providing a very complete view of each patient,” emphasizes IVO.

Achievements and new directions of research

The identification of various ovarian tumors, genetic causes, and the search for predictive biomarkers of drug response have focused research on this disease in recent years. “The most important advances in cancer treatment come from advances in identifying various ovarian tumors at a deep level, with significant improvements at the molecular level. This has allowed us to have tools to know better in each case the prognosis and the treatments that will be applied,” says Dr. Ignacio Romero, emphasizing that advances go hand in hand with the identification of genetic causes, such as, among others, BRCA1 and BRCA2 genes. “Today, cases of genetic predisposition are routinely screened for almost all malignant ovarian tumors in conjunction with genetic counseling departments and a molecular biology laboratory. And this, coupled with the development of targeted therapies such as PARP enzyme inhibitors, which we have been involved in clinical development, allows us to use them every day.”

In this sense, Raquel Lopez ReigResearcher at the Molecular Biology Service of the Institute of Higher Education, assures that ovarian cancer is one of the priority areas of research in her laboratory and they are focused on search for predictive biomarkers of drug response. There are two main research areas in IVO LBM. On the one hand, the study of genome instability as a biomarker of response to PARP inhibitors. To this end, and based on the group’s previous research, a technology called low-coverage sequencing is being developed. “This new approach allows us to achieve higher throughput when processing sequencing data. Thus, with this new technique we will not only obtain tumor genomic instability status, but also the various available genomic markers, such as tumor mutational burden (TMB) or mutational signatures.”

Another main direction of the laboratory is focused on the search for biomarkers and patterns of response to immunotherapy based on transcriptomic and metagenomic analysis of the tumor and its microenvironment using machine learning methods.

How is ovarian cancer treated?

As Dr. Josep Sanchis explains: “Surgery continues to be the fundamental basis of treatment for these patients, although new biological treatments known as targeted therapies have been developed in recent years with promising results.” It also highlights the evolution of surgery due to technological advances. “Although some methods, such as laparoscopy allowed for greater precision and better preservation of organs, great surgical advances were achieved thanks to robotic surgery. This surgical procedure allows the most complex gynecological procedures to be performed in specific situations with a higher success rate. Robotic or minimally invasive surgery can now be used safely in most cases. early cases of ovarian cancer and in particular in some isolated cases in later stages.”

Thus, treatment consists of surgery. Primary cytoreduction to remove as much tumor tissue as possible. followed by platinum-based chemotherapy. In the early stages, surgery will involve removing the tumor for diagnosis and taking a biopsy to rule out the presence of hidden metastases. In later stages, the goal will be complete elimination of the tumor, which will require a complex of surgical interventions at the gynecological, urological, intestinal and/or thoracic level.

After surgery in most cases adjuvant systemic treatment with traditional intravenous chemotherapy followed by other supportive targeted medications that help reduce the risk of relapse. “Radiation therapy is effective for gynecological tumors to a limited extent. like the pelvis, but ovarian cancer can spread throughout the entire abdomen, so radiation is not part of the initial post-operative treatment, but chemotherapy can eliminate microscopic residual disease after surgery,” comments Dr. Jose Luis GuinoClinical Head of the Brachytherapy Department of the Radiation Oncology Service of the IVO.

For its part, radiation therapy may help control disease in cases of lymph node recurrence or in areas that recur after a second surgery in limited areas. “If possible, stereotactic body radiation therapy, or SBRT, is used, which allows high doses to be delivered to very small areas, avoiding nearby organs at risk such as the bowel, rectum, bladder or kidneys. Irradiation of metastases in the bones, lungs, or brain is also helpful, reducing tumor growth and improving symptoms. In these cases, radiation therapy is given after one or two weeks with minimal side effects.”

The importance of collaboration

In addition, they are developing collection of primary cell lines, created from tumor tissue from patients, which will be used as a platform for screening available and developing treatments in order to select the drug that is best tailored to the characteristics of the tumor being analyzed. “So we can better understand tumor biology and to develop and select personalized treatments,” he notes. researcher Raquel Lopez Reigwhich emphasizes that the development of projects of this type is possible through national and international collaboration with other research groups specialized in this field.

A collaboration that is also emphasized by Dr. Ignacio Romero: “This is in our DNA, thanks to our 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 in ovarian cancer, and this involves going beyond what we do today and developing new strategies. That’s why the key is to use the underlying knowledge, integrate and participate in the development of new drugs, such as new antibodies in combination with chemotherapy.”