Ovarian cancer
In Switzerland, around 600 women are newly diagnosed with ovarian cancer every year, and over 400 women die as a result. There is no real age peak, which means that the older the woman is, the higher the risk of disease. This is usually determined at an advanced stage, as no preventive measures allow early detection. In some cases, a pre-cancerous stage is diagnosed, so-called borderline tumors, which require extensive surgery but have a good prognosis and do not require chemotherapy.
Genetics is playing an increasingly important role, because it is not uncommon for ovarian cancer to find genetic changes that indicate a hereditary cancer syndrome (e.g. BRCA1 or BRCA2 mutation). And even if the patient’s entire genome is not affected, genetic changes in the tumor can already enable targeted therapies in certain situations. Ovarian cancer therapy usually consists of complex surgery and chemotherapy. Ovarian cancer typically spreads first in the pelvis, but then soon in the entire abdomen and often forms fluid (ascites).
Surgery
The surgical treatment of ovarian cancer is very complex, requires a lot of experience and a good interdisciplinary team, which often also requires visceral surgeons and intensive care physicians. The operation should always be carried out by experienced gynecological oncologists, as this is crucial for the prognosis. As a rule, an abdominal incision is necessary here, in which an examination of the entire abdominal cavity is possible and any tumor deposits are removed. A laparoscopy is only performed in exceptional cases. The aim of the operation is to ensure that no visible tumor remains and that chemotherapy can be started within a few weeks after the operation. Sometimes not everything can be removed, e.g. when tumor masses are located on important blood vessels in the intestine. Then it may be better not to reduce the tumor during the first operation, to start chemotherapy as soon as possible and to operate at a later time, e.g. after half of the planned chemotherapy. However, some patients are already so sick or old that an operation is out of the question.
If the tumor should come back after a certain time, then in many cases a new operation can have a positive effect on the course of the disease. This should be carefully examined by an interdisciplinary team and discussed with the person concerned.
Chemotherapy
Only in very rare cases in the early stages of ovarian cancer can this be dispensed with. Chemotherapy usually consists of the preparations carboplatin and paclitaxel and lasts for approximately six months. In some cases, this is supplemented by antibody therapy (bevacizumab), e.g. if not everything could be removed, which is intended to inhibit the formation of new blood vessels in the tumors. In the event of a relapse, other substances are also used in the course of the disease, whereby the therapy should always be based on the needs of those affected and the quality of life plays an important role in this. The intra-abdominal chemotherapy advocated by some doctors, in which heated substances are given directly into the abdomen during the operation (HIPEC), is an experimental procedure and the benefits against the risks cannot be weighed with certainty. This method cannot currently be recommended in the treatment of ovarian cancer outside of controlled clinical studies.
Radiotherapy
Radiation therapy plays a subordinate role in the therapy of ovarian cancer and is only used in individual cases in the relapse situation.
Outlook
The knowledge from laboratory and clinical research is currently leading to positive advances in the treatment of ovarian cancer. Thanks to clinical studies, we know that we usually have to operate on the lymph nodes less aggressively than previously thought, which leads to faster recovery and fewer problems with lymphatic congestion. In the event of a relapse, a new operation should always be considered; this can often be useful. Genetic analyzes of the germ line of those affected or of tumors provide the opportunity for new therapies that, under certain conditions, e.g. gene mutations, can be used with fewer side effects than chemotherapy.
Molecular biological methods will allow us to better classify the different types of ovarian cancer in the foreseeable future, so that we will probably soon forego chemotherapy for some subgroups of ovarian cancer and have other options, but this must first be checked in clinical studies.