Ovarian cancer requires a clear histological diagnosis and a differentiated treatment approach. Depending on the characteristics of the tumor, oncologists and gynecologists perform sparing laparoscopic and open surgical procedures, photodynamic and radiation therapy. In addition to the conventional chemotherapy and administration of antiestrogens, the doctors started using in their clinical practice drugs for targeted therapy. The methods of targeted delivery of chemotherapeutic drugs to the tumor using nanoparticles are also being studied.
Local therapy for ovarian cancer
Local therapy includes surgical removal of the tumor, photodynamic therapy and irradiation of organs affected by metastases. A feature of local therapy is the targeted destruction of the primary tumor or metastases with minimal impact on healthy tissues. The treatment regimen includes one or more therapeutic methods and is developed according to the results of diagnostics. In the case of suspected ovarian cancer, the diagnostics includes:
- CA 125, CA 19-9, HE 4, CA 72-4 tumor marker testing
- AFP and β-HCG testing in suspected germ cell tumors
- Inhibin test in suspected stromal tumors
- Abdominal and pelvic ultrasound examination
- Contrast-enhanced CT scanning of the chest, abdominal cavity and pelvis
- Biopsy with histopathological examination
Surgical treatment is carried out when the tumor can be removed completely, or when the operation will alleviate the patient's condition significantly (eliminate pain, restore normal bowel function, etc.). The following types of surgical procedures can be performed to treat ovarian cancer:
- Unilateral removal of the ovary. If the fallopian tube is affected, it will also be removed during the laparoscopic salpingo-oophorectomy.
- Bilateral removal of the ovaries.
- Combined removal of the ovaries and uterus.
- Surgery for advanced cancer.
The most precise and safe method of surgical treatment for ovarian cancer is surgery using the da Vinci robot. The da Vinci robotic system combines the advantages of laparoscopic procedures (small incisions of the anterior abdominal wall and minimal blood loss) with higher accuracy due to the use of an advanced set of surgical instruments. In addition to the classic light source and high-resolution video camera, the da Vinci robot has 3 arms. Presence of an additional manipulator and a volume of movements compared to the human hand allow surgeons to remove precisely even small ovarian tumors of any localization. Use of special microsurgical instruments eliminates the risk of complications development.
Photodynamic therapy can be performed during surgery or in the postoperative period. Prior to the procedure, a woman should take a phthalocyanine-based drug. Phthalocyanine is a pigment that accumulates in malignant cells and decomposes with formation of the oxygen-derived radicals under the influence of infrared light rays. Oxygen radicals oxidize the internal structures of cancer cells and destroy the tumor. Photodynamic therapy is completely safe and non-toxic for healthy tissues.
Radiation therapy is rarely used as the first-line treatment for a primary tumor, but it is effective for local and distant metastases. In particular, radiation therapy is becoming the method of choice for inoperable metastases in the brain or spinal cord. Depending on the location of the malignant focus, oncologists and clinical radiologists use targeted external radiation therapy or internal irradiation – brachytherapy.
Systemic therapy for ovarian cancer
Systemic therapy involves intravenous or oral administration of drugs that enter the systemic circulation and reach the primary tumor and metastases. Systemic treatment is effective at the advanced stages of cancer, when it is impossible to remove the whole primary tumor and micrometastases are present in the uterus, fallopian tubes, omentum, spleen or liver.
Chemotherapy for ovarian cancer is carried out in a combined mode with the use of cytostatic preparations of platinum (for example, cisplatin or carboplatin) and taxanes (for example, paclitaxel and docetaxel). The drugs are administered intravenously every 3-4 weeks. In most cases, a course of chemotherapy includes from 3 to 6 such cycles.
Hormone therapy is most effective for stromal tumors. It includes three groups of drugs that block the action of estrogen:
- Luteinizing hormone-releasing hormone agonists that directly inhibit estrogen synthesis in the ovaries
- Tamoxifen with antiestrogenic activity
- Aromatase inhibitors that inhibit the synthesis of estrogen from other steroid hormones
Targeted therapy currently includes 2 types of drugs:
- Angiogenesis inhibitors that suppress vascular endothelial growth factors (VEGF) and contribute to a decrease in tumor size.
- Poly (ADP-ribose) polymerase inhibitors (PARP) that deprive tumor cells of the ability to repair damaged DNA, which ultimately leads to their death. Thanks to the accelerated approval procedure, which the FDA conducts in exceptional cases, olaparib (Lynparza), PARP inhibitor, entered the clinical practice ahead of schedule.
Additional treatments and follow-up care
Additional methods can be used as part of an integrative therapeutic approach, along with the conventional medical interventions. Their goal is to enhance the effect of the main therapy and reduce its side effects, relieve stress and improve the patient's quality of life. These methods include:
- Yoga and gymnastics qigong
After completion of active treatment and discharge from the clinic, the woman remains under the supervision of a both gynecologist and oncologist. The list of mandatory medical examinations includes a gynecological examination, a CA 125 blood test and abdominal ultrasound scanning. They are held every 3 months during the first two years, every 4 months during the third year, and every 6 months during the subsequent years.
When complaints, pathological changes on ultrasound or the increased levels of CA 125 appear, a doctor will carry out an extended examination. It includes CT scan of the abdominal cavity and pelvic organs, as well as chest X-ray or CT scan. With the timely start of treatment using modern surgical technologies and pharmaceuticals, the five-year survival rate at the first stage of ovarian cancer reaches 90%.
Treatment of ovarian tumors abroad with Booking Health
Booking Health is an online portal where patients can investigate information about medical facilities and current treatment methods, as well as book a medical program at leading clinics in the world. Booking Health works in accordance with the requirements of ISO 9001: 2015 international certification in the field of medical tourism, which allows offering patients effective therapy in the shortest possible time.
Booking Health specialists help with the following important issues:
- Selection of the clinic specializing in oncology and gynecology
- Direct communication with your attending physician
- Preliminary preparation of a medical program, taking into account current symptoms and without mandatory repetition of previously performed tests
- Control of the cost of medical services, excluding overpricing and additional coefficients for foreigners (total savings of up to 50% of the initial price)
- Making an appointment with a doctor on the desired date
- Monitoring of the implementation of all stages of the medical program
- Insurance against the cost of treatment increase in case of complications (а coverage of 200,000 EUR, valid for 4 years)
- Assistance in buying and forwarding medicines
- Communication with the clinic after the treatment completion, organization of additional medical examinations and distance consultations
- Control of invoices and return of unspent funds
- Interpreting and medical coordinator services
- Top-class service: booking hotels, airline tickets, transfer
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova