Treatment of Ovarian cancer

Symptoms

At the early stages, the symptoms of ovarian cancer are similar to those ones of benign tumors, i.e. they are virtually absent. Often, even large-size ovarian tumors do not bring any discomfort to the patient and do not cause menstrual irregularities.

Symptoms of ovarian cancer, such as bloating or discomfort in the lower abdomen, heaviness, difficulty urinating and defecating, constipation, pain, leg swelling, and thrombosis (caused by compression of the pelvic vein by the tumor), indicate a significant tumor size and a high probability of metastasizing. Due to the late treatment start, patients with ovarian cancer have a tumor that reached a significant size.

In addition to visiting the gynecologist regularly, indirect symptoms will also help to identify the development of ovarian cancer, affecting the hormonal background of the patient.

Considering the "secrecy" of ovarian cancer and the lack of regular preventive examinations, almost 80% of ovarian cancer cases are diagnosed at advanced stages.

Diagnosis making

It is important to understand that making the diagnosis and screening for the disease are not the same thing. Screening includes the assessment of potential indicators of the disease and is performed in healthy people in order to identify disease risks. Diagnostics establishes or excludes the presence of the disease and is carried out based on patient complaints or clinical manifestations (symptoms).

Tests and studies used for diagnostics in women with ovarian cancer include:

• Gynecological examination
• Transvaginal ultrasound scan
• CT scan or MRI of the abdomen 
• General urine analysis, complete blood count and biochemical blood test, blood test for tumor markers
• Chest X-ray (allows assessing the spreading of the tumor process to the lungs)
• In the case of a family history of ovarian cancer or breast cancer – genetic counseling and a genetic test to identify gene mutations
• Taking a tissue sample for histological examination at the preoperative stage (diagnostic laparoscopy) or intraoperatively (at the time of tumor removal)

The prognosis depends on many factors, including the stage of the diagnosed tumor, the general health state of a patient with ovarian cancer, and response to therapeutic measures.

Treatment options

Currently, there are different treatment options for ovarian cancer.

Ovarian cancer treatment is most often conducted with the help of surgery. Chemotherapy for ovarian cancer treatment implies the use of its systemic type. The scheme of chemotherapy administration may vary, with the specific therapeutic regimen for every stage of the disease. Most often, chemotherapy is combined with targeted therapy. Targeted therapy implies using medications with the specific action on cancer cells in administration of which healthy cells remain intact.

Radiation therapy is rarely used for ovarian cancer treatment because there’s not enough evidence of the efficacy of its usage, although it can be used with palliative aims.

Surgery

Undoubtedly, the main method of treatment for patients with ovarian cancer at the early stages is the surgical one. The surgical intervention for the treatment for ovarian cancer should be the most complete. It includes removal of the uterus with fallopian tubes and ovaries on both sides in combination with resection of the greater omentum.

The operation can be performed both by means of laparotomy and from the laparoscopic approach if the spreading of the process and the small size of the tumor allow it.

If during diagnostic laparoscopy it is detected that a patient has a widespread tumor process, a biopsy of the tumor is performed. It is followed by the administration of preoperative polychemotherapy, taking into account the tumor histotype. Polychemotherapy aims to reduce the volume of tumor and achieve partial regression or shrinkage of the tumor. That will create conditions for the subsequent radical surgical treatment. In addition, laparoscopy can be used in the future as a "second-look" operation to monitor the state of clinical remission after the performed treatment.

Laparoscopy is much more sparing for the patient. Thus, the laparoscopic approach can be successfully used at all stages of examination and treatment of patients with ovarian cancer, both for diagnosis making and treatment.

Chemotherapy

All patients with ovarian cancer who have undergone surgery need additional chemotherapy. Chemotherapy is indicated in the following cases:

• Before the surgical intervention, in order to improve its effectiveness and reduce the volume of surgery
• In the case when it is impossible to remove the tumor, which significantly increases the survival rate
• At the third or fourth stage of the disease, or after undergoing partial (palliative) surgery, in order to suppress the growth of the tumor
• With radical removal, in order to reduce the risk of metastasizing and development of relapses

After surgical treatment of ovarian cancer has been performed, chemotherapy treatment should be started in almost all cases. Usually, it includes 3-4 courses, but it can be prolonged if necessary. Immediately after the operation, the woman must undergo the first course of treatment. The next ones are scheduled in 2 months and 6 months after the operation. If necessary, it is possible to undergo chemotherapy courses every six months.

Transarterial chemoembolization for ovarian cancer

Today, treatment for ovarian cancer is almost impossible without chemotherapy. But we all know that intravenous therapy not only destroys cancer cells but also negatively affects the entire body. Fortunately, medicine is constantly evolving, introducing additional high-tech methods of treating malignant pathologies.

One of them is transarterial chemoembolization for ovarian cancer.

This method allows for the precise delivery of the chemotherapy drug to the tumor through special "microspheres" that accumulate the chemotherapy drug in their structure.

Ovarian cancer is intensively supplied with arterial blood. Therefore, during transarterial chemoembolization for ovarian cancer, the drug is injected purposefully into the arterial vessel feeding the tumor. In transarterial chemoembolization for ovarian cancer, the blood flow is partially blocked with the help of these substances, creating a trap and stopping the supply of the tumor. During about 7-14 days, the chemotherapy drug is "washed off" into the tumor, providing a prolonged therapeutic effect of transarterial chemoembolization for ovarian cancer, due to which the malignant neoplasm shrinks.

Why is HIPEC for ovarian cancer used?

Many oncological pathologies that develop in the abdominal cavity or close to it affect the peritoneum (abdominal membrane). Cancer cells are often found there when tumors are originating in proximity. It relates to ovarian cancer as well, at its advanced stages.

In HIPEC for ovarian cancer (hyperthermic intraperitoneal chemotherapy):

• Hyperthermia (heating of the chemotherapy drugs before entering the body) increases the killing impact of the selected chemotherapeutic substance on ovarian cancer cells
• The heat itself has a powerful antitumor influence
• Many tumor manifestations that the patient with ovarian cancer might have can be controlled

However, HIPEC for ovarian cancer isn’t indicated to patients with metastatic lesions beyond the abdominal region. HIPEC for ovarian cancer treatment isn’t used when there’s no possibility of all metastases destruction.

Clinical trials

Treatment of ovarian cancer becomes more successful every year thanks to elaboration of more effective and safer medicines in long-term and multicenter international clinical trials. A phase 1 of a clinical trial examines the safety and tolerability of an investigational drug in healthy volunteers. During the subsequent phases with the participation of patients, the effectiveness is determined, the safety and tolerability of the experimental therapy are clarified, including its comparison with the officially accepted standards for the treatment of the disease.

As a rule, the quality of international clinical trials is controlled by research sponsors, as well as by the international and domestic regulatory authorities.

International clinical trials are conducted in full compliance with current international rules and requirements of national legislation. To conduct clinical trials in hospitals, a consent of the ethical commissions at the medical institutions where the selected hospitals operate is required.

In order to participate in clinical trials, you need a doctor's opinion on this as well as your documented consent.

Ovarian cancer screening

Screening in medicine is a study (or several studies), with the help of which it is possible to identify a particular disease at an early stage when there are no symptoms yet. Screening is carried out with a certain regularity for people with medium risk or increased risk of developing a particular disease.

Ovarian cancer screening includes:

• Transvaginal ultrasound of the ovaries (ovarian cancer is well visualized by the ultrasound waves)
• A blood test for the tumor marker of ovarian cancer CA125 – a protein-antigen that is produced by cancer cells, therefore, its blood level increases in women with ovarian cancer

Why undergo treatment in hospitals abroad?

When the oncological diagnosis is detected, in four cases out of ten patients consider the option of undergoing treatment abroad. And this is reasonable, as the possibilities of European hospitals are ahead of the level of cancer centers outside the EU. In oncology hospitals in Europe, advanced methods and drugs are used for cancer treatment, surgery is at a high level, and the strict control of diagnostic and treatment protocols excludes the possibility of medical error.

Doctors in European hospitals do not perceive the diagnosis of cancer as a sentence, even when it comes to difficult cases, and the medical staff is friendly and positive.

Specialists of European hospitals are committed to teamwork. The employees are well trained and they constantly improve their knowledge and skills. Hospitals pay attention to continuous professional development, which allows specialists to achieve great results when prescribing anticancer care.

In addition, foreign hospitals have quality management systems implemented and certified. Medical technology is only modern and safe, and this is obvious.

Hospitalization of a new patient can be as quick as possible in order to avoid deteriorating health while waiting for treatment. Patients with severe health conditions are first offered help in foreign hospitals.

To receive a consultation about the best hospital for treatment of your diagnosis, leave a request on the Booking Health website.

The cost of treatment abroad

When choosing a country, it is necessary to take into account the ratio of the quality of treatment and its cost. The cost of treatment consists of hospital services (consultation of a doctor, diagnosis making, treatment, rehabilitation, and hospitalization).

To make it easier to navigate, we collected information about the cost of treatment in different countries:

• The cost of treatment with chemotherapy in Germany starts at 4,301 EUR. The minimal price for treatment in Turkey is 2,477 EUR. The minimal price for treatment in India is 4,844 EUR.
• The cost of treatment with CRS and HIPEC in Germany starts at 38,009 EUR. The minimal price for treatment in Turkey is 29,257 EUR. The minimal price for treatment in Israel is 64,454 EUR.
• The cost of treatment with laparoscopic salpingo-oophorectomy in Germany starts at 10,744 EUR. The minimal price for treatment in Turkey is 6,971 EUR. The minimal price for treatment in India is 15,562 EUR.

The average price of oncological rehabilitation after ovarian cancer treatment is 1,190 EUR per day, the minimum price is 1,041 EUR per day, and the maximum price is 1,553 EUR per day. Contact Booking Health to specify prices for undergoing treatment abroad for your diagnosis.

Undergoing treatment abroad with Booking Health

There are many peculiarities of organizing the treatment abroad. There are options out there that will save your time and money. One of them is using the services of the medical tourism agency.

Booking Health is the company with years of experience in medical tourism. Booking Health will help prepare medical documents, issue a medical visa even during the lockdown, organize the flight, accommodation, and transfer for you, and provide you with support throughout the whole duration of treatment abroad.

Booking Health will be happy to assist you in the organization of treatment abroad and provide you with hospital options that suit you in terms of financial and other matters.

Leave a request on the Booking Health website, and a medical advisor will contact you shortly.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Cancer Research Institute

Cancer Treatment Centers of America

Johns Hopkins Medicine