14.10.2024
In a three-part news special, Gynecologists on the Internet presents three interviews with renowned experts in gynecological oncology. In the first interview, Prof. Dr. med. Gerhard Gebauer important questions about ovarian cancer.
Our expert on the subject of ovarian cancer: Prof. Dr. med. Gerhard Gebauer (gynecology and obstetrics, focus on gynecological oncology, special operative gynecology, senior breast surgeon), chief physician at Asklepios Klinik Barmbek, Hamburg.
Origin
Ovarian cancer is the second most common disease of the female genital organs. What causes and risk factors can be identified in relation to the disease?
Why women develop ovarian cancer is still largely unknown. However, in some patients there are genetic changes that significantly increase the risk of developing breast or ovarian cancer. In these patients, these diseases typically run in families. For such constellations, genetic counseling is important in order to better assess the patient’s individual risk before the disease possibly occurs.
What makes this disease so dangerous?
Ovarian cancer is the cancer in gynecology with the worst prognosis. A main reason for this is that ovarian cancer does not cause any symptoms for a long time and can only be detected in an advanced stage with spread to many parts of the abdominal cavity. Which then requires very extensive and stressful therapy.
Treatment
What are the chances of recovery?
The optimal coordination of surgical and drug therapy is crucial for the treatment of ovarian cancer. Nevertheless, even with optimal treatment, most patients suffer a relapse within 5 years and require renewed therapy. In order to ensure such optimal treatment, patients should generally be treated in a specialized center, such as those available with the certified gynecological cancer centers in Germany.
What are therapy methods like?
The first step of therapy usually consists of surgical treatment, in which the diagnosis can be made through a tissue examination and then all of the tumor tissue in the abdominal cavity should be completely removed. This is achieved in around 50-60% of cases in specialized gynecological cancer centers. The operation is then followed by chemotherapy. As a relatively new treatment option, so-called drug maintenance therapy is usually carried out afterwards, which can further reduce the risk of relapse.
What are the biggest challenges in treatment?
Ovarian cancer requires very stressful and extensive therapy. This is especially true for surgery. In order to be able to remove all ovarian cancer deposits in the abdominal cavity, extensive interventions on the intestines, spleen, liver, diaphragm, etc. are often required. Such complex surgical measures require a very well-coordinated team from gynecological oncology, anesthesia, intensive care medicine and visceral surgery. It is crucial that the patient – as soon as the diagnosis of ovarian cancer is made – is treated in a specialized center that ensures such surgical expertise.
Early detection and prevention
What preventative and early detection measures are there?
For many years, intensive work has been carried out to detect ovarian cancer earlier in order to improve the prognosis on the one hand and to enable less intrusive therapies on the other. Unfortunately, all studies involving ultrasound examinations or tumor markers have so far not been successful. Therefore, to date there is no suitable early detection of ovarian cancer.
Future
What opportunities do you see for the future?
The introduction of so-called drug maintenance therapy has resulted in a significant improvement in the prognosis, especially for women with genetic ovarian cancer. However, we still lack tumor biological markers that allow us to use drug therapy in a more targeted manner and to identify those patients who, after surgery, chemotherapy and maintenance therapy, actually still have microscopic remnants of the disease that would require further therapy. In addition, new molecular markers could make it possible to use drugs in an even more targeted manner in the future, on the one hand to increase their effectiveness and on the other hand to limit their side effects. A new approach for this could be the use of so-called antibody-drug conjugates. These are drugs that specifically bind to the molecular structures of tumor cells and thus deliver cytostatic drugs specifically to tumor cells.
What do you think will change in the next few years?
Even if early detection of ovarian cancer is not yet possible, there are still studies that pursue this goal with the help of new markers. It is also expected that with the help of drugs that attack certain molecular markers and metabolic pathways of tumor cells, the effectiveness of the treatment of ovarian cancer will continue to improve in the future.
This article appeared abbreviated in the publication Women’s Health and Oncology (October 2024).
