Understanding Ovarian Cancer: Signs, Surgery, Chemotherapy & HIPEC

Ovarian cancer is one of the most serious gynecologic cancers because it often develops silently and is diagnosed at a later stage. However, advances in surgery, chemotherapy, and targeted therapies have significantly improved outcomes.

Key Statistics

Global

• Over 300,000 new cases are diagnosed worldwide each year.
• It is the eighth most common cancer in women globally.
• Because symptoms are vague, many cases are detected at advanced stages.

India

• Ovarian cancer is among the top 3 gynecologic cancers in Indian women.
• Most commonly diagnosed between 50–65 years of age.
• Survival improves significantly when diagnosed early.

Why Is Ovarian Cancer Called the “Silent Cancer”?

Early-stage ovarian cancer often causes no specific symptoms.

Symptoms are vague and may mimic common digestive or urinary problems.

Risk Factors

Several factors increase the risk:

• Increasing age
• Family history of ovarian or breast cancer
• BRCA1 or BRCA2 gene mutations
• Lynch syndrome
• Never having children
• Early onset of menstruation or late menopause
• Endometriosis (for certain subtypes)

Protective factors include:

• Pregnancy
• Breastfeeding
• Oral contraceptive use

Common Symptoms (Often Subtle)

Symptoms are usually persistent rather than sudden.

• Abdominal bloating
• Feeling full quickly while eating
• Pelvic or abdominal pain
• Increased urinary frequency
• Unexplained weight loss
• Change in bowel habits
• Ascites (fluid accumulation) in advanced cases

Types of Ovarian Cancer

Understanding the type is crucial because treatment differs.

1. Epithelial Ovarian Cancer (Most Common – ~90%)

Includes:

• High-grade serous carcinoma (most common)
• Endometrioid carcinoma
• Clear cell carcinoma
• Mucinous carcinoma

High-grade serous type is often diagnosed at advanced stage.

2. Germ Cell Tumors (Younger Women)

• Dysgerminoma
• Yolk sac tumor
• Teratoma

Often highly treatable with chemotherapy.

3. Sex Cord–Stromal Tumors

• Granulosa cell tumor
• Sertoli-Leydig tumor

These behave differently and may produce hormones.

How Is Ovarian Cancer Diagnosed?

There is no reliable screening test for the general population.

Diagnosis may involve:

• Ultrasound (transvaginal preferred)
• CT or MRI scan
• Tumor markers (CA-125, HE4 in selected cases)
• Diagnostic laparoscopy
• Surgical staging

Definitive diagnosis requires tissue examination.

Treatment of Ovarian Cancer

Treatment depends on:

• Stage of disease
• Tumor biology
• Molecular profile
• Patient’s overall health

Role of Surgery – Cytoreductive Surgery

Surgery is the cornerstone of treatment.

The goal is complete cytoreduction, meaning:

This may involve:

• Removal of uterus and ovaries
• Omentectomy
• Peritoneal stripping
• Bowel resection (if involved)
• Lymph node removal (selected cases)

Why Is Cytoreduction Important?

The amount of residual disease after surgery directly affects survival.

Patients with no visible residual disease have significantly better outcomes.

Interval Debulking Surgery

In some cases:

• Chemotherapy is given first (neoadjuvant chemotherapy)
• Followed by surgery

This is chosen when initial tumor burden is very extensive.

Role of HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

In selected advanced ovarian cancer cases:

After cytoreductive surgery, heated chemotherapy is circulated inside the abdominal cavity.

Purpose:

• Kill microscopic residual cancer cells
• Improve disease control
• Reduce recurrence in selected patients

HIPEC is not for every patient and requires careful selection.

Chemotherapy

Standard chemotherapy:

• Platinum-based (carboplatin)
• Combined with paclitaxel

Usually given:

• After surgery (adjuvant)
• Or before surgery (neoadjuvant)

Targeted Therapy

Modern treatment includes:

PARP inhibitors

Especially in:

• BRCA-mutated cancers
• HRD-positive tumors

These significantly improve progression-free survival.

Immunotherapy

Still evolving. Used in selected cases or clinical trials.

Survival and Prognosis

• Early-stage disease has high cure rates.
• Advanced disease is treatable but often recurrent.
• Survival improves with:
  • Complete cytoreduction
  • Appropriate chemotherapy
  • Molecularly guided therapy

Key Take-Home Messages