Types of Ovarian Cancer

There are different types of ovarian cancer. Each of them is different in their origin, patient types, and treatment plans. Epithelial Ovarian Cancer is the most prevalent of all the types; it also includes cancers of the fallopian tubes and primary peritoneal cancer.

• Germ Cell Tumours: These are rare and tend to occur more in younger patients (under 30 years). The most common of these is ovarian teratoma.
• Sex Cord Stromal Tumours: The most common is the granulosa cell tumour.
• Borderline Tumours: These are not true cancers and are mostly curable with surgery.

Signs, Symptoms and Risk Detection

Diagnoses are usually late as symptoms are more vague; hence, the Modified Goff Symptom Index (GSI) identifies the following symptoms to watch out for:

• Pelvic pain or abdominal pain
• Bloating or an increased abdominal size
• Difficulty in eating or early satiety
• Increased urinary urgency or frequency.

A positive GSI (occurrences of symptoms more than 12 months a year) manifests 65.5% sensitivity and 84.7% specificity in detection.

Genomics & Innovative Medicine

The advent of Next-Generation Sequencing (NGS) and concomitant bioinformatics has revolutionised the landscape of ovarian cancer care. Such genomic profiling unmasks tumour heterogeneity and enables personalised treatment offered based on:

• Gene mutations (e.g., BRCA1/2, TP53)
• Nature of the tumour and its site of origin (e.g., high-grade serous carcinoma deriving from STIC lesions in fallopian tubes)

Screening and Diagnosis

Cancer detection early in the disease course from the best gynecologic oncology hospital in Delhi has included:

• CA-125 & Transvaginal Ultrasound (TVS)
• New Biomarkers HE4, CHI3L1, PEBP4, and AGR2 have more sensitivity and specificity.
• The precision diagnostics would add imaging (US, MRI) along with tumour markers such as CA125, CA19-9, CEA, AFP, and SCC in a bid to further improve accuracy.

Classification of Ovarian Cancer

• Type I Tumours: Develop from precursor lesions over a long time (such as low-grade serous carcinoma, endometrioid carcinoma, and mucinous carcinoma).
• Type II Tumours: Type II Tumours arise de novo, usually these tumours would be High-Grade Serous Carcinomas (HGSC) with poor prognosis and mutations in TP53. These tumours may develop within 2 months in a healthy ovary too.

Risk Factors and Prevention

Women who form high-risk groups encompass the following:

• BRCA1/2 mutations
• Family history of breast/ovarian cancer
• History of infertility or endometriosis

The protective aspects include:

• Multiparity
• Breast feeding
• Oral contraceptives
• Tubal ligation

In women carrying BRCA, the Risk-Reducing Salpingo-Oophorectomy (RRSO) is done between 35 and 40 (for BRCA1) and 45-50 (for BRCA2). This decreases the risks of breast cancer when performed before the age of 50.

Surgery

Early-stage fertility-sparing surgery is an option for young women. Preference is given to Primary Debulking Surgery (PDS), but if not possible, Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (IDS) is standard (NCCN guidelines).

Chemotherapy

In the early stage, chemotherapy can be omitted, mainly IA/IB, grade I. Platinum-based regimens such as carboplatin + paclitaxel are first-line therapies in advanced stages and are commonly used with targeted drugs (e.g., PARP inhibitors, Bevacizumab).

Secondary debulking, newer agents (gemcitabine, topotecan), and PARP inhibitors to BRCA-mutated or HRD-positive tumours may be administered to recurrent cancers.

Targeting Cancer Stem Cells

Cancer stem cells, such as CD44, CD117, and ALDH, confer recurrence and resistance in ovarian cancer. Emerging therapies are directed against eradicating the cells in this manner, thus heralding a new age of precision treatment.

The Future of treatment is personalised development in target therapies, gene profiling, advanced surgery, and all other cross-cultural meanings that offer renewed hope in further treatment for even recurrent ovarian cancer. Genetics meets lifestyle and molecular biology in precision oncology, promising better survival and quality of life for women worldwide. To gather more information and personalised treatment for ovarian tumours, book an appointment with Sir Ganga Ram Hospital today.