A multidisciplinary approach remains the best strategy to improve and strengthen the management of ovarian cancer (Review)

Abstract

Ovarian cancer represents one of the most aggressive female tumors worldwide. Over the decades, the therapeutic options for the treatment of ovarian cancer have been improved significantly through the advancement of surgical techniques as well as the availability of novel effective drugs able to extend the life expectancy of patients. However, due to its clinical, biological and molecular complexity, ovarian cancer is still considered one of the most difficult tumors to manage. In this context, several studies have highlighted how a multidisciplinary approach to this pathology improves the prognosis and survival of patients with ovarian cancer. On these bases, the aim of the present review is to present recent advantages in the diagnosis, staging and treatment of ovarian cancer highlighting the benefits of a patient‑centered care approach and on the importance of a multidisciplinary team for the management of ovarian cancer.

Keywords: diagnosis; multidisciplinary approach; multidisciplinary team; ovarian cancer; patient‑centered care; poly (ADP‑ribose) polymerase inhibitors; staging; therapy.

Figure 1

Overview of the pharmacological treatments for the management of ovarian cancer. First-line treatments based on the administration of platinum/taxane regimen plus anti-VEGF mAb bevacizumab. Second-line treatments based on the administration of paclitaxel plus carboplatin or gemcitabine in the case of platinum sensitive tumors or bevacizumab plus paclitaxel, gemcitabine, doxorubicin or topotecan in the case of platinum resistant tumors. For BRCA mutated ovarian cancer, PARP inhibitors can be used for first-line or second-line treatments. Third-line treatments consist in the administration of the first-line and second-line drugs plus immune checkpoint inhibitors. MHC, major histocompatibility complex; RNR, ribonucleotide reductase; TCR, T-cell receptor; TOP1, type 1 topoisomerase; TOP2, type 2 topoisomerase.

Figure 2

Linear management of ovarian cancer. Main players of ovarian cancer management are the surgeon who removes the tumor, the pathologist who assesses the tumor histotype and the medical oncologist who selects and starts the pharmacological treatments. There is no interaction between these three main specialists in the management of the patient with ovarian cancer.

Figure 3

Circular approach to the management of patients with ovarian cancer patients. Main specialists involved in ovarian cancer care interact with each other sharing all of the relevant information and all clinical decisions are patient-centered.

Figure 4

Circular and multidisciplinary network for the management of patients with ovarian cancer. The gynecological surgeon, pathologist and oncologist are the key nodes of the patient-centered circular multidisciplinary network. Other specialists, including nurses, geneticists, nutritionists, radiologists, nuclear medicine physicians, radiotherapists, general practitioners, vascular surgeons, urologists, gynecologists, general surgeons and psycho-oncologists, actively participate in all the decision-making steps of ovarian cancer management.