Paradigm Shift: A Comprehensive Review of Ovarian Cancer Management in an Era of Advancements

Abstract

Ovarian cancer (OC) is the female genital malignancy with the highest lethality. Patients present a poor prognosis mainly due to the late clinical presentation allied with the common acquisition of chemoresistance and a high rate of tumour recurrence. Effective screening, accurate diagnosis, and personalised multidisciplinary treatments are crucial for improving patients' survival and quality of life. This comprehensive narrative review aims to describe the current knowledge on the aetiology, prevention, diagnosis, and treatment of OC, highlighting the latest significant advancements and future directions. Traditionally, OC treatment involves the combination of cytoreductive surgery and platinum-based chemotherapy. Although more therapeutical approaches have been developed, the lack of established predictive biomarkers to guide disease management has led to only marginal improvements in progression-free survival (PFS) while patients face an increasing level of toxicity. Fortunately, because of a better overall understanding of ovarian tumourigenesis and advancements in the disease's (epi)genetic and molecular profiling, a paradigm shift has emerged with the identification of new disease biomarkers and the proposal of targeted therapeutic approaches to postpone disease recurrence and decrease side effects, while increasing patients' survival. Despite this progress, several challenges in disease management, including disease heterogeneity and drug resistance, still need to be overcome.

Keywords: antineoplastic protocols; biomarkers; diagnosis; early detection of cancer; ovarian neoplasms.

Figure 1

Subtypes of ovarian cancer. Figure created with BioRender.com (accessed on 28 December 2023). Ovarian cancer is a heterogeneous disease, encompassing numerous malignant subtypes with distinct aetiology, origin, pathogenesis, differentiation, spread patterns, and molecular profiles. The most common subtype is epithelial ovarian cancer (~90%), which can be further subclassified into type I and type II according to specific histological and molecular features [10,11,12,14,15].

Figure 2

Stages of ovarian cancer. Figure created with BioRender.com (accessed on 28 December 2023). The FIGO staging system for ovarian cancer (OC) includes four stages that address the disease’s extent and severity by evaluating the tumour burden, dissemination within the abdomen, and the secondary involvement of distant organs. Stage I integrates tumours confined to either the ovary (one or both ovaries) or the fallopian tubes, while, at stage II, the tumour has already spread beyond the ovaries or fallopian tubes, with pelvic extension or primary peritoneal cancer. In stage III, OC cells spread to the peritoneum outside the pelvis, and there might be metastasis to the retroperitoneal lymph nodes. Lastly, stage IV is characterised by OC’s dissemination to other body parts beyond the pelvis and abdomen, namely the liver and lungs [82]. Abbreviations: FIGO, International Federation of Gynecology and Obstetrics.

Figure 3

Pivotal gene discoveries and the approval of therapeutic agents and approaches to treat ovarian cancer. Figure created with BioRender.com (accessed on 28 December 2023). Several therapeutical agents and approaches for ovarian cancer management have emerged in recent decades due to a better understanding of the disease’s pathogenesis [122,123]. Abbreviations: EMA, European Medicine Agency; FDA, Food and Drug Administration; HIPEC, hyperthermic intraperitoneal chemotherapy; HT, hormonal therapy; NCCN, National Comprehensive Cancer Network.