Ovarian cancer: a race against time

Silent, treacherous, and often invisible due to the difficulty of diagnosis. This is ovarian cancer, the most lethal gynecological tumor in Spain. There are no screening programs, symptoms are nonspecific, and diagnosis often comes when the disease is already advanced. However, advances in surgery, chemotherapy, and personalized medicine are opening a new window of hope for patients.

In 2025, approximately 3,700 women will be diagnosed with ovarian cancer in Spain. It is the leading cause of death from gynecological cancer in our country: the overall survival rate is 50%. "Although it is not the most common gynecological tumor, it is the one with the highest mortality rate because it is diagnosed in advanced stages," warns Dr. Antonio González, president of GEICO (Spanish Gynecological Cancer Research Group) and director of Medical Oncology at the University of Navarra Clinic.

The root of the problem is that it's a disease that grows rapidly and silently. "There's no guiding symptom that leads to early diagnosis, as is the case with blood in the urine in bladder cancer. Here we're talking about diffuse symptoms: abdominal swelling, digestive discomfort, a feeling of heaviness..." explains Dr. Pilar Barretina, vice president of GEICO and head of the Medical Oncology Service at the Catalan Institute of Oncology (ICO). Therefore, most women come to the doctor's office "when the disease is already very advanced and has invaded other areas of the abdomen," she adds.

The pilgrimage to diagnosis

This is how Charo Hierro, president of the Association of Women Affected by Ovarian and Gynecological Cancer (ASACO) and a patient diagnosed at an advanced stage, experienced it: “It's a treacherous cancer. There's no bleeding or gynecological signs. Almost all of us are told about gas or digestive disorders, and when you see that you're getting worse, the pilgrimage to the emergency room begins. Until one day, out of the blue, they tell you: you have ovarian cancer.”

Hierro emphasizes that, unlike breast or cervical cancer, ovarian cancer is rarely discussed, even among women. “It's unknown. It's not on your radar until you suffer from it. And then the impact is brutal: the surgery is radical, the recovery is very difficult, and the word cancer shakes you to the core.”

The clinical journey

Standard treatment for ovarian cancer includes cytoreductive surgery (to remove as much tumor volume as possible) combined with platinum-based chemotherapy, performed before and/or afterward depending on the case, and, in some cases, maintenance therapy. For this tumor, "surgery is a fundamental pillar and should be performed by surgeons with expertise in gynecologic oncology after evaluation by a specialized multidisciplinary committee," emphasizes Dr. Barretina. "The goal is to achieve complete cytoreduction, meaning no visible disease remains. This directly correlates with survival."

This is where Hierro speaks out on behalf of many patients: “There are very few officially designated centers for gynecological cancer in Spain, and it's difficult for patients to know which ones they are and the importance of being treated there. All patients should be referred to these existing centers. The specialty of gynecologic oncology is not officially established in Spain, which complicates the situation. Initial surgery is crucial and can make a difference in prognosis.”

Sensitive or resistant: a crucial division

Another key aspect in the approach to ovarian cancer is how the tumor responds to platinum treatment. Dr. Barretina explains: “When a patient relapses late after initial chemotherapy, they are considered platinum-sensitive, and they have more therapeutic options. But if the relapse occurs early, we are talking about platinum-resistant, a situation with a worse prognosis and far fewer alternatives.”

The data is overwhelming: approximately 50% to 85% of patients relapse within five years of diagnosis. “It's a gynecological tumor with a high mortality rate,” acknowledges Dr. González, “and platinum-resistant patients with relapse are especially vulnerable and have many unmet medical needs.” This is where personalized medicine takes on special relevance.

Increasingly, ovarian cancer treatment is tailored to the biological characteristics of each patient's tumor. Dr. Barretina emphasizes this: "Not all ovarian cancers are the same. Therefore, biopsy and molecular analysis are essential to tailor treatment and determine whether patients can benefit from targeted therapies." However, the path is not easy. Since 2010, more than 15 clinical trials have been conducted for platinum-resistant tumors, and only three have yielded positive results. This shows "how difficult it is to find effective options for these patients," González points out.

Research, in this context, is crucial, as Barretina explains: "Molecular alterations have been discovered that allow for the design of more specific and effective drugs. Personalized medicine is not a distant promise; it's a present necessity."

Hierro corroborates this from her experience: "The great hope is not so much a cure, but rather making the disease chronic. And that's already happening: more and more women are leading normal, full lives with follow-up and maintenance treatments."

Beyond Treatment: Well-being and Equity

Ovarian cancer not only challenges medicine, but also the emotional life of those who suffer from it: “Psychological-oncological support for patients and their families is essential,” insists Hierro. “At ASACO, we offer the Well-being Project, with individual sessions for those who need it. The emotional impact of diagnosis, radical surgery, early surgical menopause, or relapse can be devastating, especially in young women.”

Added to this is the geographic inequity: "There's a huge difference between ending up in a center with an experienced multidisciplinary team or not," warns Hierro. "Today, the prognosis often depends on luck. For this reason, we have been calling for improvements in this area for a long time, as we are seeing very encouraging advances in research that should reach all patients equitably."

For this reason, both experts and associations are calling for a network of referral centers, the formalization of the subspecialty of gynecologic oncology, personalized care, and greater social awareness. "Ovarian cancer cannot be prevented, but it can be suspected. If a woman has persistent symptoms, she should consult with healthcare professionals, and they should consider the possibility of ovarian cancer. We cannot allow this cancer to remain invisible," Barretina concludes.