Ovarian and Peritoneal Cancer

The symptoms of ovarian and peritoneal cancer are often non-specific, which may delay diagnosis. They may include:

• abdominal bloating or increase in abdominal girth
• abdominal or pelvic pain
• early satiety
• bowel or urinary disturbances
• unexplained weight loss or weight gain
• general fatigue

Persistent or worsening symptoms require medical assessment, particularly when no other cause is identified.

Diagnosis is based on a combination of clinical, imaging and laboratory investigations, including:

• gynaecological clinical examination
• pelvic ultrasound
• computed tomography (CT) or magnetic resonance imaging (MRI)
• blood tumour markers (such as CA-125, where appropriate)
• histological confirmation (biopsy or surgical specimen)

The aim of the diagnostic process is accurate disease staging, which determines the overall treatment strategy.

Management is usually multimodal and includes surgery and systemic therapy (chemotherapy). The sequence and approach are individualised for each patient.

Surgical treatment

Surgery plays a crucial role, particularly in advanced disease, and may include:

• removal of the ovaries and fallopian tubes
• removal of the uterus, where indicated
• excision of visible disease from the abdominal cavity and peritoneum
• assessment or removal of lymph nodes

In cases of advanced disease, extensive cytoreductive surgery may be required, aiming for maximal tumour removal, as residual disease volume is a key prognostic factor.

Where feasible, minimally invasive or robotic techniques may be used, always prioritising oncological safety.

Cytoreductive surgery and HIPEC

In selected cases, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may be considered.

HIPEC:

• is administered at the end of surgery
• involves the delivery of heated chemotherapy directly into the peritoneal cavity
• aims to eradicate microscopic residual disease

Patient selection is based on strict criteria, in accordance with international guidelines and the experience of specialised centres.

Adjuvant and systemic treatments

In many cases, surgical treatment is combined with:

• chemotherapy
• targeted therapies, where appropriate

Treatment decisions are made on an individualised basis, taking into account the specific characteristics of the disease.

In the United Kingdom and in many European countries, the management of gynaecological malignancies is the exclusive responsibility of the specialised gynaecological oncologist. Formal training and certification in gynaecological oncology are mandatory for clinicians undertaking the surgical and overall management of oncological cases.

This level of specialisation ensures:

• accurate and comprehensive surgical staging
• appropriate extent of surgical intervention
• adherence to international clinical guidelines
• care within a structured multidisciplinary oncology team

Clinical experience and scientific evidence demonstrate that management by a specialised gynaecological oncology team improves oncological outcomes and allows optimal planning of overall treatment.

The diagnosis of ovarian or peritoneal cancer is a challenging experience for every woman. Clear information, open communication and ongoing support are integral parts of the therapeutic process.

Each treatment plan is individualised, with respect for the patient’s needs, priorities and quality of life.

Borderline ovarian tumours represent a distinct group of ovarian neoplasms with low malignant potential. They are not benign lesions, but they are also not invasive ovarian cancer.

They are characterised by cellular atypia without stromal invasion, which distinguishes them from invasive ovarian malignancies.

Key characteristics

Borderline ovarian tumours:

• occur more frequently in younger women
• are associated with an excellent prognosis
• tend to grow more slowly than invasive ovarian cancer
• are often diagnosed at an early stage

The most common histological subtypes include:

• serous
• mucinous

Symptoms

Symptoms are often non-specific and may include:

• abdominal bloating or distension
• mild abdominal or pelvic discomfort
• a sensation of pelvic pressure

In many cases, these tumours are detected incidentally during imaging or surgery for other indications.

How are borderline ovarian tumours diagnosed

Diagnosis is based on:

• pelvic ultrasound
• imaging investigations (MRI or CT), where appropriate
• surgical removal of the lesion followed by histological examination

A definitive diagnosis can only be made after histopathological assessment.

How are borderline ovarian tumours treated

The mainstay of treatment is surgical management.

The extent of surgery depends on:

• the patient’s age
• disease stage
• fertility preservation considerations

In selected cases, fertility-sparing surgery may be performed, preserving the uterus and/or one ovary.

Prognosis and follow-up

The prognosis of borderline ovarian tumours is excellent in the vast majority of cases.

Nevertheless, regular follow-up with clinical and imaging assessment is recommended, particularly after fertility-sparing treatment.