Question 1

What is ovarian cancer?

Accepted Answer

Ovarian cancer encompasses cancers arising from the ovary, fallopian tube and peritoneum — collectively treated as a single disease entity. The most common type is high-grade serous carcinoma (HGSC — approximately 70%), which actually originates from the fallopian tube fimbriae and sheds cells onto the ovarian surface. Ovarian cancer is the deadliest gynaecological cancer — causing more deaths than cervical and uterine cancer combined — primarily because most cases are diagnosed at advanced stage when the cancer has spread to the abdomen.

Question 2

Why is ovarian cancer so deadly?

Accepted Answer

The high mortality from ovarian cancer reflects primarily late-stage diagnosis: over 75% of cases are diagnosed at stage III (spread to the peritoneum and lymph nodes) or stage IV (distant metastases). Five-year survival at stage I is approximately 90%; at stage III it is approximately 40%; at stage IV approximately 20%. The peritoneal seeding pattern of ovarian cancer makes complete surgical removal challenging. Unlike cervical cancer, there is no effective population-level screening test — even CA-125 and ultrasound screening have not proven to reduce mortality.

Question 3

What are the symptoms?

Accepted Answer

Ovarian cancer is described as a "silent killer" — but actually does cause symptoms; they are non-specific and often dismissed or attributed to IBS or other conditions: persistent abdominal bloating; abdominal or pelvic pain; difficulty eating or feeling full quickly; urinary symptoms (urgency or frequency). These symptoms occurring frequently (>12 days per month, or newly after age 50) should prompt CA-125 testing and pelvic ultrasound. Early symptom recognition and acting on them promptly is the primary strategy to achieve earlier diagnosis.

Question 4

Who is at highest risk?

Accepted Answer

Risk factors: BRCA1/2 mutations (44-46% and 12-20% lifetime risk, respectively); Lynch syndrome (MLH1/MSH2 mutations — 10-12% risk); personal history of breast cancer; nulliparity; endometriosis; older age; family history of ovarian cancer. Protective factors: oral contraceptive pill use (50% risk reduction with 5+ years — protection lasting 30+ years); breastfeeding; tubal ligation; salpingectomy; and RRSO for mutation carriers.

Question 5

What is BRCA and ovarian cancer?

Accepted Answer

BRCA1 (44-46% lifetime ovarian cancer risk) and BRCA2 (~12-20% risk) mutations cause hereditary breast and ovarian cancer syndrome (HBOC). Together they account for approximately 15-20% of all ovarian cancers. BRCA mutations cause deficient homologous recombination DNA repair — making tumours exquisitely sensitive to platinum chemotherapy and PARP inhibitors. WHO, ESGO, ASCO and all major guidelines recommend universal germline genetic testing for all women with ovarian cancer — to guide treatment and enable cascade testing of family members.

Question 6

What are PARP inhibitors?

Accepted Answer

PARP inhibitors (olaparib, niraparib, rucaparib) exploit homologous recombination deficiency — present in BRCA-mutated tumours and approximately 50% of high-grade serous ovarian cancers. When used as maintenance therapy after platinum-based chemotherapy response, PARP inhibitors dramatically extend progression-free survival: SOLO-1 trial showed that olaparib maintenance in BRCA-mutated advanced ovarian cancer reduced the risk of disease progression or death by 70%. FDA has approved PARP inhibitor maintenance across multiple lines of treatment.

Question 7

Is there ovarian cancer screening?

Accepted Answer

No validated population-level screening test for ovarian cancer exists in average-risk women. The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) — the largest ovarian cancer screening RCT — showed no mortality benefit from CA-125 + ultrasound screening. Multimodal screening (annual CA-125 with the ROCA algorithm) is offered to BRCA mutation carriers and women with strong family history as part of enhanced surveillance, though evidence that this reduces mortality is not yet definitive. Risk-reducing surgery remains the most effective preventive strategy for high-risk women.

Question 8

How is ovarian cancer treated?

Accepted Answer

Standard treatment: cytoreductive surgery (debulking — removing all visible tumour — "optimal" or "complete" cytoreduction substantially improves survival) + platinum-taxane chemotherapy (carboplatin + paclitaxel). Bevacizumab (anti-VEGF) is added for high-risk disease. PARP inhibitor maintenance follows chemotherapy response (particularly in BRCA-mutated and HRD-positive tumours). At relapse: further platinum-based therapy if platinum-sensitive; targeted therapies; immunotherapy (limited activity in ovarian cancer generally).

Question 9

How does GMJ News cover ovarian cancer?

Accepted Answer

GMJ News covers GLOBOCAN ovarian cancer data, PARP inhibitor approvals and access, BRCA testing guidelines, RRSO evidence, OCP chemopreventive role and the diagnostic delay challenge. Ovarian cancer is a significant gynaecological oncology concern in Georgia — directly relevant to PHIG's cancer prevention programme and the Georgian Medical Journal.

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