Ovarian Cancer Treatment in Istanbul: How the Tumor Is Removed as Completely as Possible — and When a Second Opinion Makes Sense

Note: This page does not replace a medical diagnosis. If a suspicion or a diagnosis exists, treatment should be planned in an experienced, ideally certified center and not postponed unnecessarily.

How is ovarian cancer treated — and what is the most important goal?

The treatment of ovarian cancer is usually based on two pillars: an operation and a subsequent chemotherapy. The most important goal of the operation is to remove the tumor as completely as possible, because the further outlook depends decisively on this. In advanced disease, a maintenance therapy is often added, which aims to delay recurrence.

Source: ESMO (European Society for Medical Oncology) recommendations on ovarian cancer

Why is the most complete tumor removal (R0) so decisive?

In ovarian cancer, the most complete removal of the tumor is the most important factor for the prognosis. If no visible tumor remains after the operation (macroscopically complete resection), the outlook is clearly better than with remaining residue. This is exactly why this operation belongs in experienced hands and in a center that performs such procedures regularly.

We say openly that complete tumor removal in advanced disease is demanding and needs an experienced, interdisciplinary team. We see our task as advising you honestly and finding the right treatment path together with you — not in playing down any situation. Where a specialized center is the better place, we say so clearly.

Source: guidelines of ESGO (European Society of Gynaecological Oncology)

Early or advanced? What the stage means for treatment

The stage at diagnosis considerably influences treatment and outlook in ovarian cancer. Because the disease causes hardly any symptoms for a long time, about three out of four ovarian carcinomas are discovered only at an advanced stage, while around 30 % are detected at an early stage. In early stages, there is a good outlook for lasting cure, while treatment at an advanced stage is more comprehensive.

These figures are average values and say nothing about the individual case. The exact stage, the tumor type and how completely the tumor can be removed remain decisive. An individual assessment is therefore only possible after reviewing all findings.

Source: NCCN (National Comprehensive Cancer Network) recommendations on ovarian cancer

Which examinations clarify the diagnosis and spread?

Before treatment comes a precise assessment of the diagnosis and spread of the disease. This includes a gynecological examination, a vaginal ultrasound, cross-sectional imaging and the tumor marker CA-125 in the blood, which is elevated in about 80 % of the most common form. The final confirmation is only achieved through the histological examination of tumor tissue.

This assessment determines how far the disease has progressed and which treatment path is an option. The more precise the picture before treatment, the better the procedure can be planned. Missing examinations are added before a decision.

What role does laparoscopy play in ovarian cancer?

Laparoscopy has a firm place in ovarian cancer above all in diagnostics and not in complete tumor removal. Through small ports, it can be assessed how far the tumor has spread and whether it can be removed completely at all. We use this option to plan the right next step, and in doing so we are honest about the limits of the method.

Diagnostic laparoscopy to assess resectability

With a diagnostic laparoscopy, tissue samples can be taken and the spread in the abdomen estimated. This allows planning of whether an immediate operation or first a chemotherapy makes sense. This assessment is an important point of decision before the actual treatment.

Why complete removal is usually done openly

In debulking surgery, as much tumor mass is removed as possible until nothing visible remains, and this can reliably be achieved usually only via a laparotomy. Especially at an advanced stage, several organ areas are often affected, so that open surgery is the safer route. Here thoroughness clearly takes precedence over the wish for small incisions.

Surgery first or chemotherapy first (neoadjuvant)?

Whether surgery is performed first or a chemotherapy is given first depends on whether the tumor can be removed completely from the outset. In many cases, primary surgery with subsequent chemotherapy is the preferred route. If complete removal cannot be achieved at first, an upfront chemotherapy (neoadjuvant) with later surgery can make sense.

This decision belongs in an interdisciplinary tumor board and depends on the findings and general condition. Both routes follow recognized guidelines and have their firm place. Which route fits can only be said after a complete assessment.

How does the chemotherapy work — and when does it begin?

Chemotherapy is a central component in ovarian cancer and usually follows the operation. As a rule, a platinum-based combination of carboplatin and paclitaxel over about six cycles is used, beginning a few weeks after surgery. The aim is to fight remaining cancer cells not visible to the eye and to lower the recurrence risk.

Only in very early cases can chemotherapy be omitted under certain conditions. The treatment is individually adapted and accompanied by supportive measures. It can often be carried out close to home in your home country.

What are maintenance therapy, PARP inhibitors and bevacizumab?

After chemotherapy, in advanced disease a maintenance therapy can delay recurrence. This includes PARP inhibitors such as olaparib or niraparib as well as the antibody bevacizumab, whose use depends among other things on the stage and the genetic test. The benefit is well documented especially with a BRCA mutation or a so-called homologous recombination deficiency.

In a large study, the combination of a PARP inhibitor and bevacizumab lowered the risk of progression overall by about 41 %, and in women with homologous recombination deficiency by around 67 %. About half of patients show such a change. Which maintenance therapy fits depends on the individual findings.

Source: ASCO (American Society of Clinical Oncology) recommendations on ovarian cancer

Ovarian cancer and heredity: when is a BRCA / genetic test worthwhile?

A portion of ovarian carcinomas is hereditary, which is why a genetic test is generally recommended with this disease. The detection of a BRCA mutation influences not only the choice of maintenance therapy but also has significance for close relatives. Genetic counseling helps to interpret the results and to decide about consequences.

With a proven BRCA mutation, a preventive removal of the ovaries and fallopian tubes after family planning is complete can lower the disease risk by about 80 to over 90 %. Such a decision is very personal and should be made without pressure and with professional support. A genetic test and its consequences are always discussed in detail beforehand.

Can fertility be preserved in ovarian cancer?

Preservation of fertility is only possible in selected early cases and after careful consideration. With an early, one-sided tumor at a favorable stage, the uterus and the unaffected ovary can be preserved under strict conditions. The prerequisite is a complete staging so that no higher stage is overlooked.

This route is always assessed in connection with the safety of the cancer treatment and is never placed above the chances of cure. At an advanced stage, preservation of fertility is generally not possible. Which option exists can only be clarified individually.

Does ovarian cancer come back after treatment?

A recurrence is possible in ovarian cancer, and at advanced stages more than half of women suffer a relapse over the course, which is why aftercare is a firm part of it. A maintenance therapy can lower the recurrence risk and extend the time until possible progression. A promise of cure would, however, not be serious with this disease.

How high the recurrence risk is depends on the stage, the tumor type and how completely the tumor was removed. Regular checks help to recognize a recurrence early. Aftercare can also be coordinated with your doctor in your home country.

Our treatment approach: guideline-compliant, honest, in the right center

Our starting point is always your findings and what makes the most medical sense. Associate Professor Dr. Cengiz Andan and our team review the stage, histology and spread and discuss the right treatment path with you. We see our strength in the honest assessment, in the diagnostic clarification and in the coordination — and say openly when a specialized center is the right place for the operation.

Findings and stage as the basis

We begin by reviewing all available documents and adding missing examinations. On this basis, we classify the disease and discuss the possible steps. Only then is a decision made about the specific treatment.

Interdisciplinary and in the right center

We are guided by current guidelines and work across specialties. Where a complex operation belongs in a specialized center, we support you with planning and coordination. This way your safety remains the priority.

Home country or Istanbul — how does the treatment differ?

The difference lies not in the quality, but above all in waiting time, continuity and cost. The treatment follows the same international guidelines, so that the medical level remains comparable. The price difference arises through the exchange rate as well as lower operating and personnel costs and thus lowers the price, not the standard.

What happens in case of complications or questions after returning?

Should complaints or questions arise after returning, we remain reachable for you. We coordinate with your treating oncologist in your home country and provide all operation and findings documents including the histological examination. This way the further treatment, such as the chemotherapy or the aftercare, can also be well accompanied remotely.

Especially with a cancer disease, this continuous coordination is important so that no gap in care arises. You should also feel in good hands after returning. A seamless handover to your team at home is part of this for us.