September is internationally recognised as Ovarian Cancer Awareness Month, highlighting a disease that remains a major challenge in gynaecological oncology despite significant advances in diagnosis and treatment.
Experts from the Therapeutics Clinic at Alexandra Hospital of the National and Kapodistrian University of Athens stress that early recognition of symptoms, knowledge of family history and genetic investigation remain critical, while progress in molecular profiling and targeted therapies is offering patients new treatment options.
A complex disease
According to oncologists Dr Maria Kaparelou and Professor Thanos Dimopoulos, ovarian cancer is not a single disease but a heterogeneous group of tumours with distinct histological and molecular characteristics.
The most common subtype is high-grade serous ovarian carcinoma (HGSOC), which is now believed to originate in many cases from the epithelium of the fallopian tubes. Other subtypes, including endometrioid, clear-cell, mucinous and low-grade serous carcinomas, display different biological behaviour and increasingly require tailored treatment approaches.
Early diagnosis remains a challenge
One of the greatest difficulties is that symptoms are often non-specific and may resemble less serious conditions.
Symptoms that warrant medical assessment include:
- Persistent abdominal pain or pelvic pressure
- Bloating
- Increased abdominal size
- Early satiety
- Changes in bowel habits
- Frequent urination
While blood testing for CA-125 and transvaginal ultrasound play an important diagnostic role, there is currently no established population-wide screening programme for women at average risk.
Genetics and family history
A significant proportion of ovarian cancers are linked to inherited genetic mutations.
The best-known are mutations in the BRCA1 and BRCA2 genes, while defects in other DNA repair genes and Lynch syndrome can also increase risk.
For that reason, genetic counselling and testing have become increasingly important.
Identifying an inherited mutation may not only guide treatment for the patient but also help identify relatives at elevated risk and allow preventive measures to be considered.
From chemotherapy to personalised treatment
The treatment of advanced ovarian cancer relies on a multidisciplinary approach.
Surgery aimed at removing all visible disease remains a key objective, while systemic treatment with carboplatin and paclitaxel continues to be a cornerstone of therapy.
In some patients, bevacizumab, an anti-angiogenic therapy targeting VEGF, may be added and continued as maintenance treatment.
One of the most significant developments in recent years has been the introduction of PARP inhibitors.
Testing for BRCA1/2 mutations and homologous recombination deficiency (HRD) can identify patients who may benefit from these targeted therapies, which have significantly extended the period before disease recurrence in selected groups.
New options for recurrent disease
Treatment strategies for recurrent ovarian cancer increasingly depend on a tumour's molecular profile.
For platinum-sensitive recurrence, platinum-based chemotherapy remains central. In platinum-resistant disease, other therapeutic targets have gained importance.
For tumours expressing high levels of folate receptor alpha (FRα), mirvetuximab soravtansine, an antibody-drug conjugate, has emerged as a significant treatment option.
Immunotherapy is also playing a growing role. Assessment of PD-L1 expression can now help guide treatment decisions, while the addition of pembrolizumab to chemotherapy has expanded options for selected patients with platinum-resistant disease.
Emerging therapies
The treatment landscape continues to evolve.
In 2026, the US Food and Drug Administration approved relacorilant in combination with nab-paclitaxel for specific patients with platinum-resistant ovarian, fallopian tube or primary peritoneal cancer previously treated with bevacizumab.
Another area of increasing interest is HER2, a molecular target found in some less common gynaecological cancers.
New HER2-targeted antibody-drug conjugates, including trastuzumab deruxtecan, have demonstrated promising anti-cancer activity in HER2-expressing ovarian tumours, reinforcing the importance of comprehensive biomarker testing.
Molecular profiling at the centre of care
Experts say ovarian cancer treatment is becoming increasingly personalised.
While tumour type and disease stage remain fundamental, treatment decisions are now also guided by biomarkers including:
- BRCA1/2
- HRD
- FRα
- PD-L1
- HER2 (in selected cases)
This approach allows therapies to be matched more closely to the individual biological characteristics of each patient's cancer.
The key message
According to the specialists, the message of Ovarian Cancer Awareness Month is twofold.
Early recognition of symptoms, awareness of family history and timely medical evaluation remain essential.
At the same time, advances in targeted therapies, immunotherapy and next-generation antibody-drug conjugates are creating new opportunities for women diagnosed with the disease, offering the prospect of longer disease control, improved survival and a better quality of life.
