The Whisper That Becomes a Roar: Confronting Ovarian Cancer at Liv Hospital

By the Editorial Team

Ovarian cancer is often called the “silent killer,” but that moniker is not entirely accurate. It doesn’t remain silent; it whispers. It speaks in subtle symptoms—bloating that won’t go away, a sudden feeling of fullness after a few bites of food, or vague pelvic pain. Because these whispers mimic common digestive issues, they are easily ignored.

By the time the disease roars, it has often spread throughout the abdomen. This reality makes ovarian cancer one of the deadliest gynecologic malignancies.

At Liv Hospital, the fight against ovarian cancer is not based on wishful thinking. It is based on aggressive surgical cytoreduction and molecular intelligence. Located in Istanbul, this center of excellence understands that in ovarian cancer, the quality of the first surgery often determines the length of the patient’s life.

The Diagnostic Trap: Beyond Ultrasound

The tragedy of ovarian cancer is the lack of a reliable screening test like the mammogram. A standard ultrasound often misses the early signs.

Liv Hospital elevates the diagnostic standard by combining High-Resolution Transvaginal Ultrasound with specific blood markers like HE4 and CA-125.

• The ROMA Score: By analyzing these markers together, doctors calculate a “Risk of Ovarian Malignancy Algorithm” score, which helps distinguish between a benign cyst and a dangerous tumor with far greater accuracy than older methods.
• PET-CT Imaging: Once diagnosed, the entire body is scanned to map the “tumor burden.” Knowing exactly where the cancer has seeded (the diaphragm, the liver surface, the bowel) allows surgeons to plan the battle before the first incision is made.

The Surgical Gold Standard: R0 Resection

In ovarian cancer, one metric matters more than any other: Macroscopic Complete Resection (R0). This means the surgeon removes all visible disease. Leaving even 1 centimeter of tumor behind can significantly reduce survival rates.

At Liv Hospital, Gynecologic Oncologists perform Ultra-Radical Cytoreductive Surgery.

• The Scope: This is not just a hysterectomy. It often involves removing the ovaries, the omentum (fatty apron), lymph nodes, and sometimes sections of the bowel or spleen if the cancer has attached itself there.
• The Goal: To achieve “zero residual disease.”

For early-stage patients, the hospital utilizes the da Vinci Xi Robotic System, allowing for precise staging and lymph node removal without large incisions. However, for advanced cases, the team is prepared for the open, extensive procedures necessary to clear the abdomen completely.

The Hot Bath: HIPEC

Ovarian cancer rarely spreads through the blood; it spreads by shedding cells into the abdominal cavity (peritoneum). Standard IV chemotherapy has trouble penetrating this lining effectively.

For eligible patients, Liv Hospital offers Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

How it works:

1. The Debulking: First, the surgeon removes all visible tumors.
2. The Lavage: While the patient is still under anesthesia, the abdominal cavity is filled with a chemotherapy solution heated to 42°C (107.6°F).
3. The Effect: The heat shocks the cancer cells, making them more porous, while the direct contact allows the drug to kill microscopic seeds that the surgeon couldn’t see.

The Reality: HIPEC is a major physiological event. It extends the surgery time and recovery, but for patients with peritoneal spread, it offers a survival advantage that standard chemo cannot match.

The Genetic Key: BRCA and PARP Inhibitors

The era of treating all ovarian cancers the same is over. We now know that about 15-20% of ovarian cancers are driven by BRCA1 or BRCA2 mutations (the same genes linked to breast cancer).

Liv Hospital’s Medical Genetics department tests every ovarian cancer patient for these mutations.

• The Maintenance Strategy: If a patient has a BRCA mutation (or Homologous Recombination Deficiency), they are prescribed PARP Inhibitors (like Olaparib) after chemotherapy ends.
• The Result: These pills block the cancer cells from repairing their own DNA. By keeping the patient on this “maintenance therapy,” doctors can delay recurrence for years, turning a deadly acute disease into a manageable chronic condition.

Targeted Therapy: Starving the Tumor

Even for patients without genetic mutations, Liv Hospital employs Targeted Therapies like Bevacizumab (Avastin).

Ovarian tumors are hungry; they build chaotic networks of blood vessels to feed themselves. Bevacizumab acts as an angiogenesis inhibitor—it effectively cuts the power lines, stopping the tumor from growing new blood vessels. This is often combined with standard chemotherapy (Carboplatin/Paclitaxel) to enhance its effectiveness.

The Council: Gynecologic Tumor Board

Ovarian cancer is complex. A surgeon might be ready to operate, but a radiologist might see a spot on the lung that changes the stage to 4B.

At Liv Hospital, the Gynecologic Tumor Council manages these pivots.

• Should we do Neoadjuvant Chemotherapy to shrink the tumor before surgery?
• Is the patient strong enough for HIPEC?

This multidisciplinary consensus ensures that the treatment plan is not just aggressive, but also logical and tailored to the patient’s physical reserve.

Fertility and Future

For young women diagnosed with early-stage germ cell tumors or borderline tumors, the conversation is different. Liv Hospital prioritizes Fertility-Sparing Surgery, removing only the affected ovary while preserving the uterus and the healthy ovary, allowing for future pregnancy.

A Marathon, Not a Sprint

Ovarian cancer is a relentless adversary. It has a high rate of recurrence, and the journey often involves multiple lines of treatment over several years.

Liv Hospital does not offer false promises of an easy cure. Instead, they offer a partnership for the marathon. With the surgical aggression of R0 resection, the innovation of HIPEC, and the intelligence of PARP inhibitors, they provide the best possible armor for a fight that requires endurance as much as hope. Live and feel life