In this article, Dr Robb Hollis, of the University of Edinburgh, discusses the findings of his recent research examining the benefits of surgery in ovarian cancers including low-grade serous.
There are multiple different types of ovarian cancer, each with their own unique underlying biology (such as gene mutations) and clinical behaviour (aggressiveness and treatment responsiveness).
The most common type is called “high grade serous” and accounts for about 70% of cases. The other types each account for 3-10% of cases. This includes low grade serous ovarian cancer.
For a long time, we have known that successful surgery (where all visible cancer is removed during the procedure) is key for maximising ovarian cancer survival. However, almost all of the evidence for this is from studying the most common type (high grade serous). It was unclear whether the other types, such as low grade serous, benefit from successful surgery to a greater or lesser extent.
This is an important gap in our knowledge because often very extensive surgical procedures are needed to achieve complete removal of all visible cancer, and this is associated with some additional surgical risks for patients. Knowing who is likely to benefit most from these extensive procedures is key for informing risk-benefit analysis when making surgical decisions.
Our most recent research has shown that successful surgery is associated with an even greater benefit in ovarian cancer patients with some of the less common forms of the disease. Specifically, the benefit appears greatest in those with low grade serous ovarian cancer, alongside with two other types, called “clear cell” and “endometrioid” ovarian cancer.
In the context of disease that has spread beyond the ovary throughout the pelvis (which we call “advanced stage”), the risk reduction in the most common type of ovarian cancer is around 50% in those whose surgery is able to completely remove all visible disease. In low grade serous, the corresponding reduction is substantially greater at around 80-85%.
This knowledge suggests that we should be prioritising specific patient groups for extensive surgical procedures. This includes low grade serous ovarian cancer patients, who appear to be one of the groups who have the most to gain from complete removal of all visible cancer during an operation. It is critical that these patients are treated within specialist centres with appropriate resources and experience to maximise the likelihood of completely removing all visible cancer.
About the author:
Dr Hollis (PhD) is a researcher at the University of Edinburgh with an interest in rare ovarian cancers including low-grade serous ovarian cancer. He completed his post-doctoral fellowship with Professor Gourley’s laboratory and currently holds an IGC Langmuir Talent Fellowship to develop his own independent research laboratory.
