-Ovarian cancer is a common cause of cancer death and women are often diagnosed at a late stage of the disease since ovarian cancer presents late and with diffuse clinical symptoms, such as vague abdominal pain or malaise. The symptoms do not differ much from colon cancer, explains Päivi.  
 
Päivi Kannisto is Associate Professor at Obstetrics and Gynecology at Lund University, a surgeon at Skåne University Hospital and chairman of the National Care Program for Vulvar Cancer. SRA Epihealth is interested in knowing how ovarian cancer is detected, what technology is used, and what the treatments and survival rates are.
 
-It is crucial that we detect early signs of ovarian cancer to increase survival rates. We use different methods to do this such as computed tomography (CT) which is often the first test with which ovarian cancer is detected. Many factors affect the sensitivity of CT for detecting ovarian cancer, such as lesion size, ascites, and technical parameters. However, CT is still considered the imaging method of choice for detecting ovarian cancer, says Päivi. She continues, 
 
-The problem with CT is that not everything can be seen using this technology. Currently, we try to optimize every imaging by numeric scoring of cancer particles in the abdomen (so called peritoneal cancer index). We hope that this procedure, made by radiologists, can help us to make a correct plan for the surgery and give the best chance for the patient to reach macroscopic radicality. We are also investigating the use of artificial intelligence to predict the pathological diagnosis of ovarian tumors by using patient information and data from preoperative examinations such as blood tests, patient background to find patterns that are invisible to the human eye. 
 
-We know that it is crucial to optimize imaging and treatment at time of diagnosis and although the initial response rates to treatments such as primary surgery and chemotherapy are good, we know that around 80% of patients will relapse and the 5-year survival rate is below 50%.  Ovarian cancer rates are highest in women aged around 65 years and since the symptoms are diffuse it is easy to confuse them with age related ailments such as a larger abdomen. But a larger abdomen might be due to fluids and a tumor in the abdomen, says Päivi.

During the interview we discuss different factors that can affect the microenvironment in the tumor. - The tumor microenvironment is the ecosystem that surrounds a tumor inside the body, and it includes immune cells, the extracellular matrix, blood vessels and other cells, like fibroblasts. A tumor and its microenvironment constantly interact and influence each other, either positively or negatively. A current study investigates that some people with ovarian cancer protect themselves better than others since the tumor itself raises the patients’ immune response to the cancer. This can help us to understand tumor development and anti-tumor immune responses, explains Paivi.
 
We continue the interview by discussing tumor-associated inflammation and how it can impair the nutritional status including the strengh of large muscles, increase body catabolism with functional iron deficiency, lower albumin level and weight loose due to the cancer inflammation. – Current research supports the notion that chronic inflammation followed by advanced ovarian cancer development might worsen the patient’s recovery and the endurance towards chemotherapy treatment. Since the treatment of ovarian cancer is multimodal, the patient needs to stay strong for a long time. 
 
We close the interview by asking Päivi if some of the results from her research have surprised her. – It surprises me that our patients with advanced ovarian cancer recover so quickly from extensive surgery that it becomes possible to administer chemotherapy only a few weeks from the surgery.  We need to continue to research to further impact survival. New drugs known as PARP inhibitors that enhances the survival of the patient can kill the hereditary form of ovarian cancer and benefit women who are newly diagnosed with advanced ovarian cancer. Their use in clinics have just started and I am very interested to see what their final role will be in the treatment of ovarian cancer patients.