In each city that hosts a congress of the European Society of Gynecological Oncology (ESGO), the most relevant in the world, the ritual of planting a tree is performed. The olive tree planted on Thursday in front of the Bellvitge hospital testifies that this year it is celebrated in Barcelona, for the first time in Spain. Jordi Ponce (Barcelona, 1965), head of gynecology at the Bellvitge hospital, chairs the congress, which brings together thousands of specialists, including the main international experts in research, treatment and care of tumors of the ovary, endometrium, neck of the uterus or vulva.
Does this congress emphasize the level of our health system?
It is number one in gynecological cancer in the world. With 3,000 registered, it is one of the largest conferences and taking it to Barcelona and Spain is not a matter of a year but of a lot of work time. I explained it at the opening ceremony: this began at least 15 years ago, when we began to have a Spanish group that works well in gynecological cancer and we positioned ourselves until we became leaders in Europe as we do now. This is a recognition of the oncological and surgical work of all of Spain, especially ours.
Do you expect many new things to come out?
There is always news because there are things that are expected to be presented at this congress. The ESGO does several very relevant things, one of them is the guides, the protocols: it is capable of defining what needs to be done in each type of tumor and what the best clinical practice is. Several new clinical practice guidelines in gynecological cancer will be presented here. Another thing is that many studies are presented, especially on chemotherapy drugs that are personalized. Many are very powerful international studies, many carried out by the pharmacological industry itself. Then there is the entire surgical part, which is the one in which I am most expert: we present several things, we even do a surgery part that is broadcast live at the congress.
They are ahead in that.
We are leaders in Europe in the most advanced surgery, which is robotics, and this is also one of the reasons why the congress has come to Barcelona. At Bellvitge we are pioneers, we have been doing robotic surgery since 2009, when there were three robots in all of Spain. In June of last year we reached 1,000 interventions, the only center in Spain that has reached this figure.
Is surgery still a pillar in gynecological cancer?
That's how it is. The most common gynecological cancer is endometrium (womb). It is prevalent in developed countries like ours, it is associated with obesity, diabetes, hypertension... We have long-lived women who are very obese, so they are very prone to developing endometrial cancer. And the main treatment is surgical. The beauty of this surgery is that we do it with minimal invasion. With a robot we manage to do 90% of the interventions without having to open the abdomen, with a very fast recovery: they go home the next day and return to social life in a week.
The most lethal is the ovarian one.
Because it is diagnosed in advanced stages because it does not cause symptoms. Unfortunately we do not have an early diagnosis for ovarian cancer. Here it is important that we know more and more about the molecular part of this type of tumor and therefore we have more and more target drugs. Many things about ovarian target drugs will be presented here: chemotherapy molecules that attack certain genetically studied parts of the tumor, and this is what has made us advance a lot.
Is a cervical tumor a won battle?
In Europe we have less and less because we have primary prevention, which is the vaccine, and secondary prevention, which is the screening campaigns. In Catalonia we are pioneers in doing the campaigns the other way around than before: now we first look for the virus and then we do cytology, only on people who have the virus. It is a tumor that has a tendency towards eradication and we hope that in 2030-2040 we will have it practically eradicated in our environment. Everything is based on having a vaccine and prevention campaigns. In South America and Southeast Asian countries it is absolutely prevalent, but in Europe, with screening campaigns since the 1940s, we have less and less.
In recent years survival has increased very significantly.
In most tumors, yes. Even in the case of the ovarian tumor, which was stagnant a few years ago and now we have managed to improve a lot. Endometrial tumors tend to have a good prognosis and we cure most of them. In the cervical area we have everything, it is difficult for me to talk about it because we have very few cases: we are a reference center but we still treat 30 or 40 a year, of which 25 are from the population from outside who come with the tumor position.
Are there any particularly telling symptoms?
The most prevalent, which is the endometrium, has a very clear symptom, which normally occurs in women who are close to losing their period or mostly when they have already lost it: genital bleeding. In these conditions the woman has to go to the gynecologist. It does not mean that she has cancer but it is the warning sign that she may have it. It is a very early symptom, which occurs many times and makes the diagnosis very early, so with surgery we cure it.
Where is the future going?
In pharmaceuticals, the future is towards targeted therapy. Identify the molecular profile of the tumor to make drugs that attack this molecular profile. If this works well, we will need surgery less and less. The second trend is that the surgery we have to do is without opening the abdomen, minimally invasive. Here we are talking about the fundamental role of endoscopy, and within endoscopy, robotics.
