OBJECTIVE:

I. To aid in early diagnosis and treatment, distinguish the symptoms of ovarian cancer from those of other gynecological disorders¹.

II. To Use the proper techniques, such as transvaginal ultrasonography, pelvic exams, and tumor marker tests, to screen patients for ovarian cancer.²

III. To Use multimodal therapy, imaging scans, and biopsy as part of evidence-based ovarian cancer diagnosis and treatment methods³.

IV. To Utilize inter professional team techniques to enhance ovarian cancer patients' care coordination and results⁴.

INTRODUCTION:

Both epithelial and non-epithelial ovarian cancers are classified as ovarian cancers⁵. Over 95% of ovarian cancers are epithelial, whereas non epithelial ovarian cancers (such as germ cell, sex-cord stromal, and small cell ovarian cancers) make up about 5% of all ovarian cancers⁶. High-grade serous, low-grade serous, clear cell, endometrioid, and mucinous ovarian cancers are among the subtypes of epithelial ovarian cancers that are separated by histologic classification because the subtypes can affect patient outcomes, therapy, and diagnostic evaluation⁷.

Ovarian cancer is the primary cause of mortality among women diagnosed with gynecological cancers and the second most frequent gynecologic malignancy in the United States, according to the Centers for Disease Control and Prevention. Ovarian cancer is the third most prevalent gynecologic cancer in the world⁸.

In the United States, ovarian cancer ranks fifth among all cancers that kill women, and it ranks eighth globally⁹. The vague clinical symptoms of ovarian cancer and the absence of preventative screening techniques undoubtedly contribute to the illness's high death rate by delaying diagnosis; the majority of patients are diagnosed with advanced-stage disease¹⁰. Advanced age is the biggest risk factor for ovarian cancer, which primarily affects postmenopausal women¹¹.

Clinical assessment, imaging examinations, and tumor markers are the main tools used to evaluate any ovarian mass in order to identify the mass's characteristics and determine the patient's risk factors for malignancy; an ovarian cancer diagnosis is confirmed by histology. Treatment strategies are determined on the stage and histology of the tumor as well as patient characteristics (such as comorbidities and prior treatments)¹². At the moment, systemic chemotherapy and surgical debulking are usually advised, either in conjunction with or apart from targeted therapies¹³. Antiangiogenic bevacizumab, polyadenosine diphosphate (ADP)-ribose polymerase (PARP) inhibitors, and immunotherapy are examples of targeted therapy¹⁴. Furthermore, new approaches to the treatment of ovarian cancer include hot intra peritoneal chemotherapy, interval surgical debulking, and neo adjuvant therapy¹⁵. A high recurrence rate and mortality rate, however, persist despite advancements in ovarian cancer treatment, highlighting the need for inter professional management, effective prevention and detection strategies, and novel treatment modalities founded on a deeper comprehension of the molecular features of ovarian cancer.

Risk Factors for Ovarian Cancer:

Although the exact cause of ovarian cancer is unknown, a number of factors have been found to raise the risk of developing the disease¹⁶. The following are risk factors for ovarian cancer:

i. Older age

ii. Menarche at an early age

iii. Menopause's late start

iv. Family background

v. The absence of nulliparity

vi. Being overweight

vii. Use of perineal talcSmoking

viii. Endometriosis

ix. Hormone replacement treatment

Fig No.1 Risk Factor of Ovarian cancer

A higher risk of ovarian cancer is linked to factors that enhance ovulation throughout one's lifespan, such as nulliparity, early menarche, or late menopause¹⁷. The precise etiologic process is unknown, though. Furthermore, it is believed that oxidative stress and deoxyribonucleic acid damage caused by inflammatory diseases (such as endometriosis and obesity) contribute to the development of ovarian cancer¹⁸. A substantial risk factor for ovarian cancer is a positive personal or family history of breast or ovarian cancer. One common underlying reason of a person's predisposition to cancer is germline mutations in the BRCA1 or BRCA2 genes¹⁹. Mismatch repair genes in Lynch syndrome, tumor protein p53 (TP53) in Li-Fraumeni syndrome, STK11 in Peutz-Jeghers syndrome, CHEK2, RAD51, BRIP1, and PALB2 are among the other hereditary cancer syndromes linked to gene mutations that also raise the risk of ovarian cancer²⁰. Based on detected alterations in the distal epithelium in fallopian serous tubal intraepithelial carcinoma, an HGSC precursor, recent results indicate that high-grade serous ovarian cancer (HGSC) may have its genesis in the fallopian tube²¹. Although studies have not shown that suggested ovarian cancer screening procedures are helpful, several organizations have agreed that it is appropriate to offer these high-risk people a variety of screening options.

Epidemology:

According to study findings, a woman has a 1.1% chance of getting ovarian cancer during her lifetime up to age 95²². Over 19,000 new cases of ovarian cancer were detected in the United States in 2022, and over 12,000 people were thought to have died from the disease²³. Additionally, there are age-related differences in the incidence of ovarian cancer subtypes²⁴. Women aged 45 to 50 years had the highest incidence of low-grade endometroid ovarian cancer, while those aged 60 to 65 years have the highest incidence of high-grade serous ovarian cancer²⁵. Women between the ages of 55 and 60 are most likely to develop clear-cell ovarian cancer²⁶. Non-Hispanic White women have the highest incidence of low-grade endometrioid and high-grade serous malignancies; Clear cell cancer is more common in Asian/Pacific Islander women, while non-Hispanic Black women have the lowest incidence of all ovarian cancer subtypes. The 5-year survival rate for early-stage ovarian cancer is 93.1%, while the 5-year survival rate for advanced-stage disease is 30.8%. The recurrence risk for stage I ovarian cancer is less than 10%, while 90% of women with stage IV ovarian cancer experience recurrence²⁷

SYMPTOMS:

· Bloating or a swollen feeling in the stomach

· Feeling full quickly after eating

· Frequent or urgent Pelvic pain

· abdominal pain or cramping

· Unexplained weight loss

· Fatigue²⁸

Bloating

Early satiety (feeling full quickly) or difficulty eating

Pelvic or abdominal pain

A need to urinate frequently or urgently

Fig No 2.symptoms of ovarian cancer

Fruits with Potential Anti-Cancer Activity:

1.Pomegranate

Image No.1 pomegranate Image No.2 Botanical profile of Pomegranate

The biological source of pomegranate is the plant Punica granatum L., which belongs to the family Lythraceae²⁹

Chemical Constituents with Anti-Ovarian Cancer Potential:

Polyphenols:

· Punicalagin and punicalin: Hydrolyzable tannins with strong antioxidant and anti-inflammatory effects³⁰

· Ellagic acid and Gallic acid: Known to induce apoptosis and inhibit cancer cell proliferation³¹

· Flavonoids: Includes quercetin, kaempferol, catechin, epicatechin, and rutin—modulate cell signaling and oxidative stress³².

Phenolic Acids:

· Caffeic acid, Ferulic acid, p-Coumaric acid: Contribute to antioxidant and anti-proliferative activities³³

Anthocyanins:

· Provide antioxidant effects and may influence cancer cell cycle regulation³⁴

Sterols and Alkaloids:

· Present in smaller amounts but may support anti-cancer mechanisms³⁵

Punicic Acid:

· Found in pomegranate seed oil; a conjugated fatty acid with anti-inflammatory and anti-tumor properties³⁶

COMPOUND	Class Specific Molecules	Role in Ovarian Cancer Treatment Class
Phenolic Acids	Ellagic acid, gallic acid, caffeic acid, ferulic acid, p-coumaric acid	Antioxidant, anti-inflammatory, DNA damage protection
Hydrolyzable Tannins	Punicalagin, punicalin, ellagitannins	Induce apoptosis, inhibit proliferation, modulate cell cycle
Flavonoids	Catechin, epicatechin, quercetin, rutin, kaempferol	Suppress Tumor growth, Regulate signaling pathway
Anthocyanins	Delphinidin, Cyanidin, pelargonidin derivatives	Antioxidant, Modulate oxidative stress
Steroids and Phytoestrogens	Estrone, estradiol, testosterone	Influence hormone-related cancer pathways

Chart No.1 Chemical Constituents with Anti-Ovarian Cancer Potential

Mechanisms of Action Against Ovarian Cancer

· Cell Cycle Arrest: PPE increases levels of CDKN1A (p21), halting cancer cell proliferation

· Apoptosis Induction: Promotes programmed cell death in ovarian cancer cells (e.g., OVCAR-3 line)

· Oxidative Stress Modulation: Acts as antioxidant in healthy cells and prooxidant in cancer cells, disrupting their survival

· Growth Factor Suppression: Reduces TGF-β2 and EGF levels and their receptors (TGFBR2, EGFR) in cancer cells

· Steroidogenesis Influence: Stimulates estradiol secretion in non-cancerous ovarian cells, potentially supporting hormonal balance³⁷

1 phenolic acids:

It act against ovarian cancer, with a focus on their molecular targets, mechanisms, and therapeutic relevance.³⁸

● What Are Phenolic Acids?

Phenolic acids are a subclass of plant-derived polyphenols, mainly divided into:

· Hydroxybenzoic acids: e.g., Gallic acid, Protocatechuic acid, Salicylic acid

· Hydroxycinnamic acids: e.g., Caffeic acid, Ferulic acid, p-Coumaric acid³⁹

They’re found in fruits like pomegranate, berries, and vegetables, and are known for their antioxidant, anti-inflammatory, and anticancer properties.⁴⁰

Structure no 1. Phenolic acid

2. Hydrolyzable tannins:

Especially gallotannins and ellagitannins—are a class of polyphenolic compounds found in plants like pomegranate, Terminalia chebula, and Phyllanthus niruri⁴¹. They’ve gained attention for their potent anti-ovarian cancer effects through multiple molecular mechanisms.⁴²

● What Are Hydrolyzable Tannins?

These are tannins that can be hydrolyzed into sugars and phenolic acids (like gallic acid and ellagic acid)⁴³. Two major types:

· Gallotannins: Esters of gallic acid with glucose (e.g., tannic acid, corilagin, chebulagic acid)

· Ellagitannins: Esters of hexahydroxydiphenic acid with glucose (e.g., punicalagin, pedunculagin)⁴⁴

Strcture no 2. Hydrolyzable tannins

3. Flavonoids:

Flavonoids are a diverse group of plant-derived polyphenolic compounds that have shown significant anti-ovarian cancer potential through multiple biochemical and cellular mechanisms⁴⁵. Let’s unpack their types, molecular actions, and therapeutic relevance in detail⁴⁶.

● What Are Flavonoids?

Flavonoids are secondary metabolites found in fruits, vegetables, tea, wine, and medicinal herbs.⁴⁷

Stru.no.3. Flavonoids

4. Anthocyanins:

Anthocyanins are vibrant plant pigments responsible for the red, purple, and blue hues in many fruits and vegetables—and they’re emerging as powerful allies in the fight against ovarian cancer⁴⁸

What Are Anthocyanins?

Anthocyanins are a subclass of flavonoids found in the cell vacuoles of plants. They exist as glycosides of anthocyanidins⁴⁹

Their antioxidant capacity is influenced by the number and position of hydroxyl and methoxy groups on their B-ring.⁵⁰

Stru.no 4. Anthocyanins

5. Steroids and Phytoestrogens:

Steroids, particularly glucocorticoids and sex steroids, are used in ovarian cancer treatment for both therapeutic and supportive⁵¹

Stru.no 5. Steroids and Phytoestrogens

CONCLUSION:

Ovarian cancer remains one of the deadliest gynecological malignancies due to late-stage diagnosis and high recurrence rates. Early detection through imaging and tumor markers is critical, but treatment remains challenging, especially in recurrent cases. Advances in targeted therapies—such as PARP inhibitors and bevacizumab—have shown promise. Understanding molecular pathology, implementing multimodal diagnostic strategies, and enhancing interprofessional care coordination are vital for improving outcomes. Additionally, emerging natural compounds like those found in pomegranate offer potential in adjunctive therapeutic strategies.

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Received on 05.08.2025 Revised on 27.08.2025

Accepted on 15.09.2025 Published on 15.10.2025

Available online from October 30, 2025

Research J. Science and Tech. 2025; 17(4):272-278.

DOI: 10.52711/2349-2988.2025.00038

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