Ovarian cancer: Diagnosis and treatment

Abstract

Ovarian neoplasms comprise several distinct histopathological entities. The most common of them is epithelial ovarian carcinoma (EOC) which accounts for approximately 90% of all ovarian cancer cases. This entry is mainly devoted to this cancer type. Ovarian cancer is a silent killer. Early EOC is often asymptomatic and many patients present with advanced disease. At the same time, routine screening of the general population for ovarian cancer with the existing methods does not seem to decrease the associated mortality and is not recommended as it may lead to overtreatment. In any case, any pelvic mass in a postmenopausal woman should be treated as a suspected ovarian cancer. In premenopausal woman, ovarian cysts are frequent. These are usually benign and regress either spontaneously, or after a two-month contraceptive treatment. If they do not, a tissue-based diagnosis should be made. The definitive diagnosis of EOC is usually made based on a pathological evaluation of a biopsy or a surgical specimen. The most common primary treatment of a presumed ovarian cancer is surgery which includes surgical exploration with comprehensive staging and debulking. Most patients receive adjuvant chemotherapy after surgery, usually a platinum agent with paclitaxel. Patients who are not candidates for frontline debulking may receive neoadjuvant chemotherapy followed by interval debulking and further chemotherapy. However, the outcomes tend to be worse than with the primary surgery. Ovarian cancers usually respond well to frontline therapies. However, the recurrence rates are very high and recurrent EOC is associated with a very poor prognosis. Recurrent patients are usually retreated with multiple courses of chemotherapy, with serious adverse effects and poor outcomes. Novel targeted therapeutics, combined with “traditional” cytotoxic regimens or with other targeted agents of different classes seem to have a potential to improve patient outcomes. These include in particular antiangiogenics (like bevacuzimab) and PARP inhibitors (olaparib). Both cited agents are already approved by the US Food and Drug Administration (FDA) for treatment of recurrent EOC under certain conditions and their utility for treatment of EOC patients in other settings and in different combinations, as well as other, similar, therapeutics, are tested in further clinical trials.