Over view and recent advances in the management of Epithelial Ovarian Cancer

Abstract

Ovarian epithelial tumours are thought to arise from the simple cuboidal surface epithelium of the ovary, and account for 75% of all ovarian tumours, and 90-95% of ovarian malignancies. A higher risk for developing epithelial ovarian cancer is observed for nulliparous women and a lower risk for those who have had children, who have breastfed, who have undergone tubal ligation, or who have taken oral contraceptives. The World Health Organization (WHO) classification of ovarian tumours recognizes six major histotypes (serous, mucinous, endometrioid, clear cell, transitional cell and squamous). Most early ovarian carcinomas and the serous and mucinous cystadenomas are asymptomatic. Two-thirds of patients present with extensive intra-abdominal metastases. Patients with advanced carcinomas usually present with vague abdominal swelling or discomfort, abdominal bloating, dyspepsia and early satiety, lack of appetite, malaise, urinary frequency and weight change (either gain or loss). The primary workup of a patient with a suspicious pelvic mass should include an ultrasound and/or abdominal/pelvic computed tomography (CT) scan after an abdominal/pelvic examination and appropriate laboratory studies. Transvaginal ultrasonography (TVUS) is an important diagnostic tool in the evaluation of patients with a pelvic mass. TVUS is more sensitive at detecting ovarian tumors compared to other tests such as computed tomography (CT). CT or magnetic resonance imaging (MRI) ishelpful in defining the extent of peritoneal disease in patients with suspected ovarian cancer. FDG PET/CT can significantly modify the assessment of the extent of primary and recurrent ovarian cancer and, hence, often alters patient management substantially. The CA 125 serum level is elevated in more than 80% of serous epithelial ovarian cancers; however, it is not a reliable diagnostic test, since it can also be elevated in a variety of benign gynecologic conditions. Traditional staging for ovarian cancer is based on the FIGO staging system. A parallel American Joint Committee on Cancer system of TNM staging also exists, with strong correlations between stage and prognostic value of these sub stages.