Epithelial ovarian cancer is the most lethal of the gynecologic
malignancies, largely due to the advanced stage at diagnosis in most patients. Screening strategies using ultrasound and the
cancer antigen (CA) 125 tumor marker are currently under study and may lower stage at diagnosis but have not yet been shown to improve survival. Women who have inherited a deleterious mutation in the BRCA1 or BRCA2 gene and those with the
Lynch syndrome (
hereditary nonpolyposis colorectal cancer) have the highest risk of developing
ovarian cancer but account for only approximately 10% of those with the disease. Other less common and less well-defined genetic syndromes may increase the risk of
ovarian cancer, but their contribution to genetic risk is small. A clear etiology for sporadic
ovarian cancer has not been identified, but risk is affected by reproductive and hormonal factors. Surgery has a unique role in
ovarian cancer, as it is used not only for diagnosis and staging but also therapeutically, even in patients with widely disseminated, advanced disease.
Ovarian cancer is highly sensitive to
chemotherapy drugs, particularly the
platinum agents, and most patients will attain a remission with initial treatment. Recent advances in the delivery of
chemotherapy using the intraperitoneal route have further improved survival after initial
therapy. Although the majority of
ovarian cancer patients will respond to initial
chemotherapy, most will ultimately develop disease recurrence.
Chemotherapy for recurrent disease includes
platinum-based, multiagent regimens for women whose disease recurs more than 6 to 12 months after the completion of initial
therapy and sequential single agents for those whose disease recurs earlier. New targeted
biologic agents, particularly those involved with the
vascular endothelial growth factor pathway and those targeting the
poly (ADP-ribose) polymerase (PARP)
enzyme, hold great promise for improving the outcome of
ovarian cancer.