Elsevier

Mayo Clinic Proceedings

Volume 82, Issue 6, June 2007, Pages 751-770
Mayo Clinic Proceedings

SYMPOSIUM ON SOLID TUMORS
Current Management Strategies for Ovarian Cancer

https://doi.org/10.4065/82.6.751 Get rights and content

Epithelial ovarian cancer originates in the layer of cells that covers the surface of the ovaries. The disease spreads readily throughout the peritoneal cavity and to the lymphatics, often before causing symptoms. Of the cancers unique to women, ovarian cancer has the highest mortality rate. Most women are diagnosed as having advanced stage disease, and efforts to develop new screening approaches for ovarian cancer are a high priority. Optimal treatment of ovarian cancer begins with optimal cytoreductive surgery followed by combination chemotherapy. Ovarian cancer, even in advanced stages, is sensitive to a variety of chemotherapeutics. Although improved chemotherapy has increased 5-year survival rates, overall survival gains have been limited because of our inability to eradicate all disease. Technologic advances that allow us to examine the molecular machinery that drives ovarian cancer cells have helped to identify numerous therapeutic targets within these cells. In this review, we provide an overview of ovarian cancer with particular emphasis on recent advances in operative management and systemic therapies.

Section snippets

Categories

The 3 categories of ovarian cancer are named for their cell of origin. Ninety percent of ovarian cancers arise from cells that make up the epithelial layer that covers the surface of the ovaries. These are known as epithelial cancers. In general, when the term ovarian cancer is used, it implies epithelial ovarian cancer, the focus of this review. The other 2 types are germ cell tumors and stromal tumors. Stromal tumors arise in the hormonally active elements within the connective tissue stroma

Clinical Presentation

Symptoms. The symptoms of ovarian cancer are fairly nonspecific and often occur when the disease is already spread throughout the abdominal cavity. Abdominal discomfort or vague pain, abdominal fullness, bowel habit changes, early satiety, dyspepsia, and bloating are frequent presenting symptoms.37 Occasionally, patients may present with bowel obstruction due to intra-abdominal masses or shortness of breath due to pleural effusion. Early-stage disease is usually asymptomatic, and the diagnosis

TREATMENT

The first step in the management of patients with epithelial ovarian cancer is an accurate diagnosis and thorough staging, with optimal surgical cytoreduction of metastatic disease. Postoperative taxane- and platinum-based chemotherapy is then administered to patients with a significant risk of recurrence. In this section we review the role of surgery and chemotherapy in the management of patients with ovarian cancer. We highlight surgical approaches to obtain optimal tumor cytoreduction in

CONCLUSION

Symptoms of ovarian cancer are fairly nonspecific and often occur after the disease has spread throughout the abdominal cavity. The presence of a pelvic mass at physical examination is the most important sign of ovarian cancer. The serum CA-125 level has been widely used as a marker for a possible epithelial ovarian cancer in the primary assessment of a pelvic mass. The predominant use of CA-125 measurement is to monitor disease status of patients with ovarian cancer, such as detecting early

Acknowledgments

We are indebted to Vicki Shea for her help and expertise in the preparation of the submitted manuscript. We dedicate this review to our patients with ovarian and primary peritoneal cancer.

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    This study was supported by a grant (R01 CA86888) from the National Institutes of Health and grants from the Andersen Foundation and the Minnesota Ovarian Cancer Alliance.

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