Ovarian Cancer by Gautam G. Rao, M.D.
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States. Ovarian cancer is the fourth most frequent cause of cancer death in women and accounts for 5% of all cancer deaths in women in this country. Annually, there will be an estimated 24,400 new cases of diagnosed which accounts for 4% of all cancer diagnoses. 1 in 70 women will develop ovarian cancer in her lifetime and 1 in 100 will die from this disease which represents approximately 15,000 deaths per year in the United States.
In the last three decades, the overall incidence of ovarian cancer has been relatively unchanged, with a declining incidence for younger women but an increasing incidence for older women. Also, during this same time period, several studies have noted an increasing ovarian cancer mortality rate in older women and decreasing rate in younger women. Overall, the ovarian cancer mortality rate has remained stable in the United States over the past decade. The overall 5-year survival rate is now approximately 50%. In other words, median survival is approximately 5 years. There has been steady improvement in the survival rate for ovarian cancer over the past few decades.
For early ovarian cancer, stage I and II, the mainstay of treatment is staging surgery. Staging serves to guide therapy and provide prognostic information. For advanced ovarian cancer, stage III and IV, cytoreductive surgery (tumor debulking) has been proven to improve survival. This procedure usually includes total abdominal hysterectomy/bilateral salpingo-oophorectomy/removal of grossly enlarged tumor masses.
The amount of residual ovarian tumor after debulking surgery inversely correlates with length of survival. The National Institutes of Health Consensus Development Conference on Ovarian Cancer in 1994 concluded that \aggressive attempts at cytoreductive surgery as the primary management of ovarian cancer will improve the patient's opportunity for long-term survival.\ For stage early ovarian cancer, adjuvant chemotherapy is given after surgery for those patients with an unfavorable prognosis. Adjuvant chemotherapy is the current standard of care for advanced ovarian cancer. The most common regimen is Taxane and Platinum based chemotherapy.
Our knowledge of ovarian cancer and its treatments is changing rapidly. Intraperitoneal chemotherapy has recently become used more often to deliver drug directly to the ovarian cancer cells and has been shown to be more effective than standard intravenous chemotherapy. Current research is focused on finding a reliable and cost-effective screening test for ovarian cancer. Factors being studied are genetic and epigenetic markers, imaging studies such as ultrasound and PET scan, and serum proteinomics. Identification of patients or families at high risk is key. Clinical trials are also being conducted to find more effective and less toxic chemotherapy regimens as well as novel chemotherapeutic and biologic treatments.