Epithelial Ovarian Cancer

Excerpt

Ovarian cancers comprise epithelial and nonepithelial ovarian malignancies. Epithelial ovarian cancer is the most prevalent type, accounting for more than 95%, while approximately 5% are nonepithelial ovarian cancers (eg, germ cell, sex-cord stromal, and small cell ovarian cancers). Epithelial ovarian malignancies are subdivided by histologic classification as diagnostic assessment, management, and patient outcomes can vary based on the subtype, including high-grade serous, low-grade serous, clear cell, endometrioid, and mucinous ovarian cancer.

Ovarian cancer is the leading cause of death in women diagnosed with gynecological cancers and the second most common gynecologic malignancy in the United States, according to the Centers for Disease Control and Prevention. Worldwide, ovarian malignancy ranks as the third most common gynecologic cancer. Ovarian cancer is also the fifth most frequent cause of death from any cancer in women in the United States and the eighth worldwide. Ovarian cancer's high mortality is most likely secondary to the disease's nonspecific clinical symptoms and lack of preventative screening methods, which leads to delayed diagnosis; most patients have advanced-stage disease at diagnosis. The most significant risk factor for ovarian cancer is advanced age, occurring most frequently in women who are postmenopausal.

Evaluation of any ovarian mass primarily consists of clinical assessment, imaging studies, and tumor markers to discern a patient's risk factors for malignancy and characterize the mass; an ovarian cancer diagnosis is histologically confirmed. Treatment approaches are based on patient factors (eg, comorbidities and previous treatment) and the tumor's stage and histology. Currently, surgical debulking and systemic chemotherapy are typically recommended with or without targeted therapies. Targeted therapy includes antiangiogenic bevacizumab and poly adenosine diphosphate (ADP)-ribose polymerase (PARP) inhibitors and immunotherapy. Additionally, neoadjuvant treatment, interval surgical debulking, and heated intraperitoneal chemotherapy are evolving strategies in ovarian malignancy management. However, despite advances in ovarian cancer treatment, a high recurrence rate and mortality remain a challenge, indicating the need for effective prevention and detection strategies, interprofessional management, and new treatment modalities based on a better understanding of ovarian cancer's molecular characteristics.