Skip to main content

Diagnosis and Management of Epithelial Ovarian Cancer

  • Living reference work entry
  • First Online:
  • 229 Accesses

Abstract

Ovarian cancer is the fifth most common cancer among women after breast, bowel, lung, and endometrial and remains the leading cause of death due to gynecological malignancy (Cancer.org 2016). Epithelial ovarian cancer accounts for the vast majority of ovarian malignancies with figures of around 85 %. Due to its insidious nature of presentation, it is often not diagnosed until the later stages leading to a high mortality rate. Five-year survival is very much influenced by stage at diagnosis. Over the last 20 years, incidence and mortality have remained fairly static, and much research is being undertaken looking for aids to diagnosis, possible screening methods, and improvement in treatment options, both surgical and medical. In this chapter we will discuss presentation, diagnostic tools, and possible management regimes for patients with epithelial ovarian cancer.

This is a preview of subscription content, log in via an institution.

References

  • Braicu EI, Sehouli J, Richter R, Pietzner K, Lichtenegger W, Fotopoulou C. Primary versus secondary cytoreduction for epithelial ovarian cancer: a paired analysis of tumour pattern and surgical outcome. Eur J Cancer. 2012;48(5):687–94. Epub 2011 Jul 13.

    Article  PubMed  Google Scholar 

  • Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20(5):1248–59.

    Article  PubMed  Google Scholar 

  • Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta- analysis. Gynecol Oncol. 2009;112(1):265–74.

    Article  PubMed  Google Scholar 

  • Chan K, Urban R, Hu JM, Shin JY, Husain A, Teng NN, Berek JS, Osann K, Kapp DS. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients. Br J Cancer. 2007;96:1817–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Colombo PE, Mourregot A, Fabbro M, et al. Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol. 2009;35(2):135–43.

    Google Scholar 

  • De Iaco P, Musto A, Orazi L, Zamagni C, Rosati M, Allegri V, Cacciari N, Al-Nahhas A, Rubello D, Venturoli S, Fanti S. FDG-PET/CT in advanced ovarian cancer staging: value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy. Eur J Radiol. 2011;80(2):e98–103. Epub 2010 Aug 4.

    Article  PubMed  Google Scholar 

  • Doufekas K, Olaitan A. Clinical epidemiology of epithelial ovarian cancer in the UK. Int J Womens Health. 2014;6:537–45.

    PubMed  PubMed Central  Google Scholar 

  • du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115(6):1234–44.

    Article  PubMed  Google Scholar 

  • Eisenkop SM, Spirtos NM, Montag TW, et al. The impact of subspecialty training on the management of advanced ovarian cancer. Gynecol Oncol. 1992;47:203–9.

    Article  CAS  PubMed  Google Scholar 

  • Fotopoulou C, Richter R, Braicu EI, Schmidt SC, Lichtenegger W, Sehouli J. Can complete tumor resection be predicted in advanced primary epithelial ovarian cancer? A systematic evaluation of 360 consecutive patients. Eur J Surg Oncol. 2010;36(12):1202–10. Epub 2010 Sep 22.

    Article  CAS  PubMed  Google Scholar 

  • Fotopoulou C, Richter R, Braicu IE, et al. Clinical outcome of tertiary surgical cytoreduction in patients with recurrent epithelial ovarian cancer. Ann Surg Oncol. 2011;18:49–57.

    Article  PubMed  Google Scholar 

  • Fotopoulou C, Zang R, Gultekin M, Cibula D, Ayhan A, Liu D, Richter R, Braicu I, Mahner S, Harter P, Trillsch F, Kumar S, Peiretti M, Dowdy SC, Maggioni A, Trope C, Sehouli J. Value of tertiary cytoreductive surgery in epithelial ovarian cancer: an international multicenter evaluation. Ann Surg Oncol. 2013a;20(4):1348–54. Epub 2012 Oct 2.

    Article  PubMed  Google Scholar 

  • Fotopoulou C, Savvatis K, Kosian P, Braicu IE, Papanikolaou G, Pietzner K, Schmidt SC, Sehouli J. Quaternary cytoreductive surgery in ovarian cancer: does surgical effort still matter? Br J Cancer. 2013b;108(1):32–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gabra H. Back to the future: targeting molecular changes for platinum resistance reversal. Gynecol Oncol. 2010;118:210–1.

    Article  PubMed  Google Scholar 

  • Goff B. Symptoms associated with ovarian cancer. Clin Obstet Gynecol. 2012;55(1):36–42.

    Article  PubMed  Google Scholar 

  • Gultekin M, Velipaşaoğlu M, Aksan G, Dursun P, Dogan NU, Yuce K, Ayhan A. A third evaluation of tertiary cytoreduction. J Surg Oncol. 2008;98(7):530–4.

    Article  PubMed  Google Scholar 

  • Harter P, du Bois A, Hahmann M, Hasenburg A, Burges A, Loibl S, Gropp M, Huober J, Fink D, Schröder W, Muenstedt K, Schmalfeldt B, Emons G, Pfisterer J, Wollschlaeger K, Meerpohl HG, Breitbach GP, Tanner B, Sehouli J, Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee, AGO Ovarian Cancer Study Group. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13(12):1702–10.

    Article  PubMed  Google Scholar 

  • Harter P, Hahmann M, Lueck HJ, Poelcher M, Wimberger P, Ortmann O, Canzler U, Richter B, Wagner U, Hasenburg A, Burges A, Loibl S, Meier W, Huober J, Fink D, Schroeder W, Muenstedt K, Schmalfeldt B, Emons G, du Bois A. Surgery for recurrent ovarian cancer: role of peritoneal carcinomatosis: exploratory analysis of the DESKTOP I trial about risk factors, surgical implications, and prognostic value of peritoneal carcinomatosis. Ann Surg Oncol. 2009;16(5):1324–30.

    Article  CAS  PubMed  Google Scholar 

  • Harter P, Sehouli J, Reuss A, Hasenburg A, Scambia G, Cibula D, Mahner S, Vergote I, Reinthaller A, Burges A, Hanker L, Pölcher M, Kurzeder C, Canzler U, Petry KU, Obermair A, Petru E, Schmalfeldt B, Lorusso D, du Bois A. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer. 2011;21(2):289–95.

    Article  PubMed  Google Scholar 

  • Helm CW, Chief Editor: Harris JE. Ovarian cancer staging. http://emedicine.medscape.com/article/2007140-overview

  • Hızlı D, Boran N, Yılmaz S, Turan T, Altınbaş SK, Celik B, Köse MF. Best predictors of survival outcome after tertiary cytoreduction in patients with recurrent platinum-sensitive epithelial ovarian cancer. Eur J Obstet Gynecol Reprod Biol. 2012;163(1):71–5.

    Google Scholar 

  • http://www.cancer.org/cancer/ovariancancer/overviewguide/ovarian-cancer-overview-survival

  • http://www.nice.org.uk/guidance/CG122/chapter/Appendix-D-Risk-of-malignancy-index-RMI-I

  • http://www.who.int/selection_medicines/committees/expert/20/applications/EpithelialOvarian.pdf?ua=1

  • Janczar S, Graham JS, Paige AJW, Gabra H. Targeting locoregional peritoneal dissemination in ovarian cancer. Expert Rev Obstet Gynecol. 2009;4(2):133–47.

    Article  Google Scholar 

  • Jemal A, et al. Cancer statistics. Cancer J Clin. 2007;57(1):43–66.

    Article  Google Scholar 

  • Karam AK, Santillan A, Bristow RE, Giuntoli 2nd R, Gardner GJ, Cass I, Karlan BY, Li AJ. Tertiary cytoreductive surgery in recurrent ovarian cancer: selection criteria and survival outcome. Gynecol Oncol. 2007;104(2):377–80. Epub 2006 Oct 2.

    Article  PubMed  Google Scholar 

  • Kehoe S, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386(9990):249–57.

    Google Scholar 

  • Kurman RJ, Shih I-M. The origin and pathogenesis of epithelial ovarian cancer- a proposed unifying theory. Am J Surg Pathol. 2010;34(3):433–43.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leitao Jr MM, Kardos S, Barakat RR, Chi DS. Tertiary cytoreduction in patients with recurrent ovarian carcinoma. Gynecol Oncol. 2004;95:181–8.

    Article  PubMed  Google Scholar 

  • Monk BJ, Coleman RL. Changing the paradigm in the treatment of platinum-sensitive recurrent ovarian cancer: from platinum doublets to nonplatinum doublets and adding antiangiogenesis compounds. Int J Gynecol Cancer. 2009;19 Suppl 2:S63–7. doi:10.1111/IGC.0b013e3181c104fa.

    Article  PubMed  Google Scholar 

  • Morris M, Gershenson DM, Wharton JT. Secondary cytoreductive surgery in epithelial ovarian cancer: nonresponders to first-line therapy. Gynecol Oncol. 1989;33(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  • Omura G, et al. A randomized trial of cyclophosphamide and doxorubicin with or without cisplatin in advanced ovarian carcinoma. A Gynecologic Oncology Group Study. Cancer. 1986;57:1725–30.

    Article  CAS  PubMed  Google Scholar 

  • Paulsen T, Kjaerheim K, Kaern J, et al. Improved short-term survival for advanced ovarian, tubal, and peritoneal cancer patients operated at teaching hospitals. Int J Gynecol Cancer. 2006;16 Suppl 1:11–7.

    Article  PubMed  Google Scholar 

  • Petrillo M, Ferrandina G, Fagotti A, Vizzielli G, Margariti PA, Pedone AL, Nero C, Fanfani F, Scambia G. Timing and pattern of recurrence in ovarian cancer patients with high tumor dissemination treated with primary debulking surgery versus neoadjuvant chemotherapy. Ann Surg Oncol. 2013;20(12):3955–60.

    Google Scholar 

  • Segna RA, Dottino PR, Mandeli JP, Konsker K, Cohen CJ. Secondary cytoreduction for ovarian cancer following cisplatin therapy. J Clin Oncol. 1993;11(3):434–9.

    CAS  PubMed  Google Scholar 

  • Sehouli J, Papanikolaou G, Braicu EI, Pietzner K, Neuhaus P, Fotopoulou C. Feasibility of surgery after systemic treatment with the humanized recombinant antibody bevacizumab in heavily pretreated patients with advanced epithelial ovarian cancer. Ann Surg Oncol. 2012;19(4):1326–33.

    Article  PubMed  Google Scholar 

  • Shih KK, Chi DS, Barakat RR, Leitao Jr MM. Tertiary cytoreduction in patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer: an updated series. Gynecol Oncol. 2010a;117:330–5.

    Article  CAS  PubMed  Google Scholar 

  • Shih KK, Chi DS, Barakat RR, Leitao Jr MM. Beyond tertiary cytoreduction in patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. Gynecol Oncol. 2010b;116(3):364–9. Epub 2009 Nov 7.

    Article  CAS  PubMed  Google Scholar 

  • Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;341.

    Google Scholar 

  • Tian WJ, Chi DS, Sehouli J, Tropé CG, Jiang R, Ayhan A, Cormio G, Xing Y, Breitbach GP, Braicu EI, Rabbitt CA, Oksefjell H, Fotopoulou C, Meerpohl HG, du Bois A, Berek JS, Zang RY, Harter P. A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: an evidence-based proposal for patient selection. Ann Surg Oncol. 2012;19(2):597–604.

    Article  PubMed  Google Scholar 

  • Timmerman D. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;341:c6839.

    Google Scholar 

  • Vaughan S, Coward JI, Bast Jr RC, Berchuck A, Berek JS, Brenton JD, Coukos G, Crum CC, Drapkin R, Etemadmoghadam D, Friedlander M, Gabra H, Kaye SB, Lord CJ, Lengyel E, Levine DA, McNeish IA, Menon U, Mills GB, Nephew KP, Oza AM, Sood AK, Stronach EA, Walczak H, Bowtell DD, Balkwill FR. Rethinking ovarian cancer: recommendations for improving outcomes. Nat Rev Cancer. 2011;11(10):719–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Vergote et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363:943–53.

    Google Scholar 

  • Vernooij F, Heintz P, Witteveen E, et al. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol. 2007;105:801–12.

    Article  PubMed  Google Scholar 

  • Zang RY, Harter P, Chi DS, Sehouli J, Jiang R, Tropé CG, Ayhan A, Cormio G, Xing Y, Wollschlaeger KM, Braicu EI, Rabbitt CA, Oksefjell H, Tian WJ, Fotopoulou C, Pfisterer J, du Bois A, Berek JS. Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort. Br J Cancer. 2011;105(7):890–6. Epub 2011 Aug 30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Katherine Nixon or Christina Fotopoulou .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this entry

Cite this entry

Nixon, K., Fotopoulou, C. (2016). Diagnosis and Management of Epithelial Ovarian Cancer. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_1-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17002-2_1-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-17002-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics