The Lancet, Volume 384, Issue 9951, Pages 1376 – 1388, 11 October 2014

Ovarian cancer

Summary
Epithelial ovarian cancer is the commonest cause of gynaecological cancer-associated death.

The disease typically presents in postmenopausal women, with a few months of abdominal pain and distension. Most women have advanced disease (International Federation of Gynecology and Obstetrics [FIGO] stage III), for which the standard of care remains surgery and platinum-based cytotoxic chemotherapy.

Although this treatment can be curative for most patients with early stage disease, most women with advanced disease will develop many episodes of recurrent disease with progressively shorter disease-free intervals.
These episodes culminate in chemoresistance and ultimately bowel obstruction, the most frequent cause of death.

For women whose disease continues to respond to platinum-based drugs, the disease can often be controlled for 5 years or more.

Targeted treatments such as antiangiogenic drugs or poly (ADP-ribose) polymerase inhibitors offer potential for improved survival.

The efficacy of screening, designed to detect the disease at an earlier and curable stage remains unproven, with key results expected in 2015.

G Mohan.