Epithelial ovarian cancer: Prevention, diagnosis, and treatment

The leading cause of death from gynecologic malignancies in the United Stat es is epithelial ovarian cancer. The significant risk factor for developmen t of ovarian cancer is advancing age although there is clearly a genetic pr edisposition-often associated with the BRCA1 and BRCA2 genes-in at least 5% to 10% of all epithelial ovarian cancers. Oral contraceptives are known to reduce the risk for development of ovarian cancer and should he considered as a method of birth control in women at i ncreased risk. Currently there is no acceptable method of screening for thi s disease although measurement of CA-125 level and transvaginal ultrasound have been utilized. Ovarian cancer is a surgically staged disease. In apparent early-stage dise ase, complete surgical staging is critical for the selection of adjunctive therapy. In advanced-stage disease, the goal is primary cytoreduction. Standard postoperative therapy for advanced-stage ovarian cancer includes p latinum-based chemotherapy with the substitution of paclitaxel for cyclopho sphamide occuring in the last decade, Despite these advances in chemotherap y, ovarian cancer continues to be fatal in far too many cases.