Ovarian cancer: current management and future directions

Ovarian cancer has the highest mortality of all the gynaecological malignancies. Epithelial ovarian cancer is the most common subtype. Approximately 5–10% occur in women with an inherited predisposition. These patients may benefit from prophylactic surgery. Diagnosis involves measurement of CA 125 and ultrasound. The results of both are combined to give a risk of malignancy index; this is used to decide where treatment takes place. Treatment of advanced epithelial ovarian cancer usually involves debulking surgery and chemotherapy. The correct order of these treatments is currently being evaluated. There are survival benefits if surgery is performed by a specialist gynaecological oncologist. Current standard chemotherapy for epithelial ovarian cancer is carboplatin with paclitaxel. Treatment may prolong life and palliate symptoms but it is rarely curative. New treatments are constantly being developed and offer the hope of improved outcomes. These include ultraradical surgery, intraperitoneal chemotherapy and novel drug treatments.