Surgical Prevention in Ovarian Cancer: What Is the Optimal Strategy?

Surgical Prevention in Ovarian Cancer: What Is the Optimal Strategy?

Alexios Papanikolaou (2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece), Anastasios Liberis (2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece) and Anastasia Vatopoulou (Aristotle University of Thessaloniki, Greece)
DOI: 10.4018/978-1-7998-4213-2.ch014

Abstract

Ovarian cancer is the second most common malignant disease of the female genital tract, but the first in mortality because it is usually diagnosed at an advanced stage. Options for early detection, diagnosis, and treatment are limited. Prevention of ovarian cancer relates to primary prevention by avoiding factors that are epidemiologically associated with an increased incidence of ovarian cancer and the adoption of protective habits. These include interventions to exclude the fallopian tubes and ovaries. Secondary prevention is related to early diagnosis. The chapter aims to summarize current evidence on prevention of ovarian cancer as well as role of surgery to prevent advanced-stage disease.
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Introduction

Ovarian cancer is the second most common malignant disease of the female genital tract, but the first in mortality because it is usually diagnosed at an advanced stage. Options for early detection, diagnosis and treatment are limited. The outcome is not good because the disease is often diagnosed late. Ovarian cancer is composed of several subtypes with distinct biological and molecular properties (even within the same histological subtype), and there is inconsistency in availability of and access to treatment. Upfront treatment largely relies on

debulking surgery to no residual disease and platinum-based chemotherapy with the addition of novel targeted agents (Cortesi, 2013).

Epithelial Ovarian Cancer Subtypes

In recent years, many of the pathogenetic mechanisms of ovarian carcinogenesis have been understood and it is now realized that ovarian epithelial cancer is not a single clinical entity (Gilks, 2008) (Table 1).

The most common histological type (> 70%) is the High grade serous type (HG-serous), which is typically diagnosed at an advanced stage, having peritoneal metastases and poor prognosis. The second most common types (about 10%) are the endometriod and clear cell type, which are usually less localized and associated with endometriosis. There are also the low grade - serous tumor (4%), which is of different origin from the high grade serous type. Low grade tumors are platinum resistant and are associated with borderline malignancies. Even more rare (less than 4%) is the mucous cystadenocarcinoma that is usually localized and has different origins.

Prevention of Ovarian Cancer

Prevention of ovarian cancer relates to primary prevention by avoiding factors that are epidemiologically associated with an increased incidence of ovarian cancer and by the adoption of protective strategies (Table 2).

These include interventions to excise the fallopian tubes and ovaries. Secondary prevention is related to early diagnosis with preventive examinations (specific tumor markers and vaginal ultrasound) in order to diagnose the disease at an early stage and have a good outcome (Table 3).

Ovarian cancer develops in a high-risk population with hereditary ovarian cancer and in a population with normal risk (Τemkin, 2017).

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