Ovarian cancer update: management challenges and advances

Although less common than cervical or uterine cancer, ovarian cancer accounts for more deaths than the other two gynecologic malignancies combined.

Ovarian cancer produces few symptoms while confined to the ovary. A palpable ovary in a postmenopausal woman should arouse the clinician's suspicion. Most tumors have already spread at the time of the initial laparotomy and require chemotherapy. The standard regimen contains cisplatin or carboplatin plus cyclophosphamide; paclitaxel (Taxol) shows promise and will probably be incorporated into the standard regimen, as well. Estrogen replacement therapy is not contraindicated. The rate of relapse is high, even in women who have achieved a complete clinical response. If persistent disease is found at a second laparotomy, intraperitoneal chemotherapy may be appropriate in some patients.

Because the patient's chance of survival is much better if the disease is discovered when it is still confined to the ovary, physicians should be alert to the possibility of ovarian cancer, particularly in postmenopausal women with vague abdominal complaints or with a palpable ovary.