ROMA or death: advances in epithelial ovarian cancer diagnosis.

摘要

Epithelial ovarian cancer (EOC) is the fourth most common cause of cancer mortality in women in the Western world, and the leading cause of death from gynecological malignancy. The high death rate from EOC is mostly attributable to its late detection at an advanced stage and the high tendency for diffuse metastasis and recurrence. In fact, while early EOC detection results in a 92% 5-year survival rate, the overall 5-year survival rate is <50%. This is because only 19% of EOC cases are diagnosed prior to extra-ovarian spread owing to the lack of obvious symptoms prior to progression (1). Besides the obvious importance of early detection of cancer, EOC diagnosis represents a specific challenge. While for most malignant tumors, e.g., breast cancer, gastrointestinal malignancies or carcinoma of the uterine cervix, the diagnosis can be easily histologically confirmed before surgery, histological verification of EOC before surgery is usually not possible and the diagnosis is obtained from the tumor specimen obtained at surgery. The surgical approach for benign and malignant tumors differs fundamentally, and pre-operative diagnosis allows for careful planning of the surgical procedure, including referral to high volume centers, composition of the surgical team and post-operative care. As with cancers in other primary locations, the quality of primary surgery remains a principal factor determining the long-term prognosis of EOC patient. Thus, obtaining the diagnosis before histological verification is of fundamental importance for patient management in EOC, and considerable efforts have been devoted in the past decades for identifying imaging techniques and laboratory tests that would diagnose EOC prior to surgery.