Surgical debulking of ovarian cancer:Past, present, or future?

摘要

Ovarian cancer is the "silent killer," causing more deaths in the United States than all other gynecologic malignancies combined. This article focuses on the recent debate of whether or when patients with advanced disease should undergo debulking surgery.One in 71 American women (1.4%) will develop ovarian cancer during her lifetime. In 2009, it is estimated that 21,550 new patients were diagnosed and 14,600 deaths occurred. This highly lethal disease has been portrayed as a "silent killer" because it does not present with dramatic bleeding, excruciating pain, or an obvious lump. Instead, the typical symptoms of ovarian cancer tend to be indolent (Table I). Patients and their healthcare providers often attribute such nonspecific changes to aging, dietary indiscretions, stress, depression, or the onset of irritable bowel syndrome. Frequently, women are medically managed for indigestionor other presumed ailments without having a pelvic examination. As a result, substantial delays before diagnosis are the norm, and more than two-thirds of patients still present with advanced stage III-IV disease.