Whence epithelial ovarian carcinoma?

摘要

Among common malignancies, epithelial ovarian carcinoma (EOC) remains enigmatic in at least two important respects. First, the histologic region of origin for this cancer remains obscure and second, an identifiable premalignant or precursor lesion that is generally recognized by cancer pathologists is yet to be defined. This state of uncertainty is particularly problematic since the majority of these cancers are diagnosed at an advanced stage, leading directly to the high mortality to incidence ratio associated with EOC, which accounts for more deaths than all other gynecologic malignancies combined . The good prognosis for patients with disease confined to the ovary suggests that early detection could lessen mortality substantially. The use of serum CA-125 measurements and radiologic technology, alone or in combination, has yet to prove effective in either the high risk or general populations , although the detection of diagnostic serum proteomic patterns or biomarker panels holds promise in this context. In the genetically predisposed population, prophylactic bilateral salpingo-ophor-ectomy is a highly effective preventive measure, but is not without morbidity, side effects, and a residual risk of pelvic malignancy . Development of optimal primary and secondary prevention strategies for EOC in the high-risk and general populations would, presumably, be greatly facilitated by an improved understanding of its early natural history.