Carcinoma of the ovary

Ovarian carcinoma presents a difficult management problem. Localized disease is difficult to diagnose and advanced disease is usually present by the time the patient presents with symptoms (pain, discomfort, distention, mass, and so on). Surgery alone is inadequate because even if a complete resection is performed approximately 50% of cases recur. Postoperative adjuvant therapy is given in the form of radiation therapy, radioisotopes, or chemotherapy for stage I, stage II, and optimal stage III disease. No clear benefit can be ascribed to any treatment. It is evident, however, that abdominopelvic irradiation is superior to pelvic irradiation alone; many of patients receiving pelvic irradiation alone fail in the upper abdomen owing to occult disease. Prognosis depends on many variables in addition to stage: grade of tumor, histology, age of patient,and completeness of surgery. Several studies have tried to incorporate these variables into their results. Dembo perhaps has been the most diligent in incorporating them into appropriate low-, intermediate- and high-risk groups. Patients with residual macroscopic or bulk disease have the poorest prognosis; chemotherapy is the usual first-line treatment choice, although no optimal treatment is known. Regimens usually include cisplatin; many single agent and multiagent drugs have been tried. The challenge of the future lies in earlier diagnosis; those diagnosed early can attain long term survival. The problem lies in choosing the appropriate therapy because randomized controlled studies are few and all modalities can be effective. No clear picture emerges about the best treatment, although there is a slight indication that irradiation affords better intra-abdominal control. Continued studies are needed to prove this