Future Directions in the Management of Epithelial Ovarian Cancer

Sarah Blagden; Hani Gabra


Future Oncol. 2008;4(3):403-411. 

In This Article

Abstract and Introduction


Epithelial ovarian cancer can be a difficult malignancy to manage, partially owing to its heterogenous biology. Whilst desirable, screening designed to reduce mortality has not yet proven effective, though results of ongoing studies are awaited. In this brief review, we attempt to highlight some important issues in the current management of primary and recurrent ovarian cancer, and to place these issues in the context of cutting-edge approaches to targeted therapy and its combination with chemotherapy, as well as other novel treatment strategies. It is hoped that this will lead to further improvements in progression-free and overall survival for patients with ovarian cancer, whilst maintaining their quality of life for as much of the disease journey as possible.


Approximately 7000 new cases of epithelial ovarian cancer (EOC) are diagnosed every year in the UK, with an incidence that has increased by approximately 13% over the last 30 years. This increase has been gradual, from around 15 in 100,000 women in 1975 to around 17 in 100,000 women in 2004.[1,2,3,4] EOC primarily affects postmenopausal women, with almost 85% of cases in women over the age of 50 years. The rise in incidence of EOC is only partly explained by age-related population changes, namely a 45% expansion in the over 50s since 1951. It appears that, even taking this into account, the age of onset of EOC is also increasing. Between 1975 and 2004, the number of patients aged 65 years or over with a diagnosis of EOC rose by 48%.[5] The causes of this rise are unclear - a contribution may have been made by the (current at the time of diagnosis) use of hormone-replacement therapy, estimated to have caused an additional 1300 ovarian cancers since 1991 (hazard ratio [HR]: 1.20).[6] Another contributing factor may be obesity; the Million Women Study has recently identified ovarian cancer as one of a number of tumors that can result from obesity (relative risk: 1.14).[7] However, these two factors may be overshadowed by changing lifestyle trends, such as increasing maternal age at first birth and reduced family size.

Despite the rising incidence of ovarian cancer, the mortality has remained unchanged since the 1970s, at between 10 and 12 per 100,000 women (66% of the incidence),[1,2,3,4] reflecting improvements in the medical and surgical management of the disease. Screening, although very challenging owing to the relative rarity of ovarian cancer in the population and the lack of certainty regarding clearly defined early lesions/tumor progression models, does offer a potential reduction in cancer-specific mortality. Our future aims are to reduce mortality from ovarian cancer by increasing cure rates and, in cases where cure is not possible, to lengthen the progression-free intervals for patients suffering from the disease. A number of clinical and scientific developments in recent years have made these aims attainable.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.