Ovarian cancer (review). Etiology, diagnosis, prognosis, surgery, radiotherapy, chemotherapy and endocrine therapy.

The increased incidence of ovarian cancer in women whose ovulations were not suppressed by pregnancy or oral contraceptives and the increase in the incidence of the disease with the onset of climacterium support the hypothesis that ovarian cancer is an endocrine-related disease. Animal experimental results further support this contention. However, identification of a population at risk, prevention, and early detection is difficult. At present, tumor markers are useful in monitoring the disease, though cannot be used for screening. Most of the diagnosed cases are of advanced stages. Besides staging, tumor histology, and residual tumor load are of prognostic importance. The need for accurate initial surgical staging with optimal tumor cytoreduction and the importance of second-look surgery to confirm the response to therapy are emphasized. The precise role for radiotherapy in the treatment of ovarian cancer is still to be established. Presently, response rates of 80% are achieved using cisplatin based combination chemotherapy. In spite of this, long term survival has not improved. Endocrine therapy has hitherto been used empirically and mainly as a last resort in the treatment of advanced ovarian cancer. Response rates of about 10% have been reported. Information on tumor predisposition related to hormonal control should be a key parameter in selecting the appropriate therapy. Tumor analysis has shown that androgen receptors predominate in ovarian cancer, compared to estrogen and progestin receptors. A clinical trial based on endocrine parameters is warranted.