Surveillance and management of patients at high genetic risk for ovarian carcinoma.

The present study is concerned with surveillance/management programs for hereditary ovarian cancer syndromes. These syndromes lack distinguishing premonitory physical signs or biomarkers; therefore, in these genotypic settings, ovarian cancer risk must be assessed by analysis of the patient's pedigree. The authors describe 10 families showing a hereditary proclivity to ovarian carcinoma and/or associated cancer(s) in accord with their respective cancer-prone genotypes. Cancer education, genetic counseling, and surveillance should be instituted early. In addition to bimanual pelvic examination, ultrasound should be tested for its possible efficacy as a screening technique. The option of prophylactic bilateral oophorectomy and hysterectomy is thoroughly discussed with highly selected candidates. The authors believe that the aggressive management approach proposed for ovarian carcinoma is warranted for high-risk members of cancer-prone families, wherein the risk for ovarian cancer may approach 50%.