Definition
Ovarian cancer is a malignant tumor originating from the ovary, often arising from epithelial cells, though it can also develop from germ cells or stromal cells.
- Most common type: Epithelial ovarian carcinoma (~90%).
- Subtypes: Serous, endometrioid, clear cell, mucinous, Brenner tumor.
Epidemiology
- Usually diagnosed in postmenopausal women (median age ~63).
- Often diagnosed at advanced stages due to vague symptoms.
- Lifetime risk: ~1–2% in general population.
Risk Factors
- Genetic: BRCA1/2 mutations, Lynch syndrome.
- Family history: First-degree relative with ovarian/breast cancer.
- Reproductive factors: Nulliparity, early menarche, late menopause.
- Protective factors: Oral contraceptives, parity, breastfeeding.
Pathogenesis
- High-grade serous carcinoma (HGSC): TP53 mutations, often from fallopian tube fimbriae.
- Low-grade serous carcinoma (LGSC): KRAS, BRAF mutations.
- Other subtypes have distinct molecular alterations (e.g., PTEN in endometrioid, ARID1A in clear cell).
Clinical Features
- Abdominal bloating, pain, early satiety
- Urinary frequency, constipation
- Ascites, pleural effusion in advanced disease
- Often late-stage diagnosis (FIGO III–IV)
Diagnostics
- Imaging: Ultrasound, CT, MRI of pelvis/abdomen.
- Tumor markers: CA-125 (high in epithelial ovarian cancer).
- Histopathology: Confirms subtype.
- Molecular testing: BRCA1/2, HRD, MSI, PD-L1 as needed for therapy planning.
Treatment (Oncology Pharmacy Focus)
Surgery
- Cytoreductive (debulking) surgery
- Goal: no gross residual tumor.
- Can be primary or interval after neoadjuvant chemotherapy.
- First-line: Platinum + taxane (Carboplatin + Paclitaxel)
- Intraperitoneal chemotherapy: Selected cases.
- Dose-dense regimens may improve outcomes in some patients.
Targeted / Maintenance Therapy
- PARP inhibitors: Olaparib, Niraparib, Rucaparib (especially in BRCA-mutated or HRD-positive tumors).
- Bevacizumab: Anti-VEGF, used in combination with chemo or maintenance.
- Immunotherapy: For MSI-H/dMMR tumors (Pembrolizumab).
Supportive Care
- Antiemetics (5-HT3 antagonists, NK1 antagonists)
- Growth factor support if neutropenia occurs
- Thromboprophylaxis due to high VTE risk
Prognosis
- Dependent on stage at diagnosis, residual tumor after surgery, and molecular profile.
- High-grade serous: aggressive, median survival ~40–50 months if treated optimally.
- Low-grade serous: slower progression, relatively chemoresistant.