Robert E Bristow and Deborah K Armstrong

Ovarian cancer remains the leading cause of gynecologic cancer-related morbidity and mortality in developed countries. This volume contains contributions from many of the leading authorities in the clinical management of ovarian cancer as well as those at the cutting edge of basic research and translational science. Although the epidemiology of ovarian cancer has been relatively well defined, continued advances are being made with respect to understanding the molecular and genetic basis for disease. These advances have led to (1) progress in identifying women who have an increased risk of developing ovarian cancer and to (2) the development of more effective disease prevention strategies. Radiographic imaging is an integral part of ovarian cancer detection, diagnosis, management, and post-treatment surveillance.

A number of imaging modalities are available, and a variety of new techniques, especially molecular imaging approaches, are being developed to facilitate detection of early-stage disease as well as to define the extent of metastatic tumor in women with a more advanced stage of disease. This information is critical to the effective planning of surgical and adjuvant therapy.

As described in this volume, the goal of primary surgery for advanced-stage ovarian cancer is to accurately establish a diagnosis and leave little or no residual disease by using a variety of cytoreductive surgical techniques and approaches. Advances in the use of chemotherapy for ovarian cancer have contributed to recent improvements in the expected survival times for women with advanced-stage tumors. Both novel therapeutic agents as well as delivery mechanisms have been integrated into routine clinical practice.

Despite important gains in early detection and primary treatment, a significant proportion of women with ovarian cancer will ultimately experience disease recurrence. Recent evidence indicates that for a select group of patients, a repeat attempt at cytoreductive surgery may be indicated, with successful tumor removal being associated with a clinically meaningful prolongation of survival time. Selection of second-line adjuvant therapy should be evidence-based and done according to guidelines that consider the treatment-free interval, prior therapy received, and prior toxicity. The role of chemoresistance and chemosensitivity testing in the setting of recurrent disease remains to be further defined. A number of encouraging therapeutic agents, including angiogenesis inhibitors, are currently in clinical trials and may ultimately be shown to be effective against ovarian cancer in both the primary and recurrent disease settings.

In the coming years, improvements in the early detection and management of ovarian cancer will depend on incremental, but nevertheless forward-leaning, scientific discoveries as well as more effective and less toxic therapies. Equally important is the seamless integration of a multidisciplinary clinical care team, including the specialties of gynecologic and medical oncology, radiology, critical care, pharmacy, genetic counseling, nursing, social work, and psychiatry to deliver optimum therapy and ultimately make meaningful gains in both survival time and quality of life.

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