Surgical and Medical Management of Epithelial Ovarian Cancer

Epithelial cancer of the ovary, fallopian tube or primary peritoneum, collectively described as ‘ovarian cancer’ or EOC, is relatively uncommon. It represents 2% of total cancer cases in the UK (data from 2013) but is the most lethal of all gynaecological cancers. This is partly due to its insidious presentation but also because of its intrinsic histological and molecular heterogeneity. EOC comprises at least five distinct histological subtypes (high-grade serous, endometrioid, clear cell, mucinous, seromucinous and low-grade serous), the most common and well-studied being high-grade serous ovarian cancer (HGSOC). For the majority of patients after successful initial treatment with debulking surgery and chemotherapy, the disease will relapse and become increasingly chemotherapy resistant with each episode of recurrence. Future treatment strategies, as well as improving response to front-line therapy, are focusing on ways to overcome chemotherapy resistance in the relapsed setting, with the judicious use of novel cytotoxic and/or targeted therapies. These options are realized with improvements in our understanding of the molecular behaviour of the disease. In this chapter, we summarize the current status quo of the surgical and medical management of ovarian cancer and present results from a number of key studies that have explored genetic, molecular and histological-targeted strategies in the treatment of this disease.