Ovarian Cancer: Causes, Symptoms, Treatment and Prognosis — Overview, Diagnosis & Treatment Options | MyMedicPlus

Ovarian cancer arises from ovarian epithelium (90%), germ cells, or stromal tissue. Approximately 314,000 new cases occur globally each year. Most cases are diagnosed at advanced stage (FIGO III/IV) due to non-specific early symptoms, with epithelial ovarian carcinoma (EOC) being the most lethal gynecologic malignancy.

BRCA1/2 germline mutations account for approximately 15% of EOC. Risk is increased with nulliparity, endometriosis, PCOS, and family history. Oral contraceptive use, breastfeeding, and risk-reducing salpingo-oophorectomy are protective, particularly for BRCA mutation carriers.

Abdominal bloating, pelvic pain, early satiety, urinary frequency, and back pain are common but non-specific symptoms. Over 75% of patients are diagnosed at advanced stage because early-stage disease is frequently asymptomatic or symptoms are attributed to other conditions.

CA-125 and HE4 serum markers with transvaginal ultrasound guide initial assessment. CT/PET for staging. FIGO surgical staging (I-IV) is established at primary cytoreductive surgery. BRCA1/2 germline testing is mandatory. HRD (homologous recombination deficiency) testing guides PARP inhibitor eligibility.

Optimal cytoreductive surgery (debulking to no residual disease) combined with carboplatin plus paclitaxel chemotherapy is the cornerstone. PARP inhibitors (olaparib, niraparib, rucaparib) as maintenance therapy significantly extend PFS, especially in BRCA-mutated and HRD-positive patients. Bevacizumab is added for advanced disease.

Stage I: 5-year survival approximately 90%. Stage III: 30-40%. Stage IV: 15-20%. BRCA-mutated patients respond better to platinum-based chemotherapy and PARP inhibitors with improved survival. Optimal cytoreduction (no gross residual disease) is the strongest modifiable prognostic factor.