http://emedicine.medscape.

com/article/255771-overview
Ovarian cancer is the most common cause of cancer death from gynecologic
tumors in the United States. Malignant ovarian lesions include primary lesions
arising from normal structures within the ovary and secondary lesions from
cancers arising elsewhere in the body. Primary lesions include epithelial
ovarian carcinoma (70% of all ovarian malignancies). Current research
suggests that the majority of these originate from the fallopian tubes.
Stromal tumors of the ovary include germ-cell tumors, sex-cord stromal
tumors, and other more rare types. Metastases to the ovaries are relatively
frequent; common sources are tumors in the endometrium, breast, colon,
stomach, and cervix. See the image below.

An enlarged ovary with a papillary

serous carcinoma on the surface.

Signs and symptoms

Early ovarian cancer causes minimal, nonspecific, or no symptoms. The
patient may feel an abdominal mass. Most cases are diagnosed in an
advanced stage.
Epithelial ovarian cancer presents with a wide variety of vague and
nonspecific symptoms, including the following:

Bloating; abdominal distention or discomfort

Pressure effects on the bladder and rectum
Constipation
Vaginal bleeding
Indigestion and acid reflux
Shortness of breath
Tiredness
Weight loss

Early satiety
Symptoms independently associated with the presence of ovarian cancer
include pelvic and abdominal pain, increased abdominal size and bloating,
and difficulty eating or feeling full.[1] Symptoms associated with later-stage
disease include gastrointestinal symptoms such as nausea and vomiting,
constipation, and diarrhea.[2] Presentation with swelling of a leg due to venous
thrombosis is not uncommon. Paraneoplastic syndromes due to tumormediated factors lead to various presentations.
See Clinical Presentation for more detail.

Diagnosis
Physical findings are uncommon in patients with early disease. Patients with
more advanced disease may present with ovarian or pelvic mass, ascites,
pleural effusion, or abdominal mass or bowel obstruction.
The presence of advanced ovarian cancer is often suspected on clinical
grounds, but it can be confirmed only pathologically by removal of the ovaries
or, when the disease is advanced, by sampling tissue or ascitic fluid.
Screening
The US Preventive Services Task Force (USPSTF) recommends against
screening (with serum CA125 level or transvaginal ultrasonography) for
ovarian cancer in the general population.[3] The National Cancer Institute (NCI)
recommends that high-risk women seek advice from their physicians and
consider having annual ultrasonographic examinations and annual CA125
testing, as well as consider oophorectomy or participation in a clinical trial.
Laboratory testing
No tumor marker (eg, CA125, beta-human chorionic gonadotropin, alphafetoprotein, lactate dehydrogenase) is completely specific; therefore, use
diagnostic immunohistochemistry testing in conjunction with morphologic and
clinical findings. Also, obtain a urinalysis to exclude other possible causes of
abdominal/pelvic pain, such as urinary tract infections or kidney stones.
Imaging studies
Routine imaging is not required in all patients in whom ovarian cancer is
highly suggested. In cases in which the diagnosis is uncertain, consider the
following imaging studies:

Pelvic ultrasonography [4, 5] : Warranted

Pelvic and abdominal computed tomography (CT) scanning [4, 5] :
Warranted
Pelvic and abdominal magnetic resonance imaging: Increases
specificity of imaging when sonography findings are indeterminate [6]

Chest radiography: Routine imaging to exclude lung metastases

Mammography: Part of preoperative workup for women older than 40
years who have not had one in the preceding 6-12 months; estrogenproducing tumors may increase the risk of breast malignancies, and breast
cancers can metastasize to the ovaries and are often bilateral
In patients with diffuse carcinomatosis and GI symptoms, a GI tract workup
may be indicated, including one of the following imaging studies:

Upper and/or lower endoscopy

Barium enema
Upper GI series
Procedures
Fine-needle aspiration (FNA) or percutaneous biopsy of an adnexal mass is
not routinely recommended, as it may delay diagnosis and treatment of
ovarian cancer. Instead, if a clinical suggestion of ovarian cancer is present,
the patient should undergo laparoscopic evaluation or laparotomy, based on
the presentation, for diagnosis and staging. An FNA or diagnostic
paracentesis should be performed in patients with diffuse carcinomatosis or
ascites without an obvious ovarian mass.
See Workup for more detail.

Management
Standard treatment for women with ovarian cancer involves aggressive
debulking surgery and chemotherapy. The aim of cytoreductive surgery is to
confirm the diagnosis, define the extent of disease, and resect all visible
tumor. Neoadjuvant chemotherapy is increasingly used.
Surgery
The type of procedure depends on whether or not disease is visible outside
the ovaries. When no disease is visible outside the ovaries, or no lesion
greater than 2 cm is present outside of the pelvis, the patient requires formal
surgical staging, including peritoneal cytology, multiple peritoneal biopsies,
omentectomy, pelvic and para-aortic lymph node sampling, and biopsies of
the diaphragmatic peritoneum.
If disease greater than 2 cm is noted then aggressive surgical debulking, with
the intent to remove all visible diseaes should be undertaken. If the surgeon
determines that optimal debulking is not possible, then neoadjuvant
chemotherapy should be considered. For patients with stage IV disease,
surgery should be individualized on the basis of presentation.
Surgical procedures that may be performed in women with ovarian cancer are
as follows:

Surgical staging
Cytoreductive surgery
Interval debulking
Laparoscopic surgery
Secondary surgery
Chemotherapy
Postoperative chemotherapy is indicated in all patients with ovarian cancer,
except those who have surgical-pathologic stage I disease with low-risk
characteristics. Standard postoperative chemotherapy for ovarian cancer is
combination therapy with a platinum compound and a taxane (eg, carboplatin
and paclitaxel). Additional agents for recurrent disease include the following:

Liposomal doxorubicin
Etoposide
Topotecan
Gemcitabine
Vinorelbine
Ifosfamide
Fluorouracil
Melphalan
Altretamine
Bevacizumab
Olaparib
Adjunctive medications include the following:

Cytoprotective agents (eg, mesna)

Antiemetics (eg, ondansetron, granisetron, palonosetron,
dexamethasone)
See Treatment and Medication for more detail.

References
1. Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM,
et al. Development of an ovarian cancer symptom index: possibilities
for earlier detection. Cancer. 2007 Jan 15. 109(2):221-7. [Medline].
2. Ryerson AB, Eheman C, Burton J, McCall N, Blackman D,
Subramanian S, et al. Symptoms, diagnoses, and time to key
diagnostic procedures among older U.S. women with ovarian
cancer. Obstet Gynecol. 2007 May. 109(5):1053-61. [Medline].
3. Moyer VA. Screening for ovarian cancer: U.S. Preventive Services Task
Force reaffirmation recommendation statement. Ann Intern Med. 2012
Dec 18. 157(12):900-4. [Medline]. [Full Text].

4. Fleischer A. Ovarian cancer. Fleischer AC, Javitt MC, Jeffrey RB Jr, et

al. Clinical Gynecologic Imaging. Philadelphia, Pa: Lippincott Williams
& Wilkins; 1996. 107.
5. Yazbek J, Raju SK, Ben-Nagi J, Holland TK, Hillaby K, Jurkovic D.
Effect of quality of gynaecological ultrasonography on management of
patients with suspected ovarian cancer: a randomised controlled
trial.Lancet Oncol. 2008 Feb. 9(2):124-31. [Medline].
6. Iyer VR, Lee SI. MRI, CT, and PET/CT for ovarian cancer detection and
adnexal lesion characterization.AJR Am J Roentgenol. 2010 Feb.
194(2):311-21. [Medline].
7. Reade CJ, McVey RM, Tone AA, Finlayson SJ, McAlpine JN, FungKee-Fung M, et al. The fallopian tube as the origin of high grade serous
ovarian cancer: review of a paradigm shift. J Obstet Gynaecol Can.
2014 Feb. 36 (2):133-40. [Medline].
8. Gharwan H, Bunch KP, Annunziata CM. The role of reproductive
hormones in epithelial ovarian carcinogenesis. Endocr Relat Cancer.
2015 Dec. 22 (6):R339-63. [Medline].
9. Harmsen MG, Arts-de Jong M, Hoogerbrugge N, Maas AH, Prins JB,
Bulten J, et al. Early salpingectomy (TUbectomy) with delayed
oophorectomy to improve quality of life as alternative for risk-reducing
salpingo-oophorectomy in BRCA1/2 mutation carriers (TUBA study): a
prospective non-randomised multicentre study. BMC Cancer. 2015 Aug
19. 15:593. [Medline].
10.Pantoja E, Noy MA, Axtmayer RW, Colon FE, Pelegrina I. Ovarian
dermoids and their complications. Comprehensive historical
review. Obstet Gynecol Surv. 1975 Jan. 30(1):1-20. [Medline].
11. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature
cystic teratoma: a clinicopathologic evaluation of 517 cases and review
of the literature. Obstet Gynecol. 1994 Jul. 84(1):22-8. [Medline].
12.Hippisley-Cox J, Coupland C. Identifying women with suspected
ovarian cancer in primary care: derivation and validation of
algorithm. BMJ. 2011 Jan 4. 344:d8009. [Medline]. [Full Text].
13.Integrated genomic analyses of ovarian carcinoma. Nature. 2011 Jun
29. 474(7353):609-15. [Medline].
14.Koboldt DC, Fulton RS, McLellan MD, Schmidt H, Kalicki-Veizer J,
McMichael JF, et al. Comprehensive molecular portraits of human
breast tumours. Nature. 2012 Sep 23. [Medline].

15.Ramus SJ, Kartsonaki C, Gayther SA, Pharoah PD, Sinilnikova OM,

Beesley J, et al. Genetic Variation at 9p22.2 and Ovarian Cancer Risk
for BRCA1 and BRCA2 Mutation Carriers. J Natl Cancer Inst. 2011 Jan
19. 103(2):105-116. [Medline].
16.Rafnar T, Gudbjartsson DF, Sulem P, et al. Mutations in BRIP1 confer
high risk of ovarian cancer. Nat Genet. 2011 Oct 2. 43(11):11047. [Medline].
17.Mrch LS, Lkkegaard E, Andreasen AH, Krger-Kjaer S, Lidegaard O.
Hormone therapy and ovarian cancer. JAMA. 2009 Jul 15. 302(3):298305. [Medline].
18.Cramer DW, Vitonis AF, Terry KL, Welch WR, Titus LJ. The Association
Between Talc Use and Ovarian Cancer: A Retrospective Case-Control
Study in Two US States. Epidemiology. 2016 May. 27 (3):334-46.
[Medline].
19.Genkinger JM, Hunter DJ, Spiegelman D, Anderson KE, Arslan A, et al.
Dairy products and ovarian cancer: a pooled analysis of 12 cohort
studies. Cancer Epidemiol Biomarkers Prev. 2006 Feb. 15 (2):36472. [Medline].
20.Liu J, Tang W, Sang L, Dai X, Wei D, Luo Y, et al. Milk, yogurt, and
lactose intake and ovarian cancer risk: a meta-analysis. Nutr Cancer.
2015. 67 (1):68-72. [Medline].
21.Surveillance, Epidemiology, and End Results Program. SEER Stat Fact
Sheets: Ovary Cancer. National Cancer Institute. Available
at http://seer.cancer.gov/statfacts/html/ovary.html. Accessed: March 21,
2016.
22.American Cancer Society. Cancer Facts & Figures 2016. American
Cancer Society. Available
athttp://www.cancer.org/acs/groups/content/@research/documents/doc
ument/acspc-047079.pdf. Accessed: March 21, 2016.
23.Chan JK, Teoh D, Hu JM, Shin JY, Osann K, Kapp DS. Do clear cell
ovarian carcinomas have poorer prognosis compared to other epithelial
cell types? A study of 1411 clear cell ovarian cancers. Gynecol Oncol.
2008 Jun. 109(3):370-6. [Medline].
24.Woodward ER, Sleightholme HV, Considine AM, Williamson S, McHugo
JM, Cruger DG. Annual surveillance by CA125 and transvaginal
ultrasound for ovarian cancer in both high-risk and population risk
women is ineffective. BJOG. 2007 Dec. 114(12):1500-9. [Medline].

25.Bakhru A, Buckanovich RJ, Griggs JJ. The impact of diabetes on

survival in women with ovarian cancer.Gynecol Oncol. 2011 Apr.
121(1):106-11. [Medline].
26.Yang D, Khan S, Sun Y, et al. Association of BRCA1 and BRCA2
mutations with survival, chemotherapy sensitivity, and gene mutator
phenotype in patients with ovarian cancer. JAMA. 2011 Oct 12.
306(14):1557-65. [Medline].
27.Bolton KL, Chenevix-Trench G, Goh C, et al. Association between
BRCA1 and BRCA2 mutations and survival in women with invasive
epithelial ovarian cancer. JAMA. 2012 Jan 25. 307(4):38290. [Medline].
28.Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of
symptoms of ovarian cancer in women presenting to primary care
clinics. JAMA. 2004 Jun 9. 291(22):2705-12. [Medline]. [Full Text].
29.ACOG Practice Bulletin. Management of adnexal masses. Obstet
Gynecol. 2007 Jul. 110(1):201-14.[Medline].
30.Suh-Burgmann E, Kinney W. Potential harms outweigh benefits of
indefinite monitoring of stable adnexal masses. Am J Obstet Gynecol.
2015 Dec. 213 (6):816.e1-4. [Medline].
31.Suh-Burgmann E, Kinney W. The Value of Ultrasound Monitoring of
Adnexal Masses for Early Detection of Ovarian Cancer. Front Oncol.
2016. 6:25. [Medline]. [Full Text].
32.Anthoulakis C, Nikoloudis N. Pelvic MRI as the "gold standard" in the
subsequent evaluation of ultrasound-indeterminate adnexal lesions: a
systematic review. Gynecol Oncol. 2014 Mar. 132 (3):661-8.[Medline].
33.Coleman RL, Herzog TJ, Chan DW, Munroe DG, Pappas TC, Smith A,
et al. Validation of a Second-generation Multivariate Index Assay for
Malignancy Risk of Adnexal Masses. Am J Obstet Gynecol. 2016 Mar
9. [Medline].
34.Tanaka YO, Okada S, Yagi T, Satoh T, Oki A, Tsunoda H, et al. MRI of
endometriotic cysts in association with ovarian carcinoma. AJR Am J
Roentgenol. 2010 Feb. 194(2):355-61. [Medline].
35.Stany MP, Maxwell GL, Rose GS. Clinical decision making using
ovarian cancer risk assessment. AJR Am J Roentgenol. 2010 Feb.
194(2):337-42. [Medline].
36.Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et
al. Effect of screening on ovarian cancer mortality: the Prostate, Lung,

Colorectal and Ovarian (PLCO) Cancer Screening Randomized

Controlled Trial. JAMA. 2011 Jun 8. 305(22):2295-303. [Medline].
37.Lachance JA, Choudhri AF, Sarti M, et al. A nomogram for estimating
the probability of ovarian cancer.Gynecol Oncol. 2011 Apr. 121(1):27. [Medline].
38.van Nagell JR Jr, Miller RW, DeSimone CP, et al. Long-term survival of
women with epithelial ovarian cancer detected by ultrasonographic
screening. Obstet Gynecol. 2011 Dec. 118(6):1212-21. [Medline].
39.Hirai M, Hirai Y, Tsuchida T, et al. Stage IA Ovarian Cancers:
Comparison of Sonographic Findings and Histopathologic Types
Between Patients With Normal and Elevated Serum Cancer Antigen
125 Levels. J Ultrasound Med. 2011 Jul. 30(7):943-52. [Medline].
40.Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian
cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO)
Cancer Screening Randomized Controlled Trial. JAMA. 2011 Jun 8.
305(22):2295-303. [Medline].
41.[Guideline] National Comprehensive Cancer Network. NCCN Clinical
Practice Guidelines in Oncology, Ovarian Cancer Including Fallopian
Tube Cancer and Primary Peritoneal Cancer. Version 2.2015. Available
at http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.
Accessed: June 16, 2016.
42.No JH, Jeon YT, Park IA, et al. Activation of mTOR signaling pathway
associated with adverse prognostic factors of epithelial ovarian
cancer. Gynecol Oncol. 2011 Apr. 121(1):8-12. [Medline].
43.Tapia V, Gabler F, Munoz M, et al. Tyrosine kinase A receptor (trkA): a
potential marker in epithelial ovarian cancer. Gynecol Oncol. 2011 Apr.
121(1):13-23. [Medline].
44.Lin HW, Tu YY, Lin SY, et al. Risk of ovarian cancer in women with
pelvic inflammatory disease: a population-based study. Lancet Oncol.
2011 Sep. 12(9):900-4. [Medline].
45.Zeppernick F, Meinhold-Heerlein I. The new FIGO staging system for
ovarian, fallopian tube, and primary peritoneal cancer. Arch Gynecol
Obstet. 2014 Nov. 290 (5):839-42. [Medline].
46.Lin L, Liu C, Tan H, et al. Anaesthetic technique may affect prognosis
for ovarian serous adenocarcinoma: a retrospective analysis. Br J
Anaesth. 2011 Jun. 106(6):814-22. [Medline].
47.van der Burg ME, van Lent M, Buyse M, et al. The effect of debulking
surgery after induction chemotherapy on the prognosis in advanced

epithelial ovarian cancer. Gynecological Cancer Cooperative Group of

the European Organization for Research and Treatment of Cancer. N
Engl J Med. 1995 Mar 9. 332(10):629-34. [Medline].
48.Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin
SC. Secondary surgical cytoreduction for advanced ovarian
carcinoma. N Engl J Med. 2004 Dec 9. 351(24):2489-97. [Medline].
49.Tangjitgamol S, Manusirivithaya S, Laopaiboon M, Lumbiganon P.
Interval debulking surgery for advanced epithelial ovarian
cancer. Cochrane Database Syst Rev. 2009 Jan 21.
CD006014. [Medline].
50.[Guideline] American College of Obstetricians and Gynecologists.
ACOG Practice Bulletin. Management of adnexal masses. Obstet
Gynecol. 2007 Jul. 110 (1):201-14. [Medline].
51.Park JY, Eom JM, Kim DY, Kim JH, Kim YM, Kim YT, et al. Secondary
cytoreductive surgery in the management of platinum-sensitive
recurrent epithelial ovarian cancer. J Surg Oncol. 2010 Jan 15.
[Medline].
52.Fruscio R, Garbi A, Parma G, Lissoni AA, Garavaglia D, Bonazzi CM, et
al. Randomized Phase III Clinical Trial Evaluating Weekly Cisplatin for
Advanced Epithelial Ovarian Cancer. J Natl Cancer Inst. 2011 Jan
7. [Medline].
53.Katsumata N, Yasuda M, Takahashi F, Isonishi S, Jobo T, Aoki D, et al.
Dose-dense paclitaxel once a week in combination with carboplatin
every 3 weeks for advanced ovarian cancer: a phase 3, open-label,
randomised controlled trial. Lancet. 2009 Oct 17. 374(9698):13318. [Medline].
54.Katsumata N, Yasuda M, Isonishi S, et al, for the Japanese
Gynecologic Oncology Group. Long-term results of dose-dense
paclitaxel and carboplatin versus conventional paclitaxel and
carboplatin for treatment of advanced epithelial ovarian, fallopian tube,
or primary peritoneal cancer (JGOG 3016): a randomised, controlled,
open-label trial. Lancet Oncol. 2013 Sep. 14(10):1020-6. [Medline].
55.Morgan MA, Sill MW, Fujiwara K, et al. A phase I study with an
expanded cohort to assess the feasibility of intraperitoneal carboplatin
and intravenous paclitaxel in untreated ovarian, fallopian tube, and
primary peritoneal carcinoma: A Gynecologic Oncology Group
study. Gynecol Oncol. 2011 May 1. 121(2):264-8.[Medline]. [Full Text].
56.Kurtz JE, Kaminsky MC, Floquet A, et al. Ovarian cancer in elderly
patients: carboplatin and pegylated liposomal doxorubicin versus

carboplatin and paclitaxel in late relapse: a Gynecologic Cancer

Intergroup (GCIG) CALYPSO sub-study. Ann Oncol. 2011 Nov.
22(11):2417-23. [Medline].
57.Winter-Roach BA, Kitchener HC, Dickinson HO. Adjuvant (postsurgery) chemotherapy for early stage epithelial ovarian
cancer. Cochrane Database Syst Rev. 2009 Jan 21.
CD004706. [Medline].
58.Nelson R. Pazopanib improves PFS in advanced ovarian cancer.
Medscape Medical News. June 1, 2013. Available
at http://www.medscape.com/viewarticle/805168. Accessed: June 17,
2013.
59.Du Bois A, Floquet A, Kim JW, et al. Randomized, double-blind, phase
III trial of pazopanib versus placebo in women who have not
progressed after first-line chemotherapy for advanced epithelial
ovarian, fallopian tube, or primary peritoneal cancer (AEOC): results of
an international Intergroup trial (AGO-OVAR16). Presented at the 49th
Annual Meeting of the American Society of Clinical Oncology; June 1,
2013; Chicago, IL. Abstract LBA5503.
60.Tewari D, Java JJ, Salani R, Armstrong DK, Markman M, Herzog T, et
al. Long-term survival advantage and prognostic factors associated
with intraperitoneal chemotherapy treatment in advanced ovarian
cancer: a gynecologic oncology group study. J Clin Oncol. 2015 May 1.
33(13):1460-6. [Medline]. [Full Text].
61.Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S.
Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med.
2006 Jan 5. 354(1):34-43. [Medline].
62.Hess LM, Benham-Hutchins M, Herzog TJ, Hsu CH, Malone DC,
Skrepnek GH. A meta-analysis of the efficacy of intraperitoneal cisplatin
for the front-line treatment of ovarian cancer. Int J Gynecol Cancer.
2007 May-Jun. 17(3):561-70. [Medline].
63.Elit L, Oliver TK, Covens A, Kwon J, Fung MF, Hirte HW. Intraperitoneal
chemotherapy in the first-line treatment of women with stage III
epithelial ovarian cancer: a systematic review with
metaanalyses.Cancer. 2007 Feb 15. 109(4):692-702. [Medline].
64.NCI Clinical Announcement on Intraperitoneal Chemotherapy in
Ovarian Cancer. National Cancer Institute. Available
at http://ctep.cancer.gov/highlights/docs/clin_annc_010506.pdf.

65.Jaaback K, Johnson N, Lawrie TA. Intraperitoneal chemotherapy for the

initial management of primary epithelial ovarian cancer. Cochrane
Database Syst Rev. 2011 Nov 9. 11:CD005340. [Medline].
66.Tanner EJ, Black DR, Zivanovic O, et al. Patterns of first recurrence
following adjuvant intraperitoneal chemotherapy for stage IIIC ovarian
cancer. Gynecol Oncol. 2012 Jan. 124(1):59-62. [Medline].
67.Joly F, Ray-Coquard I, Fabbro M, et al. Decreased hypersensitivity
reactions with carboplatin-pegylated liposomal doxorubicin compared
to carboplatin-paclitaxel combination: analysis from the GCIG
CALYPSO relapsing ovarian cancer trial. Gynecol Oncol. 2011 Aug.
122(2):226-32. [Medline].
68.Pignata S, Scambia G, Ferrandina G, et al. Carboplatin Plus Paclitaxel
Versus Carboplatin Plus Pegylated Liposomal Doxorubicin As First-Line
Treatment for Patients With Ovarian Cancer: The MITO-2 Randomized
Phase III Trial. J Clin Oncol. 2011 Sep 20. 29(27):3628-35. [Medline].
69.Vergote I, Trop CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et
al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV
ovarian cancer. N Engl J Med. 2010 Sep 2. 363(10):943-53. [Medline].
70.Markman M, Liu PY, Moon J, Monk BJ, Copeland L, Wilczynski S, et al.
Impact on survival of 12 versus 3 monthly cycles of paclitaxel (175
mg/m2) administered to patients with advanced ovarian cancer who
attained a complete response to primary platinum-paclitaxel: follow-up
of a Southwest Oncology Group and Gynecologic Oncology Group
phase 3 trial. Gynecol Oncol. 2009 Aug. 114(2):195-8. [Medline]. [Full
Text].
71.Parmar MK, Ledermann JA, Colombo N, du Bois A, Delaloye JF,
Kristensen GB. Paclitaxel plus platinum-based chemotherapy versus
conventional platinum-based chemotherapy in women with relapsed
ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet. 2003 Jun 21.
361(9375):2099-106. [Medline].
72.Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ.
Gemcitabine plus carboplatin compared with carboplatin in patients
with platinum-sensitive recurrent ovarian cancer: an intergroup trial of
the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol.
2006 Oct 10. 24(29):4699-707. [Medline].
73.du Bois A, Herrstedt J, Hardy-Bessard AC, Mller HH, Harter P,
Kristensen G, et al. Phase III trial of carboplatin plus paclitaxel with or
without gemcitabine in first-line treatment of epithelial ovarian cancer. J
Clin Oncol. 2010 Sep 20. 28(27):4162-9. [Medline].

74.Hess LM, Rong N, Monahan PO, Gupta P, Thomaskutty C, Matei D.

Continued chemotherapy after complete response to primary therapy
among women with advanced ovarian cancer: A meta-analysis.Cancer.
2010 Nov 15. 116(22):5251-60. [Medline].
75.Sehouli J, Stengel D, Harter P, Kurzeder C, Belau A, Bogenrieder T, et
al. Topotecan Weekly Versus Conventional 5-Day Schedule in Patients
With Platinum-Resistant Ovarian Cancer: A Randomized Multicenter
Phase II Trial of the North-Eastern German Society of Gynecological
Oncology Ovarian Cancer Study Group. J Clin Oncol. 2010 Nov
29. [Medline].
76.Haldar K, Gaitskell K, Bryant A, et al. Epidermal growth factor receptor
blockers for the treatment of ovarian cancer. Cochrane Database Syst
Rev. 2011 Oct 5. CD007927. [Medline].
77.Bevacizumab solution in combination with Paclitaxel. U.S. Food and
Drug Administration. Available
athttp://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm4
23159.htm. Accessed: November 25, 2014.
78.Pujade-Lauraine E, Hilpert F, Weber B, Reuss A, Poveda A, Kristensen
G, et al. Bevacizumab combined with chemotherapy for platinumresistant recurrent ovarian cancer: The AURELIA open-label
randomized phase III trial. J Clin Oncol. 2014 May 1. 32(13):13028. [Medline].
79.Aghajanian C, Blank SV, Goff BA, Judson PL, Teneriello MG, Husain A,
et al. OCEANS: a randomized, double-blind, placebo-controlled phase
III trial of chemotherapy with or without bevacizumab in patients with
platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or
fallopian tube cancer. J Clin Oncol. 2012 Jun 10. 30 (17):203945. [Medline].
80.Aghajanian C, Goff B, Nycum LR, Wang YV, Husain A, Blank SV. Final
overall survival and safety analysis of OCEANS, a phase 3 trial of
chemotherapy with or without bevacizumab in patients with platinumsensitive recurrent ovarian cancer. Gynecol Oncol. 2015 Oct. 139
(1):10-6. [Medline].
81.Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, Van't Veer L,
Garber JE. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2
mutations. N Engl J Med. 2002 May 23. 346(21):1616-22. [Medline].
82.Stone RL, Nick AM, McNeish IA, et al. Paraneoplastic thrombocytosis
in ovarian cancer. N Engl J Med. 2012 Feb 16. 366(7):610-8. [Medline].

83.Ledermann J, Harter P, Gourley C, Friedlander M, Vergote I, Rustin G,

et al. Olaparib maintenance therapy in platinum-sensitive relapsed
ovarian cancer. N Engl J Med. 2012 Apr 12. 366(15):1382-92.[Medline].
84.Kaufman B, Shapira-Frommer R, Schmutzler RK, Audeh MW,
Friedlander M, Balmaa J, et al. Olaparib monotherapy in patients with
advanced cancer and a germline BRCA1/2 mutation. J Clin Oncol.
2015 Jan 20. 33(3):244-50. [Medline]. [Full Text].
85.Kaye SB, Lubinski J, Matulonis U, Ang JE, Gourley C, Karlan BY, et al.
Phase II, open-label, randomized, multicenter study comparing the
efficacy and safety of olaparib, a poly (ADP-ribose) polymerase
inhibitor, and pegylated liposomal doxorubicin in patients with BRCA1
or BRCA2 mutations and recurrent ovarian cancer. J Clin Oncol. 2012
Feb 1. 30(4):372-9. [Medline]. [Full Text].
86.Rungruang B, Miller A, Richard SD, et al. Should stage IIIC ovarian
cancer be further stratified by intraperitoneal vs. retroperitoneal only
disease?: a Gynecologic Oncology Group study. Gynecol Oncol. 2012
Jan. 124(1):53-8. [Medline].
87.Daponte A, Kostopoulou E, Kollia P, Papamichali R, Vanakara P,
Hadjichristodoulou C, et al. L1 (CAM) (CD171) in ovarian serous
neoplasms. Eur J Gynaecol Oncol. 2008. 29(1):26-30. [Medline].
88.[Guideline] American College of Obstetricians and Gynecologists.
Elective and risk-reducing salpingo-oophorectomy. National Guideline
Clearinghouse. Available at http://guideline.gov/content.aspx?
id=12190. Accessed: May 11, 2015.
89.Finch AP, Lubinski J, Mller P, Singer CF, Karlan B, Senter L, et al.
Impact of Oophorectomy on Cancer Incidence and Mortality in Women
With a BRCA1 or BRCA2 Mutation. J Clin Oncol. 2014 Feb 24.
[Medline].
90.Zhang S, Royer R, Li S, et al. Frequencies of BRCA1 and BRCA2
mutations among 1,342 unselected patients with invasive ovarian
cancer. Gynecol Oncol. 2011 May 1. 121(2):353-7. [Medline].
91.Burke W, Daly M, Garber J, Botkin J, Kahn MJ, Lynch P, et al.
Recommendations for follow-up care of individuals with an inherited
predisposition to cancer. II. BRCA1 and BRCA2. Cancer Genetics
Studies Consortium. JAMA. 1997 Mar 26. 277 (12):9971003. [Medline].
92.Hetland TE, Hellesylt E, Florenes VA, et al. Class III -tubulin
expression in advanced-stage serous ovarian carcinoma effusions is

associated with poor survival and primary chemoresistance. Hum

Pathol. 2011 Jul. 42(7):1019-26. [Medline].
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