Current Management of Patients with Early-Stage Ovarian Cancer

Abstract

Early-stage ovarian cancer (International Federation of Gynecology and Obstetrics [FIGO] stages I to IIA) is approximately 30% of patients with ovarian cancer; the disease is restricted to the true pelvis when it is diagnosed. Palpation of an adnexal mass during a pelvic examination is essential for diagnosis of ovarian tumor and cancer. Performing pelvic high-resolution ultrasound examination is a useful noninvasive diagnostic test. In addition, measurement of cancer antigen 125 (CA-125) is important as it was found to be elevated in greater than 80% of patients with epithelial ovarian cancer (EOC). The standard primary treatment for epithelial ovarian cancer involves pelvic and para-aortic lymphadenectomy, followed by adjuvant chemotherapy consisting of carboplatin and paclitaxel. Systematic lymphadenectomy resection and pathological examination of retroperitoneal lymph nodes have clinical significance for accurate assessment of staging and prognosis. This procedure may involve resection of para-aortic lesions, and therefore it may increase surgical morbidity, such as increased operation time, increased blood loss, lymph cyst formation, and edema in the leg. The surgical approach for EOC could be through laparotomy, laparoscopy, or robot-assisted laparoscopy, which has the advantage of being safe, better visualization of the abdominal and pelvis organs, minimal blood loss, and short hospital stay. Following surgery, patients with early ovarian cancer—FIGO stages I to IIA, except stage IA, grade 1—benefit from three to six cycles of platinum-based chemotherapy, in terms of both overall survivals. Poly(ADP-ribose) poly-merase inhibitors (PARPi) is a new active therapy for treatment of ovarian cancer. These treatment modalities are based on the mechanisms of “synthetic lethal” and “PARP trapping,” especially for patients with homologous recombination deficiencies, and they demonstrate a high survival advantage. However, resistance to PARPi is a noted issue Identifying potential biomarkers to monitor the resistance and developing drug combination strategies are effective ways to address PARPi resistance. Fertility-sparing surgery (FSS) for women of childbearing age with early-stage ovarian cancer is a desirable alternative to more radical approach. In addition, preservation of the adnexa and uterus is recommended in patients with non-epithelial tumors and epithelial borderline.KeywordsEpithelial ovarian cancerBorderline ovarian tumorsRobot-assisted surgeryFertility preservation surgery (FSS)Laparoscopic ovarian cancer staging