Ovarian cancer

Ovarian cancer is a malignant neoplasm arising in the ovary, fallopian tube, or peritoneum, and the most lethal gynecologic Cancer in high-income countries; worldwide, cervical Cancer causes more deaths. High-grade serous carcinoma (HGSOC) accounts for most cases and the worst outcomes, and the evidence now indicates that it usually begins not in the ovary but in the fimbriated end of the fallopian tube, where serous tubal intraepithelial carcinoma lesions carrying the same TP53 mutation precede it. That reassignment of origin is why opportunistic salpingectomy has become a prevention strategy. Nearly all HGSOC carries a TP53 mutation; about a fifth involves germline or somatic BRCA1 or BRCA2 defects, and roughly half shows homologous recombination deficiency more broadly. Risk rises with the number of lifetime ovulatory cycles and with hereditary predisposition syndromes, and falls with pregnancy, breastfeeding, and combined oral contraceptive use.

The disease is often called a silent killer because its early symptoms — bloating, early satiety, pelvic discomfort — are nonspecific, so most diagnoses come after peritoneal dissemination. Screening does not change that: large randomized trials of CA-125 and ultrasound in the general population shifted stage at diagnosis without reducing Mortality, and CA-125 is therefore used for monitoring treated disease rather than for detection. Five-year survival remains near 30% for advanced HGSOC, against over 90% for disease confined to the ovary.

Standard first-line treatment combines cytoreductive surgery, with completeness of resection among the strongest prognostic factors, and platinum-based chemotherapy — carboplatin with paclitaxel — after which maintenance Therapy is chosen by molecular status: a PARP inhibitor such as olaparib for BRCA-mutated or homologous recombination–deficient Tumors, bevacizumab for others. Platinum resistance, defined by how soon disease returns after treatment, governs subsequent options and remains the central clinical problem; response rates fall and few later regimens are durable. Antibody-drug conjugates directed at Folate receptor alpha have entered practice for platinum-resistant disease, while checkpoint inhibitor Therapy has largely disappointed here — HGSOC is immunologically cold — and work continues on the tumor microenvironment that makes it so.