[The impact of the pathologist on the treatment of epithelial ovarial cancer].

Abstract

The majority of patients with epithelial ovarian cancer (EOC) are diagnosed with advanced disease involving sites such as the upper abdomen, pleural space, and paraaortic lymph nodes. The standard therapy for advanced disease requires maximal cytoreductive surgery followed by postoperative platinum- and taxane-based chemotherapy. Despite maximal primary surgical effort and postoperative standard chemotherapy long-term survival of patients with advanced stage III or IV disease ranges from 30% to less than 10% due to early and late relapse or primary progressive disease. Facing the highly lethal nature of epithelial ovarian carcinoma, the clinical course of advanced disease is difficult to predict in an individual patient. This heterogeneity of clinical outcome in patients with ovarian carcinoma suggests that reliable prognostic and/or predictive factors would be of potential clinical value and new treatment options are warranted in the future. In the light of recently published studies we summarize the clinical features and the diagnostic, operative and postoperative management of epithelial ovarian carcinoma. We furthermore address the importance of the pathologist during the clinical course of patients with ovarian carcinoma. The issue of timing between surgery and chemotherapy in the setting of neoadjuvant chemotherapy treatment of advanced ovarian carcinoma is being highlighted as well as the significance of new diagnostic and therapeutic options with regard to accurate predictive markers, that might identify patients who are appropriate candidates for novel therapeutic approaches.