29. Ovarian cancer

Ovarian cancer is a relatively uncommon type of cancer. Factors that increase the risk of developing epithelial ovarian cancer are early menarche, nulliparity, late menopause, increasing age and inherited predisposition. Around 90 % of malignant tumours in the ovaries are epithelial in origin; other types include non-epithelial and metastatic tumours. The epithelial ovarian cancers form a heterogeneous group with high-grade serous carcinoma as the most common subtype. This subtype most likely originates from the epithelium of the distal fallopian tube. Due to a lack of specific symptoms the majority of patients with ovarian cancer are diagnosed with advanced stage of the disease. In most European countries, therapy for patients with ovarian cancer has been centralized to specialized hospitals ensuring higher case volumes and concentration of expertise. Standard therapy for ovarian cancer comprises a combination of surgery and chemotherapy. Despite an initial response, patients frequently develop resistance to chemotherapy. The prognosis of patients with ovarian cancer is therefore unfavourable. Innovative therapeutic strategies, for example based on molecular subtyping, are required to improve treatment outcome.