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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Demonstrate understanding of the etiology and risk factors associated with the development of ovarian cancer.
Justify the risk and benefits of the surgical and chemoprevention options available for decreasing the potential risk of developing ovarian cancer.
Interpret and understand the utility of the screening tests and serologic markers for diagnosing ovarian cancer.
Distinguish the nonspecific physical signs and symptoms of ovarian cancer.
Recommend the appropriate surgical and chemotherapy treatment options for newly diagnosed, persistent, and recurrent ovarian cancer patients.
Discuss the role of first-line maintenance treatment for improving overall survival for ovarian cancer patients.
Compare and contrast chemotherapy options for women with recurrent platinum-resistant ovarian cancer.
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Ovarian cancer is relatively uncommon but is the most incurable of the gynecologic cancers. Ovarian cancer is often denoted as the “silent killer.” 
The primary reason for the high mortality rate associated with ovarian cancer is the nonspecific symptoms and difficulty for early detection or screening that result in patients presenting with advanced disease. The majority of ovarian cancers are of epithelial origin. Each time ovulation occurs, the epithelium of the ovary is broken followed by occurrence of cell repair. The incessant ovulation hypothesis proposes that the increasing number of times the ovary epithelium undergoes cell repair is associated with the increasing risk of mutations and ultimately ovarian cancer. Although the majority of patients will achieve a complete response (CR) to primary surgery and chemotherapy, disease recurs in more than 50% of patients in the first 2 years after completion of primary treatment. Ovarian cancers often cause metastasis via the lymphatic and blood systems to the liver and/or lungs. Common complications of advanced and progressive ovarian cancer include ascites and small bowel obstruction (SBO), which often are associated with the end of life.
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EPIDEMIOLOGY AND ETIOLOGY
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In 2021, there were an estimated 21,410 new cases of ovarian cancer diagnosed with an associated 13,770 deaths.1 Ovarian cancer remains the number one gynecologic killer and the fifth leading cause of cancer-related death in women. Despite great efforts and extensive research, addition of new agents and routes of administration, there has been little change in the mortality rate associated with ovarian cancer over the past six decades. Again, this high mortality rate associated with ovarian cancer can be attributed to its insidious onset of nonspecific symptoms, resulting in the majority of patients not presenting until the cancer has progressed to stages III to IV disease.
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As with many other disease states, a significant risk factor associated with ovarian cancer is aging. Risk of ovarian cancer increases from age 40 to 79 years, with the mean age at diagnosis being 63 years and the majority of women being diagnosed between 55 and 64 years.2
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Ovarian cancer is a sporadic disease; ...