21st Century Challenge of Ovarian Cancer in the Elderly

The incidence of ovarian cancer is highest in women over 70 years old, and the disease is the leading cause of death from gynecologic malignancies in the United States and Europe. Nevertheless, improving the quality of medical care for elderly women with ovarian cancer continues to be a challenge. This paper presents the major issues related to the surgical management of presumed early-stage ovarian cancer, surgery and chemotherapy for advanced-stage ovarian cancer in the elderly, and a proposed 21st century algorithm for dealing with these major issues in ovarian cancer in the elderly. Elderly: adj. “rather old; especially being past middle age” —Merriam Webster Collegiate Dictionary, 1th ed. Given that in the 21st century many believe 70 years of age is the new 60 and 80 years of age is the new 70, any article on ovarian cancer in the elderly depends on one’s definition of elderly. To put this in a 21st century perspective, in a thoughtful article on aging in The New Yorker (“The Way We Age Now,” April 30, 2007), Atul Gawande points out, “for most of our hundred-thousand-year existence—all but the past couple of hundred years—the average life span of human beings has been 30 years or less (research suggests that subjects of the Roman Empire had an average life expectancy of 28 years). Today, the average life span in developed countries is almost 80 years.” Ovarian Cancer in the Elderly Ovarian cancer peaks in incidence during the ages of 75 to 79.[1] As a result, a significant number of women in their 70s and 80s will present with presumed ovarian cancer, requiring a dramatic change in our approach to “elderly” women with this disease. Therefore, it is reasonable in the 21st century to define elderly relative to ovarian cancer as women in their 70s and 80s.TABLE 1 FIGO Staging of Early-Stage Ovarian Carcinoma At this point, certain facts seem fairly clear: (1) In the United States and Western Europe, the incidence of ovarian cancer is highest in women over 70 years of age.[2] (2) Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States and Europe.[2] (3) Approximately 70% of epithelial ovarian cancer at presentation are in International Federation of Gynecology and Obstetrics (FIGO) stage III or IV (Table 1) with disease above the pelvis involving the peritoneal cavity.[3]