Ovarian Cancer: A Clinical Challenge That Needs Some Basic Answers

From a clinical perspective, epithelial ovarian cancer is something of an enigma. Despite improvements in aggressive debulking surgery and the initial good response of patients to platinum-based chemotherapies, there has been little improvement in the survival rates for over three decades. About 65% of women with epithelial ovarian cancer will die within five years of their diagnosis [1]. Early-stage ovarian cancers are often asymptomatic and the recognised signs and symptoms, even of late-stage disease, are vague. Consequently, most patients are diagnosed with advanced disease, and it seems unlikely that symptoms alone could help to improve the proportion of tumours that are diagnosed at earlier, more treatable stages. Unfortunately, there are no effective biomarkers that can identify early-stage disease and no reliable prognostic markers for predicting clinical response and guiding treatment regimes. Furthermore, there remains intense debate about the cellular origins, precursor lesions, and histological classification of the disease. With so many unknowns, it is perhaps not surprising that progress in reducing mortality in women diagnosed with ovarian cancer has been so limited.