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Advances in epithelial ovarian cancer.

BACKGROUND
Most epithelial ovarian cancer occurs in older women, with a mean age at diagnosis of 62 years and an overall five‑year survival rate in Australia of 43%. Most women are diagnosed with advanced disease of high-grade serous type with 20-30% five-year survival; 70% relapse within three years of initial treatment. There is no available screening test for ovarian cancer.


OBJECTIVE
The aim of this article is to highlight current management and future directions for women diagnosed with epithelial ovarian cancer, particularly the high incidence of underlying genetic mutations and new options for treatment.


DISCUSSION
Risk-reducing surgery with bilateral salpingo-oophorectomy is recommended for women at high risk of developing ovarian cancer. Ovarian cancer treatment still centres on surgery and chemotherapy, with aggressive cytoreductive techniques and intraperitoneal treatments being evaluated in advanced disease. Molecular targeting agents are revolutionising treatment options, particularly the poly adenosine diphosphate-ribose polymerase inhibitors, and especially for patients with an underlying BRCA mutation. Other molecular targeting agents, such as vascular endothelial growth factor (VEGF) receptor inhibitors and newer approaches using immunotherapy and molecular targeting, aim to individualise treatment and improve survival in the future.