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Explorations into the Genesis of Ovarian Malignancy

It has become a frustrating and repetitive cliche that early treatable carcinoma of the ovary is number one on the gynecologist's "most wanted" list; however, like most clever criminals, the lesion remains elusive and highly lethal. In spite of the endless investigative studies and reported series, attempts to develop technics by which ovarian carcinoma can be detected in its embryonic stages, or to define its specific precursors, have been few and disturbingly unproductive. Conversely, the ability to determine precursory lesions and preinvasive states for cancer in other areas of the body have improved the salvage rates dramatically. The cervix represents a prime example of the value of such studies. Epidemiologists have convincingly demonstrated that socioeconomic factors are of major importance in the genesis of cervical cancer; and cytology, colposcopy, and histopathology have provided means by which precursory states can be detected and documented. Patients with ovarian cancer have not been subjected to the close scrutiny afforded to those with cervical malignancy. A majority of publications concerning ovarian neoplasia may be classified as clinicopathologic and generally stress new therapeutic approaches. The few existing epidemiologic studies have demonstrated no consistently positive findin gs. The thorough investigation carried out by Wynder and his associates"' has shown that the ovarian cancer patient stands out as a remarkably "normal" individual. Although a few distinguishing features were noted, such as a more frequent history of heavy menstrual bleeding, an earlier menopause, and a possible relationship to an increase in dietary fat (based on a study of Japanese women at home and abroad), the authors seemed to be unimpressed with the specificity of these findings. Abu-Rustum and