The Genetics of Ovarian Cancer: Molecular Biology and Clinical Application

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Abstract

Ovarian cancer is the fifth most common malignancy among American women and the fourth leading cause of cancer death.The rapid advances in molecular genetic analysis, presymptomatic detection, and treatment of ovarian cancer are staggering. In this review, both the genetic component and the molecular biology of ovarian cancer are discussed, as well as current recommendations for genetic counseling. It is important for the practicing obstetrician and gynecologist to become familiar with these concepts, for it is he or she who will likely serve as a primary resource of information for these patients.

Today it is difficult to pick up the evening newspaper and not read some new information on ovarian or breast cancer.The rate at which new information is being published can be overwhelming. For the practicing obstetrician/gynecologist, it can be difficult to keep up with the average patient's questions on the topic. This review is meant to help with some of those questions.

Ovarian cancer is the fifth most common malignancy among American women and the fourth leading cause of cancer death *RF 1*.More women will die of ovarian cancer than from all other gynecologic malignancies combined. Ovarian cancer is predominantly a disease of perimenopausal and postmenopausal women; the mean age at diagnosis is 60 years. Currently, a number of risk factors have been associated consistently with the development of ovarian cancer, including a family history, nulliparity, and low parity. There are also a number of factors thought to decrease the risk, including high parity, breast-feeding, and oral contraceptive use.

Gynecologic cancer treatment is at the crossroads.Originally, the treatment for ovarian cancer was surgery. In 1980, organized treatment for ovarian cancer began with the Gynecologic Oncology Group's first protocol. They randomized the treatment of stage I epithelial ovarian cancer to either, no therapy, radiation therapy, and/or chemotherapy [3]. Since that time, many protocols have been completed, which have led to the predominant current therapy, which consists of a combination of surgery and chemotherapy. Tremendous benefit is likely to result from the basic science investigations at the molecular level, as already evidenced in other solid tumor systems, such as lung, breast, and colon cancer care. This molecular biology research may offer new approaches to prevention and early diagnosis, as well as new therapies for patients with gynecologic cancer. The focus of early diagnosis and treatment may soon be based on genetic technology. In this review, both the genetic component and the molecular biology of ovarian cancer will be discussed.

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