Early detection of ovarian cancer
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EDITORIAL
Early detection of ovarian cancer Rosemarie Forstner 1 Received: 1 March 2020 / Revised: 6 April 2020 / Accepted: 5 May 2020 # The Author(s) 2020
Abstract Early detection is the only way to achieve a high cure rate in women with ovarian cancer. Unfortunately, to date, there is no effective strategy for early detection, despite rapidly emerging biomarkers. The low prevalence of ovarian cancer, low specificity and high rates of false positives have been limitations of screening programs. In the hands of experts, transvaginal sonography and MRI are effective tools to characterise ovarian masses. Currently, ongoing efforts in standardization of technique and analysis are likely to improve diagnostic capabilities in clinical routine, as well as the introduction of predictive risk models of malignancy. Radiomics and radiogenomics potentially offer a broad spectrum of complementary information in ovarian cancer diagnosis and treatment. Key Points • Transvaginal sonography and MRI are effective tools to characterise ovarian masses. • Standardisation of imaging technique and implementation of predictive models of risk of malignancy contribute to early detection of ovarian cancer. Keywords Ovarian cancer . Epithelial ovarian cancer . Magnetic resonance imaging . Screening . Radiomics
From a clinical perspective, ovarian cancer remains a major challenge. Despite advances in therapy, only a marginal improvement in overall survival has been seen in the last decades. This is mainly attributed to the fact that ovarian cancer is mostly diagnosed late and subsequently will relapse. In contrast, borderline tumours and stage I invasive ovarian cancer have excellent prognoses. Unfortunately, early detection of ovarian cancer still remains one of the unmet needs in the management of this disease.
Is an improved diagnostic pathway already in sight? Undoubtedly the concept of ovarian cancer has been completely revised. Ovarian cancer is now recognised as an umbrella term for different cancer types that differ widely not only on a morphological and genetic level but also in clinical behaviour.
* Rosemarie Forstner [email protected] 1
Department of Radiology, Universitätsklinikum Salzburg, Paracelsus Medical University, Müllner-Hauptstr. 48, A-5020 Salzburg, Austria
Furthermore, heterogeneity is a feature seen not only within the primary tumour but also among its metastases [1]. Approximately 90% of ovarian cancers constitute of epithelial ovarian cancer types. Ovarian cancer has multiple cellular origins. The most common and aggressive type is highgrade serous ovarian cancer (HGSOC) which originates in the epithelium of the fallopian tube as a STIC lesion. HGSOC may manifest as an ovarian or fallopian tube mass or primary peritoneal cancer, and the term tubo-ovarian cancer is often used. In contrast, only the biologically more indolent type I cancers (low-grade serous, mucinous, endometrioid, and clear cell) derive from the ovaries. These two distinct cancer categories differ not only in origin and aggressiveness, but al
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