At present, there is no evidence that the use of high-dose chemotherapy in conjunction with peripheral blood, stem cell, or bone marrow rescue has any value. The risk is increased in women who have a strong family history of the disease. Unfortunately, no accurate screening tests are available. Transvaginal sonography and CA-125 determinations can be valuable in selected patients. Attempts at prevention with oral contraceptive use and indicated or prophylactic oophorectomy should be seriously considered.
Conservative treatment is appropriate in selected patients with early-stage ovarian cancer.
However, because the majority of patients present with advanced disease, maximum cytoreductive surgery followed by chemotherapy is usually required. Such an approach results in a high incidence of initial clinical remission and can prolong survival to 2 or 3 years. Eventually, however, relapse and death often occur in spite of additional therapy. Another operation may be needed for secondary cytoreduction or palliation. Bowel obstruction, recurrent ascites, and pleural effusion are often terminal events.