Treatment of High-Grade Pelvic-Type Serous Carcinomas (Ovary, Fallopian Tube and Peritoneum): Current Therapeutic Paradigms, Prospects, and Challenges

Ovarian cancer represents the second most common gynecologic cancer in the United States, with an estimated 22,000 new diagnoses and 14,000 deaths attributed in 2014 [1]. While the term loosely encompasses a large and varied assortment of malignancies, greater than 90% of ovarian cancers are epithelial carcinomas. Again within this category, there are a number of different histologic subtypes however, 60-70% of ovarian cancers are high-grade serous carcinomas. Overall, high-grade serous carcinomas account for 90% of deaths due to ovarian cancer. Early stage diagnosis has good prognosis with a predicted 5-year survival rate of over 90%. In contrast, late stage diagnosis has a 5-year survival of only 30%, a number which has not significantly changed over the past roughly half century [2]. Unfortunately the majority of ovarian cancers tend to be diagnosed in late stage (stage 3), due in part to both lack of a cost-effective early detection screening method and the non-specificity of symptoms. The incidence of ovarian cancer is 9.4 cases per 100,000 women. In contrast, the rarer fallopian tube and primary peritoneal carcinomas represent a much smaller proportion, with an incidence of 0.41 and 0.46 cases per 100,000, respectively [3, 4]. Due to relatively recently elucidated histologic findings as well as molecular similarities, evidence indicates that these three serous carcinomas may stem from the same origin. Together, epithelial serous ovarian, fallopian and primary peritoneal carcinomas comprise the “extrauterine serous adenocarcinomas” and are staged and managed consistently with ovarian serous cancer [5]. Following is a review of the diagnosis and treatment of these deadly malignancies, with commentary on future therapeutic directions.