Preface

Chapter 8 **The Past, Present and Future of Diagnostic Imaging in**

**Ovarian Cancer 175** Subapriya Suppiah

**VI** Contents

Chapter 10 **Screening for Ovarian Cancer 215** Poonam Jani and Rema Iyer

**Section 3 Surgery in Ovarian Cancer 233**

Rasiah Bharathan

Janos Balega

Hans Nagar

Desmond PJ Barton

**Ovarian Cancer 295**

**Ovarian Cancer 297**

**Based Chemotherapy 309**

Nora Naqos

Limborska

Chapter 9 **Ascites in Advanced Ovarian Cancer 197** Katarina Cerne and Borut Kobal

Chapter 11 **Surgical Management of Ovarian Cancer 235**

Chapter 13 **The Role of Lymphadenectomy in Ovarian Epithelial Cancer 261**

Chapter 14 **Surgery for Recurrent Ovarian Cancer 271**

**Section 4 Chemotherapy and Other Treatment Options in**

Chapter 15 **Chemotherapy for Primary and Recurrent Epithelial**

Chapter 16 **Ethnic Differences in Susceptibility to the Effects of Platinum-**

Chapter 17 **Novel Systemic Treatments in High Grade Ovarian Cancer 331** Amit Samani, Charleen Chan and Jonathan Krell

Andrey Khrunin, Alexey Moisseev, Vera Gorbunova and Svetlana

Chapter 12 **Patient Selection for Ovarian Cancer Debulking Surgery 249**

Our understanding of ovarian malignancy is constantly changing and over the last few years research into cancer genetics and molecular biology has revealed a huge amount of information. This knowledge has been used to develop management strategies as well as new and novel treatment agents. The role of clinical genetics to guide treatment protocols and preventative surgical options has also entered the clinical domain. The place of surgery, be it as a primary manoeuvre, or as an adjunct to primary chemotherapy as well as in the recurrent setting, is still being defined. This book brings together a variety of up-to-date con‐ cepts in the field of ovarian cancer management and addresses some of these issues. Special‐ ists from around the world have contributed a variety of topics, including pathogenesis, molecular biology, diagnosis, screening, and both surgical and chemotherapeutic manage‐ ment. In addition, newer novel treatment strategies have also been outlined. This book out‐ lines the breadth of scientific knowledge that forms the basis of new concepts in this disease and addresses the traditional treatment strategies. We hope the reader will be encouraged to explore this subject further and also contribute to the research of this devastating disease.

> **Dr. Andreas Papadopoulos and Professor Omer Devaja** Department of Gynaecological Oncology Kent Oncology Centre, UK

**Section 1**

**Pathogenesis and Molecular Biology of Ovarian**

**Cancer**

**Pathogenesis and Molecular Biology of Ovarian Cancer**

**Chapter 1**

**Provisional chapter**

**Ovarian Cancer Genetics: Subtypes and Risk Factors**

The genetics of ovarian cancer are a complex, ever evolving concept that presents hurdles in classification, diagnosis, and treatment in the clinic. Instead of common driver mutations, genomic instability is one of the hallmarks of ovarian cancer. While ovarian cancer is stratified into different clinical subtypes, there still exists extensive genetic and progressive diversity within each subtype. In high-grade serous ovarian cancer, the most common subtype, *TP53* is mutated in over 90% of all patients while the next most common mutation is less than 20%. However, next-generation sequencing and biological statistics have shown that mutations within DNA repair pathways, including *BRCA1* and *BRCA2*, are common in about 50% of all high-grade serous patients leading to the development of a breakthrough therapy of poly ADP ribose polymerase (PARP) inhibitors. This is just one example of how a better understanding of the complex genetic background of ovarian cancer can improve clinical treatment. A thorough review of ovarian cancer genetics and the effect it has on disease development, diagnosis, progression, and treatment will

enhance the understanding of how to better research and treat ovarian cancer. **Keywords:** genetics, subtypes, pathogenesis, *BRCA1*, *BRCA2*, *TP53*, risk factors

**Ovarian Cancer Genetics: Subtypes and Risk Factors**

DOI: 10.5772/intechopen.72705

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

the debate of cellular origins of ovarian cancer will be discussed in Section 4.

Ovarian cancer is a generic term used to classify cancers involving the ovaries though they can arise from many different cell types within the Müllerian compartment. Ovarian cancer presents as a distinct subset of cancers with a wide variety of genomic variation (*e.g.,* somatic *TP53* mutations, germline *BRCA1/2* mutations, copy number gains in *BRAF*, *CCNE1*, *TERC*, *TERT*, and copy number loss of *RB1* and/or *PTEN*) as demonstrated through a Pan-Cancer analysis using The Cancer Genome Atlas (TGCA) database (**Figure 1**). The pathogenesis and

Jeff Hirst, Jennifer Crow and Andrew Godwin

Jeff Hirst, Jennifer Crow and Andrew Godwin

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.72705

**Abstract**

**1. Introduction**

**Provisional chapter**
