FUTURE DIRECTIONS

The development of additional information about the nature and management of germ cell cancers and rarer malignant tumors of the ovary as well as fallopian tube cancer will continue to be restricted by the low frequency of these lesions. With regard to celomic epithelial carcinomas of the ovary, however, progress should continue to be rapid. Current and future investigational efforts focus on several distinct areas: biology of ovarian carcinoma, screening and early detection, the proper role of surgery, new agents and their role in systemic therapy, and the value of approaches to achieve greater dose intensity.
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First, with regard to the biology of ovarian carcinoma, specific studies are seeking (1) to characterize factors associated with ovarian carcinoma and its outcome such as specific genetic defects associated with hereditary ovarian carcinoma, various oncogenes, and DNA ploidy; (2) to identify features predictive of the likelihood of developing ovarian carcinoma; and (3) to ascertain the biologic reasons for the observation that more aggressive disease is associated with older patients. As these and other investigations expand the understanding of the basic nature of ovarian carcinoma, the development of better and more specific methods for early detection and treatment of the disease should be possible. Where this line of work will ultimately lead is speculative but exciting.

Second, the evolution of effective techniques for screening for and early detection of ovarian carcinoma has a high priority in ovarian carcinoma, the only one of the major gynecologic cancer for which early detection is not the rule. Most interest centers on the potential for transvaginal sonography, especially when enhanced by color flow Doppler, to permit earlier detection of disease. Studies are currently directed at improving the specificity of the technique and at demonstrating an impact on the morbidity and mortality of the disease. Ultimately, confirmation of the value of the procedure will depend on a large screening trial of high-risk women (one or more first-order relatives), a study now planned but as yet unfunded.