Diagnostic Dilemmas in Ovarian Cancer

Ovarian cancer ranks fifth in terms of mortality rates of all cancers among women. According to GLOBOCAN 2020, the age adjusted global incidence was 6.6 per 100,000 women, and the mortality rate was 4.2 per 100,000 women. India, on the other hand, had an age adjusted incidence rate and mortality rate of 6.7 and 4.8 per 100,000 women, respectively (Sung et al. in CA Cancer J Clin. 71:209-249, 2021). Women of all ages are susceptible, although it is commonly diagnosed between the ages of 55 and 64 (Torre et al. in CA Cancer J Clin. 68:284-296, 2018). More than 75% of affected women are diagnosed at an advanced stage because early-stage disease is usually asymptomatic, and symptoms of late-stage disease are non-specific. Early diagnosis, when tumours are small and still confined to the ovaries, is the most important prognostic factor (Jayson et al. in Lancet. 384:1376-88, 2014) Despite advances in medical and surgical management of the disease, early diagnosis, appropriate diagnostic and tailored management of advanced ovarian cancer remains a challenge for healthcare providers. This review aims to summarize the current clinical dilemmas in ovarian cancer diagnosis and highlights areas in need of further research. The areas discussed in this article are screening and early detection of ovarian cancer, tumour markers and imaging modalities for the diagnosis and recent advances in histopathological classification and use of immunohistochemistry and molecular pathology for the correct diagnosis of the exact subtype of the disease.