In most developed countries, ovarian carcinoma is the second most common malignancy of the female genital tract, following endometrial carcinoma. This chapter reviews the major morphological sub-types of ovarian carcinoma including their pathogenesis, and discusses problematic areas in typing. Most of the grading systems are universal in that they can be applied to all the major morphological sub-types of ovarian carcinoma. The major morphological sub-types of ovarian carcinoma are serous, endometrioid, clear cell and mucinous. Two relatively recent population-based studies that included central pathology review have provided updated information regarding the relative frequencies of the major sub-types. The perceived relationship between benign, borderline and malignant ovarian serous neoplasms was controversial. The morphological features of ovarian carcinomas treated by chemotherapy often differ markedly from native tumours. The chapter also summarizes the evidence that most high-grade pelvic serous carcinomas arise from the fimbria of the fallopian tube.

Ovarian cancer is the fourth most common cause of cancer deaths in women and the leading cause of gynaecological cancer death in Europe with a lifetime prevalence in the developed world of 1-2%. Primary ovarian tumours are a heterogeneous group, which includes epithelial tumours, sex-cord stromal and germ-cell tumours. There are a number of indications for surgery for ovarian carcinoma: establishment of diagnosis, accurate staging, primary cytoreduction, interval and secondary cytoreduction, and palliative and salvage surgery. Modest improvement in progression-free survival in the lymphadenectomy arm was offset by increased morbidity. Although surgery is usually the primary treatment, ovarian cancer is a chemosensitive disease and chemotherapy has been shown to improve prognosis in advanced disease. Treatment for relapsed disease is usually regarded as a palliative measure in women with symptomatic recurrent tumours. Radiotherapy is mainly used as palliative treatment to reduce pain and, occasionally, to control bleeding.