The Indian Council of Medical Research (ICMR) has issued a draft consensus document for management of ovarian cancer.

This consensus document represents the experts ‘current thinking on the topic based on available evidence. This has been developed by national experts in the field and does not in any way bind a clinician to follow this guideline verbatim as these are recommendatory in nature and not binding on a treating oncologist or team. One can use an alternate mode of therapy based on discussions with the patient and institution, national or international guidelines. The mention of pharmaceutical drugs for therapy does not constitute endorsement or recommendation for use but is a guidance for clinicians in complex decision-making.

The ICMR has come out with this document as ovarian cancer was estimated to be the third most common cancer among Indian women in 2008. It is also a leading cause of death from cancer in Indian women. While five-year survival from ovarian cancer is 94 per cent when diagnosed in stage I, only 15 per cent of cases are diagnosed at this stage. Most (62 per cent) of cases are diagnosed in stages III and IV, when five-year survival is only 28 per cent. Ovarian cancer is relatively uncommon in the general population with an estimated age-adjusted incidence varying from 0.9 – 8.4 per 100,000 women in various cancer registries in India.

The incidence of ovarian cancer increases with age. The age specific incidence rate (ASIR) increases from age 35 years and peaks between the ages of 55-64 years. There has been a gradual increase in the incidence in most registries. Since the population prevalence is low, the specificity of any screening strategy must therefore be high in order to achieve an acceptable positive predictive value (PPV), particularly since the follow-up testing associated with screen positive results is quite invasive.

The draft consensus document provides current thinking of the national experts on various aspects of management of ovarian cancer like epidemiology, risk factors, prevention, screening and early detection, pathology, clinical presentation, investigations, surgical staging and surgical management of early stage disease, adjuvant systemic therapy for early stage disease, surgical treatment of advanced stage disease, adjuvant systemic therapy for advanced stage disease, neoadjuvant chemotherapy as initial treatment of advanced stage disease, management of low malignant potential tumours, second look surgery, recurrent ovarian cancer, serological relapse, clinical relapse, surgery in recurrent ovarian cancer.