Ovarian cancer

Ovarian cancer refers to any cancerous growth that emerges in the ovary, one of the primary female reproductive organs. It is considered the second most common gynecologic malignancy, but unfortunately, it leads as the cause of death from gynecologic cancers due to its late-stage diagnosis.

Bilateral ovarian serous carcinomas, gross pathology

Ovarian cancers by histopathology

Ovarian tumors by incidence and cancer risk

Epidemiology and Risk Factors

Globally, ovarian cancer is the fifth leading cause of cancer death among women, after lung, breast, colon, and pancreas cancers. The disease prevalence is higher in industrialized nations, apart from Japan. In the United States, the lifetime risk of a woman developing ovarian cancer is 1.4% to 2.5%. Despite intense research, the etiology remains largely unknown and is described as idiopathic.

Symptoms

Ovarian cancer often goes unnoticed until it has spread within the pelvis and abdomen, largely due to its vague and nonspecific symptoms. Early-stage symptoms can include a sense of pelvic heaviness, abnormal menstrual cycles, and unexplained back pain. As the disease progresses, symptoms may evolve into weight changes, increased abdominal girth, and gastrointestinal complaints like indigestion, lack of appetite, and bloating. In rare cases, increased urinary frequency, urgency, and excessive hair growth may also be observed.

Diagnosis

Diagnosis of ovarian cancer involves a series of steps starting with symptom inquiry and physical examination, including pelvic examination. The blood test CA-125 is often used to aid diagnosis, although it is not universally considered as an effective screening tool due to its varying sensitivity and specificity. Further investigation may involve trans-vaginal ultrasounds, CT scans, or repeated CA-125 tests. Ultimately, a tissue biopsy is often required for definitive diagnosis.

Classification

Ovarian cancer can be classified according to the histology of the tumor. The most common and prototypical ovarian cancers are surface epithelial-stromal tumors. Other types include sex cord-stromal tumors, germ cell tumors, and other lesions including metastases to the ovary.

Staging

Staging of ovarian cancer is conducted post-surgery using the FIGO system and is crucial in determining the extent of disease spread and appropriate treatment options.

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Treatment

Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. The specific approach depends on the cancer stage, type, and grade, as well as the patient's general health status. Recently, the use of intraperitoneal chemoperfusion has shown promise in treating advanced ovarian cancer.

Prognosis

The prognosis of ovarian cancer varies greatly depending on the stage at diagnosis. Late-stage diagnosis, which is common due to the vague symptoms associated with the disease, often results in a poorer prognosis.

References

• "Ovarian Cancer: Epidemiology, Biology, and Prognostic Factors"
• "Symptoms of ovarian cancer"
• "New advances in the treatment of ovarian cancer"
• "Advances in the management of ovarian cancer: from screening to surgery"

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