OVARIAN CANCER

3.4.2016
Mark Browning, M.D.
IUSME

Incidence/Deaths

22,000 Cases
14,000 Deaths
Overall Survival Rate is 35%
Survival Rate Depends on Stage

Types of Ovarian Cancer

Epithelial Cancer 90% of Cases

Surface of Ovary or Special Cells in Fallopian
Tubes
High Grade Serous Tumors
Low Grade Serous Tumors

Germ Cell Tumor

Stromal Cell Tumor

Ovarian Cancer

Usually presents with advanced

disease

have disease beyond the ovary at

diagnosis

Pelvic exams are helpful in diagnosing

large masses
Premenopausal adnexal mass usually a
cyst that regresses over time (7% are
cancer)
Postmenopausal adnexal mass is
worrisome (30% are cancer)

Ovarian Cancer: The NOT the silent

killer

95% of women DO report symptoms.

Symptoms can be vague and not
gynecologic:

Abdominal bloating
Swollen abdomen
Fatigue
Diarrhea or constipation
Urinary symptoms
Abdominal/pelvic pain
Menstrual irregularities

Clinical behavior

Spread by direct exfoliation of cells onto

peritoneal surface/cavity
Most common mode of spread
Follow path of peritoneal fluid circulation into
pericolic gutter and hemidiaphragm (develop
a pleural effusion)
Peritoneal mets/adhesions

Diagnosis of Ovarian
Cancer

Pelvic Exam, Transvaginal Ultrasound, CA

125
CT Scan, MRI, PET
Biopsy

Ovarian Cancer workup

Surgical staging is mandatory

CA-125 is non-specific marker

AFP and b-HCG if suspect germ cell

tumor (younger woman)

Pathology

Adenocarcinomas
Primary peritoneal carcinoma
Germ Cell Tumors

Rare

Low malignant potential (LMP)

borderline tumors
Single ovary, confined, younger age, premenopausal

Ovarian Cancer Treatment

Salpingo-oophorectomy
Hysterectomy
Lymph Node Dissection
Omentectomy
Cytoreductive/Debulking Surgery
ChemoAdjuvantNeoadjuvant
Chemo for Recurrence

Epithelial ovarian cancer: Origin

Ovarian cancer
originates from
the cells that
cover the ovary
(epithelium).

Ovarian
epithelium
represents < 1%
of the ovary.

Screening of individuals at high risk

Women who carry a known mutation that

predisposes to ovarian cancer (BRCA gene
mutation)

Women who have a family history of ovarian or

breast cancer

These women should be followed closely (CA125,

gynecologic exam and ultrasound)

These women should consider removal of ovaries

(oophorectomy) preventively.

Prophylactic removal of ovaries in

BRCA carriers

559 women, carriers of BRCA 1 or 2

259 women surgery:
6 diagnosed with stage 1 ovarian cancer
2 developed primary peritoneal cancer
292 no surgery:
58 developed ovarian cancer
Risk reduction: 96%
(Rebbeck, NEMJ, 2002)

OVARIAN CANCER TREATMENT:

SURGERY

Ovarian Cancer Points to

Remember

Family history and parity are most impt risk

factors
BRCA-1 is a strong risk factor (50% risk)
BRCA-2 also a risk factor, but much less so
Lynch II syndrome (DNA mismatch repair defect):
HNPCC, ovarian, breast, endometrial ca
Prophylactic oophorectomy reduces risk 96%

Incessant ovulation hypothesis: risk decreases

with decreasing ovulation
Use of OCP that suppress ovulation reduces
lifetime risk by as much as 50%