- Seventy-five percent of ovarian carcinomas are epithelial in origin; these include serous cystadenocarcinoma and mucinous, endometrioid, and clear cell tumors. Germ cell tumors make up fewer than 5% of all cancerous ovarian tumors, but in women under 20 years of age, they account for 65% of diagnosed ovarian cancers.

Causes and Incidence The etiology has not been established, but an increasing incidence among nulliparous women suggests that uninterrupted ovulation is a predisposing factor. Other risk factors include a family history of the disease; a high-fat, low-fiber, vitamin A–deficient diet; and occupational exposure to asbestos and talc. Ovarian cancer is the sixth most common form of cancer in women and the fourth leading cause of death from cancer, and the incidence is rising. Ovarian cancer is most common in Western industrialized nations among older white women of NorthernEuropean descent.

Disease Process Ovarian cancer begins in the various tissues of the ovary and then spreads by direct extension and lymphatics to the regional nodes in the pelvis and paraaortic region and to the abdominal and pelvic peritoneum. Metastasis is commonly to the liver and lungs.

Symptoms Symptoms of early disease are often absent or mild and associated with other common problems. They include such things as vague abdominal discomfort, dyspepsia, bloating, flatulence, and digestive disturbances. Later stage signs and symptoms include ascites, abdominal and pelvic pain, abdominal and pelvic masses, persistent gastrointestinal symptoms, urinary complaints, and menstrual irregularities.

Potential Complications The prognosis is good with diagnosis at an early stage. However, because early ovarian cancer is typically asymptomatic, the chances of prompt diagnosis are slim. Complications include intestinal obstruction, ascites, and cachexia.

Diagnostic Tests An enlarged ovary on manual examination is often the first diagnostic sign. A definitive diagnosis is made by biopsy through laparoscopy. Tumor marker CA-125 is being evaluated as a diagnostic tool. It is predictive in only about 50% of early cases but may prove useful for tracking treatment progress.

Treatments

Surgery
Salpingo-oophorectomy with or without hysterectomy is the primary treatment.

Drugs
Systemic chemotherapy as adjuvant to surgery.

General
Radiation therapy as adjuvant to surgery.

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