Ovarian cancer is the leading cause of cancer deaths from GYN tumors. It is second to cervical Ca. The rate is 1.5/10K, and is higher in developed countries, lower in developing.
Ovarian tumors are mostly (80-09%) epithelial (coelomic epithelium), germ-cell tumors, or sex cord/stromal neoplasms.
Etiology is not known. Association include involuntary infertility, low parity, prolonged duration from menarche to menopause. Lowered risk with BCP's (by about 40%). Inherited OCa includes 3 AD conditions. W/O family Hx lifetime risk is only 1-4%, with + fam Hx (first degree relatives), the incidence rises to 5-7%. With an inherited OCa syndrome, it is up 40%. BRCA1 increases OCa, as well as breast cancer. Cumulative risk for BRCA1 (up to age 70) is 63% OCa and 85% breast Ca. However, for BRCA2, the cumulative risk (to 70 yrs) is < 10%.
These facts suggest that the ovulatory cycle itself is a predisposing factor. The concept is that ovulation stimulates mitotic activity in the ovarian epithelium required to repair itself. Cell types classified by behavior (borderline, low malignant, invasive) and cell type (serous 56%, mucinous 11%, endometrioid 16%, clear-cell 5%, mixed 2%, other 10%). Most form cystic tumors and spread through lymphatics, hematogenous, and peritoneally. Although hematogenous spread at time of Dx is uncommon, peritoneal spread is frequent, as cells exfoliate and float in peritoneal fluid.
SURVIVAL:
Stage I - 80%, II - 60%, III - 25%, IV - 15% at 5 yrs.
DIAGNOSIS:
At initial presentation, 2/3 are advanced. Sx may be mild/absent, pelvic mass, secondary bowel changes (from peritoneal mets), transvaginal sonography, serum CA 125 antibodies, ascites, nodular peritoneal implants.