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, pre-
menopausal
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%