Facts About Ovarian Cancers: Medical Diagnosis
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Facts About Ovarian Cancers: Medical Diagnosis

Ovarian cancer is the second most common gynecologic malignancy, the most common cause of death among women with gynecologic malignancies, and the fifth leading cause of cancer death in women in the United States.

Ovarian cancer is the second most common gynecologic malignancy, the most common cause of death among women with gynecologic malignancies, and the fifth leading cause of cancer death in women in the United States. Approximately 22,430 American women will be diagnosed with ovarian cancer yearly, and an estimated 15,280 will die of their disease. Because of the vague nature of its symptoms, and the lack of a useful screening regimen, most patients are diagnosed in late stages and the cure rate is correspondingly low.

Ovarian cancer patients are typically older than 50 years of age and the incidence increases with age, with a peak incidence of 54 per 100,000 in patients 75 to 79 years of age. Older women have poorer outcomes, perhaps due to less aggressive treatment. Although there are no specific symptoms to suggest ovarian cancer, most affected patients have nonspecific symptoms such as lower abdominal pressure or discomfort, gas, bloating, constipation, menstrual irregularities, low back pain, nausea, or fatigue. Since these symptoms are nonspecific, ovarian cancer is likely missed during the initial evaluation.

Epithelial ovarian cancers typically spread intraperitoneally with drop metastases and carcinomatosis, but they can also undergo lymphatic and occasionally hematogenous spread. The majority of the patients present with a distended abdomen and omental caking.

Physical examination may reveal a solid, fixed mass, and if tumor has spread, ascites, and/or pleural effusions. Computed tomography (CT) scans of the abdomen and pelvis are also helpful to delineate the extent of disease prior to surgery. Evaluation should include a serum CA- 125 level, imaging with CT and/or ultrasound and prompt referral to a gynecologic oncologist.

Ovarian cancers may arise from four different cell lines:

  • Epithelial ovarian cancers (serous [75% of all ovarian cancers], mucinous, endometrioid, clear cell, Brenner tumors, and carcinosarcomas [mixed Müllerian tumors]) arise from the epithelial lining covering the ovary and are contiguous with the parietal peritoneum
  • Nonepithelial tumors arise from the germ cells (dysgerminoma, yolk sac, embryonal carcinoma, choriocarcinoma, teratoma)
  • Gonadal stroma (granulosa cell, thecoma, fibroma, Sertoli cell, Sertoli-Leydig, steroid)
  • The nonspecific mesenchyme. Nonepithelial tumors require more specialized management.

The ovary may also be the site of metastases from other primary sites such as the stomach (Krukenberg tumors), colon, breast, and endometrium, or from non- Hodgkin lymphomas.

There are three special circumstances in the differential diagnosis of ovarian cancer that must be considered.

  • Low malignant potential or borderline tumors may resemble ovarian carcinomas, although they often present at a younger age and a lower stage. They may be treated conservatively with preservation of the uterus and contralateral ovary. Full surgical staging is frequently performed when the diagnosis is acquired on a frozen section, because up to half will actually have invasive pathology on permanent sections. Borderline tumors usually do not require adjuvant therapy, but may present with late recurrences 10 to 20 years later.
  • Primary peritoneal carcinoma, arising from the coelomic epithelium of the peritoneum, presents like ovarian cancer, and can occur even when the ovaries have been removed. Staging, treatment, and prognosis are the same as epithelial ovarian cancer.
  • Fallopian tube cancers are rare, present much like ovarian cancer, and are treated in an identical fashion.

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Comments (1)

Very informative, and well written.