Ovarian Cancer is an insidious disease which takes the lives of approximately 15,000 women a year. An estimated 21,650 new cases are expected in the United States in 2008. Ovarian cancer accounts for about 3% of all cancers among women and ranks second among gynecologic cancers, following cancer of the uterine corpus.
Deaths: An estimated 15,520 deaths are expected in 2008. Ovarian cancer causes more deaths than any other cancer of the female reproductive system.
Signs and symptoms: The most common sign is enlargement of the abdomen, which is caused by accumulation of fluid. Early ovarian cancer usually has no obvious symptoms. However, recent studies indicate that some women may experience persistent non-specific symptoms such as bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, or urinary urgency or frequency. Women who experience such symptoms daily for more than a few weeks should seek prompt medical evaluation. Abnormal vaginal bleeding is rarely a symptom of ovarian cancer.
Risk Factors: Risk for ovarian cancer increases with age and peaks in the late 70s. Pregnancy and the long-term use of oral contraceptives reduces the risk of developing ovarian cancer. Tubal ligation and hysterectomy may also decrease risk. The use of estrogen alone as post-menopausal hormone therapy has been shown to increase risk in several large studies. Heavier body weight may be associated with increased risk of ovarian cancer. Women who have had breast cancer or who have a family history of breast or ovarian cancer are at increased risk. Inherited mutations in BRCA1 or BRCA2 genes increase risk. Studies suggest that preventive surgery to remove ovaries and fallopian tubes can decrease the risk of ovarian cancers in women with BRCA1 and BRCA2 mutations. Another genetic syndrome, hereditary nonpolyposis colon cancer, has also been associated with endometrial and ovarian cancer. Ovarian cancer incidence rates are highest in Western industrialised countries.
Early detection: Routine screening for women at average risk is not recommended because no sufficiently accurate screening test is currently available. Pelvic examination only occasionally detects ovarian cancer, generally when the disease is advanced. However, the combination of a thorough pelvic exam, transvaginal ultrasound, and blood test for tumor marker CA125 may be offered to women who are at high risk of ovarian cancer and to women who have persistent, unexplained symptoms. For women at average risk, transvaginal ultrasound and testing for tumor marker CA125 may help in diagnosis but are not used for routine screening.
Treatment: Treatment options include surgery, chemotherapy, and occasionally radiation therapy. Surgery usually involves removal of one or both ovaries, fallopian tubes (salpingoophorectomy) and the uterus (hysterectomy). In younger women with very early stage tumors who wish to have children, only the involved ovary may be removed. In advanced disease, all abdominal metastases may be removed surgically to enhance the effect of chemotherapy. For advanced ovarian cancer, studies have shown that chemotherapy administered both intravenously and directly into the abdomen improves survival.
Survival: Relative survival varies by age; women younger than 65 are about twice as likely to survive 5 years (56%) following a diagnosis as women 65 and older (29%). Overall, the 1 and 5 year relative survival of ovarian cancer patients is 75% and 45%, respectivitly. If diagnosed at the localized stage, the 5 year survival rate is 92%; however, only about 19% of all cases are detected at this stage, usually fortuitously during another medical procedure. For women with regional and distant disease, 5 year survivial rates are 71% and 30% respectively. The 10 year relative survival rate for all stages combined is 38%.
- "Cancer Facts and Figures 2008" American Cancer Society
Ovarian Cancer Sites
Ovarian Cancer National Alliance
Ovarian Cancer Web:John Hopkins Pathology
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