Epithelial ovarian cancer
Epithelial ovarian cancer is the most lethal gynecologic malignancy because nonspecific symptoms and the absence of an effective screening test mean most women present with stage III or IV disease. Diagnosis rests on pelvic examination, cancer antigen 125 (CA-125), and transvaginal ultrasonography followed by surgical staging; treatment is cytoreductive surgery plus platinum-taxane chemotherapy, with olaparib maintenance in breast cancer susceptibility gene (BRCA)-mutated disease.
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What this article covers
- Overview
A malignancy of the ovarian surface epithelium (or, increasingly, the distal fallopian tube), accounting for roughly 90% of ovarian cancers; germ cell and sex cord-stromal tumors are rare and behave differently.
- Epidemiology
Disease of older women: average age at onset is approximately 60 years; onset in younger women is more likely hereditary.
- Risk factors
BRCA1 or BRCA2 mutation: the strongest risk factor; accounts for most hereditary EOC.
- Pathophysiology
Repeated ovulatory trauma to the ovarian surface epithelium is the classic mechanism: each ovulation causes surface disruption and repair, and more lifetime ovulatory cycles raise the cumulative opportunity for malignant transformation.
- Clinical features
Nonspecific gastrointestinal and pelvic symptoms are the dominant presentation: bloating, abdominal or pelvic pain, early satiety, nausea, and change in bowel or bladder habits, frequently overlooked until the tumor is large or has spread.
- Differential diagnosis
Functional ovarian cyst (follicular or corpus luteum cyst): simple and unilocular on ultrasound, resolves spontaneously over one to two cycles, unlike the solid, septated, or nodular mass of EOC.
- Diagnosis
No blood or imaging test confirms EOC; the diagnosis is established by histopathology.
- Management
First, refer to a gynecologic oncologist for surgical staging and cytoreductive (debulking) surgery: total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, omentectomy, and…
- Complications
Malignant ascites, from peritoneal seeding, causing abdominal distension and discomfort.
- Prognosis
Stage at diagnosis is the dominant determinant of survival: stage I is greater than 90% (grade 1, favorable) falling to 75% to 80% (grade 3 or clear cell); stage II is 60% to 70%; stage III is 25% to…
- Prevention
No screening test is recommended for average-risk women: transvaginal ultrasonography and serum CA-125 lack the sensitivity, specificity, and cost-effectiveness for population screening, and this…
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An adnexal mass found on exam or incidental imaging is triaged by menopausal status, ultrasound morphology, and CA-125 into observation, gynecology referral, or urgent gynecologic-oncology referral. Getting this triage right avoids both unnecessary surgery on a physiologic cyst and delayed staging surgery on an early ovarian cancer.
- Functional ovarian cysts
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- Endometriosis
Endometrial-like glands and stroma implanted outside the uterus drive cyclic pelvic pain, dyspareunia, dyschezia, and infertility. Diagnosis is presumed clinically and confirmed by laparoscopic visualization with biopsy; treatment is staged from NSAIDs and hormonal suppression through conservative or definitive surgery.