Benign and malignant tumors developing in the ovaries are seen in 5% to 7% of women. Approximately one in 70 women will develop ovarian cancer in their lifetime. According to the American Cancer Society, in 2006, there were approximately 20,180 new cases of ovarian cancer, resulting in 15,310 deaths. Ovarian cancer, similar to breast cancer (the most common in women), occurs 10 times less frequently, and lung cancer (the highest mortality rate) causes 4.5 times more deaths. The average age at diagnosis is 63.
Factors Related to the Development of Ovarian Cancer
Reproductive, behavioral, and genetic factors influence the transformation into cancer. A primary reproductive risk factor is not having given birth. Even a single pregnancy resulting in childbirth reduces the risk of ovarian cancer by 40%, and subsequent pregnancies reduce the risk by 15% per pregnancy. Infertility doubles the risk of developing ovarian cancer compared to the general population. Long-term use of oral contraceptives reduces the risk of ovarian cancer by 50%, even in the presence of a genetic predisposition.
While not present in all studies, some behavioral factors that are considered influential in the development of ovarian cancer include a high-fat diet, obesity, and exposure to talc in the genital area. Recent studies indicate that estrogen use during menopause is associated with an increased risk. Interestingly, the removal of the uterus or the ligation of the fallopian tubes, both, individually, are associated with a risk reduction of up to 40%.
Hereditary mutations are identified in 10% of all ovarian cancers. BRCA1 and BRCA2 mutations increase the lifetime risk of developing ovarian cancer by more than 40%. These genes, along with other yet-undiscovered high-risk genes, are found in 90% of genetic breast/ovarian cancer familial syndromes. Women with one of these high-risk genetic mutations who have given birth and are over the age of 35 are recommended to have their tubes and ovaries removed as a preventive measure.
Ovarian Cancer Symptoms
The onset of ovarian cancer is insidious. At the time of diagnosis, the presence of localized disease in the ovaries is only seen in 25% of cases. Vague symptoms may include discomfort and bloating in the abdomen, indigestion, early satiety, nausea, constipation, pelvic pressure, frequent urination, pain during sexual intercourse, fatigue, and shortness of breath. The majority of early-stage ovarian cancers are diagnosed incidentally during routine examination upon the discovery of an asymptomatic ovarian cyst or for other reasons during radiographic evaluation. Advanced disease is often diagnosed when it becomes more pronounced or with an excessive accumulation of fluid in the abdominal cavity.
Management of Suspected Ovarian Masses
In medically stable patients with suspected ovarian masses, surgical evaluation is necessary. In acceptable-sized masses (usually 8-10 cm or smaller) without fluid in the abdomen or distant disease, laparoscopic evaluation can be acceptable. Pathological evaluation of the suspicious ovary should be ensured during surgery. If findings strongly suggest ovarian cancer, it is more appropriate to involve a gynecologic oncologist.
If cancer is detected, it is generally recommended to perform a hysterectomy, bilateral salpingo-oophorectomy, lymph node removal, resection of involved areas within the abdomen, and peritoneal washings for staging purposes. For patients with disease confined to one ovary and a desire for future childbearing, sparing the uninvolved ovary and uterus may be appropriate.
In cases of advanced disease within the abdomen, efforts are made to remove all cancer tissue. After surgery, the presence of residual tumor with a maximum diameter of <1 cm is considered optimal and has been shown to improve disease-free and overall survival.
Please note that the content provided is for informational purposes only, and you should consult your doctor for diagnosis and treatment.
Content Update Date: December 26, 2022