Ovarian Cancer
Risk: Ovarian cancer is the second most common gynecologic malignancy, but it is the most common cause of death among women who develop gynecologic cancer. Most patients with ovarian cancer are diagnosed between the ages of 40 and 65.
The lifetime risk of developing ovarian cancer is 1.4 to 1.8 percent for women living in the United States. Risk factors for developing ovarian cancer include nulligravidity, history of infertility, and having a first- or second-degree relative with a history of ovarian cancer.
Diagnosis: Diagnosing patients with early stage ovarian cancer is difficult as the symptoms of early stage disease are often vague and may not be severe enough to prompt a woman to seek medical attention. Adnexal masses may be noted incidentally by the examining provider at an annual exam. When there is a concern for adnexal pathology, tumor markers (eg, serum CA 125) and ultrasound examination can help distinguish between malignant and benign pelvic masses. However, these tests are not infallible.
Unfortunately, there is no consistently reliable noninvasive method to determine the malignant potential of an ovarian mass. The finding of a pelvic mass usually requires surgery for definitive histologic diagnosis.
Treatment: Surgery is necessary for diagnosing ovarian cancer, and it is crucial for successful treatment. Thorough surgical staging is critically important because subsequent treatment and prognosis will be determined by the surgical stage of disease. Following surgery, most patients with ovarian cancer will also be treated with chemotherapy, which usually consists of carboplatinum and paclitaxel.
A patient’s response to treatment is dependent upon many factors, including disease stage, histologic subtype and grade, age at diagnosis, and amount of residual disease at the time of the initial surgery.
Prevention: Factors shown to decrease a patient’s chance of developing ovarian cancer include the use of oral contraceptive pills, multiparity, tubal ligation, and breastfeeding. The strongest known risk factor for ovarian cancer is a family history, which is present in about 10 to 15 percent of women who develop the disease.
Screening strategies for ovarian cancer for all women include taking a careful family history and performing an annual pelvic examination. Women with a family history of ovarian cancer may undergo other screening procedures such as CA 125 testing and ultrasonography, but these tests cannot reliably find early disease. These high risk patients should also be referred to a genetic counselor for consideration of testing for BRCA1 and BRCA2 mutations. Prophylactic oophorectomy at the completion of childbearing or by age 35 has generally been recommended for women with hereditary ovarian cancer synDr.omes.