Chapter 135 Ovarian Cancer
INTRODUCTION
Description: Ovarian cancer is a malignancy arising in the ovary, generally of epithelial origin. This represents the second most common malignancy of the genital tract (after endometrial cancer), but it is the most common fatal gynecologic cancer.
Prevalence: Annually: 22,430 cases (estimated for 2007); 15,280 deaths (estimated for 2007). Ovarian cancer is the most common cause of gynecologic cancer death. The lifetime risk of developing ovarian cancer is approximately 1 in 70.
Predominant Age: Postmenopausal (50%), average 59, highest rate 60 to 64 years. Only one fourth to one third of ovarian tumors in postmenopausal women are malignant.
ETIOLOGY AND PATHOGENESIS
Risk Factors: Family history (greatest risk in those few women with an inheritable cancer syndrome, such as Lynch II), high-fat diet, advanced age, nulliparity, early menarche, late menopause, white race, higher economic status, and the use of talc on the perineum. More than 95% of patients with ovarian cancer have no risk factor. Oral contraception, high parity, tubal ligation, hysterectomy, and breastfeeding reduce risk.
CLINICAL CHARACTERISTICS
WORKUP AND EVALUATION
Laboratory: Serum testing for tumor markers, such as CA-125, lipid-associated sialic acid, carcinoembryonic antigen, α-fetoprotein, lactate dehydrogenase (LDH) and others, should be reserved for following the progress of patients with known malignancies and not for prognostic evaluation.
