Fourth leading cause of cancer death in women; leading cause of gynecologic cancer death. Average lifetime risk is 1 in 70 with median age at diagnosis of 63 years. Highly curable if diagnosed at an early stage, but 75% present with stage III or IV disease. Early diagnosis is frequently difficult because of vague abdominal symptoms at presentation and a lack of a good screening test. Risk factors: nulliparity, first parity >35 years, infertility, early menarche, late menopause, ovulation inducing drugs, hormone replacement therapy, obesity. Strongest risk factor is a family history of ovarian cancer, yet only 5–10% of tumors result from a known genetic disposition. Lifetime risk: general population 1.8%, one first-degree relative: 5%, two first-degree relatives: 25–50%. Consider genetic testing and/or prophylactic salpingo-oophorectomy for a strong family history. Familial syndromes tend to occur earlier and have a more indolent course than sporadic variants: BRCA1 (lifetime risk 45%). BRCA2 (lifetime risk 25%), HNPCC. Pathology: epithelial 65%, germ cell 25%, sex cord-stromal 5%, metastases 5%. Epithelial histologic types: serous 50%, endometrioid 20%, undifferentiated 15%, mucinous 10%, clear cell <5%. Patterns of spread: exfoliation into peritoneal cavity, hematogenous and lymphatic (mainly pelvic/paraaortic, but inguinals also at risk via round ligament). 90% recurrences occur within 5 years; only 15% relapse extraabdominally. Most patients die from local disease (small bowel obstruction, ascites, abdominal organ infiltration, etc.). Most important negative prognostic factors: stage, grade, residual volume of disease. Other negative factors: age>65, pre-op ascites, CA125 elevated after 3c chemo or nadir >20 U/mL after first-line therapy.
KeywordsAdnexal Mass Strong Family History Early Menarche Seborrheic Keratose Late Menopause
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