Ovarian Cancer

  • R. Scott Bermudez
  • James Rembert
  • I-Chow Hsu


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.


Adnexal Mass Strong Family History Early Menarche Seborrheic Keratose Late Menopause 


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Further Reading

  1. Alektiar K, Fuks Z. Cancer of the Ovary. In: Leibel SA, Phillips TL, editors.Textbook of radiation oncology. 2nd ed. Philadelphia: Saunders; 2004.pp. 1131-1156.Google Scholar
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  3. Gehrig PA, Varia M, Apsarnthanarax S, et al. Ovary. In: Halperin EC, Perez CA, Brady LW, et al., editors. Principles and practice of radiation oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1629-1649.Google Scholar
  4. Greene FL. American Joint Committee on Cancer. American Cancer Society. AJCC Cancer Staging Manual. 6th ed. New York: Springer; 2002.Google Scholar
  5. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Ovarian Cancer. Available at: http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf. Accessed on May 1, 2009.

Copyright information

© Springer-Verlag New York 2010

Authors and Affiliations

  • R. Scott Bermudez
    • 1
  • James Rembert
    • 2
  • I-Chow Hsu
    • 1
  1. 1.Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Alta Bates Summit Comprehensive Cancer CenterBerkeleyUSA

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