CANCER DE CANCER DE OVARIOOVARIO

IPNIPN

MAYO 2011MAYO 2011

The vast majority of epithelial ovarian The vast majority of epithelial ovarian carcinomas are diagnosed in carcinomas are diagnosed in postmenopausal women.postmenopausal women.

the median age at diagnosis is 63 years.the median age at diagnosis is 63 years.The age-specific incidence increases from The age-specific incidence increases from

15 to 16 per 100,000 in the 40- to 44-year-15 to 16 per 100,000 in the 40- to 44-year-old age.old age.

group to a peak rate of 57 per 100,000 in group to a peak rate of 57 per 100,000 in the 70- to 74-year-old age group. the 70- to 74-year-old age group.

There has been a statistically significant improvement in There has been a statistically significant improvement in the 5-year survival rates over the last decades.the 5-year survival rates over the last decades.

with a rate of 37% in 1976, 41% in 1985, and 53% in with a rate of 37% in 1976, 41% in 1985, and 53% in 1998..1998..

This improvement in survival is likely the result of more This improvement in survival is likely the result of more effective chemotherapies and improvements in surgery effective chemotherapies and improvements in surgery and supportive care. and supportive care.

African American women in the United States have a African American women in the United States have a lower incidence of ovarian cancer (10.3 per 100,000 lower incidence of ovarian cancer (10.3 per 100,000 women) compared to white women; however, the overall women) compared to white women; however, the overall survival rate of 53% is identical. survival rate of 53% is identical.

PathogenesisPathogenesisThe common epithelial tumors account for The common epithelial tumors account for

60% of all ovarian neoplasms and for 80% 60% of all ovarian neoplasms and for 80% to 90% of ovarian malignancies. to 90% of ovarian malignancies.

The remaining tumors arise from ovarian The remaining tumors arise from ovarian germ cells or stromal cells. germ cells or stromal cells.

The epithelial tumors arise from the The epithelial tumors arise from the surface epithelium or serosa of the ovarysurface epithelium or serosa of the ovary

Only 5% to 10% of patients with epithelial ovarian Only 5% to 10% of patients with epithelial ovarian carcinoma likely have inherited a genetic predisposition.carcinoma likely have inherited a genetic predisposition.

The breast-ovarian cancer syndrome accounts for The breast-ovarian cancer syndrome accounts for approximately 90% of all hereditary ovarian cancer approximately 90% of all hereditary ovarian cancer cases and is most frequently associated with mutations cases and is most frequently associated with mutations in the in the BRCA1BRCA1 or or BRCA2BRCA2 genes. genes.22 The BRCA1 gene, The BRCA1 gene, located on chromosome band 17q12-21, and the located on chromosome band 17q12-21, and the BRCA2BRCA2 gene, located on chromosome band 13q12-13, gene, located on chromosome band 13q12-13, were identified and linked to hereditary breast and were identified and linked to hereditary breast and ovarian cancers in the 1990s.ovarian cancers in the 1990s.

Diagnosis and Symptoms Diagnosis and Symptoms Epithelial cancers of the ovary have been described as Epithelial cancers of the ovary have been described as

silent killers because the overwhelming majority of patients silent killers because the overwhelming majority of patients do not present with symptoms until the disease has spread do not present with symptoms until the disease has spread outside of the ovary and indeed outside of the pelvis. outside of the ovary and indeed outside of the pelvis.

studies surveying ovarian cancer patients have studies surveying ovarian cancer patients have demonstrated that 95% of these women have nonspecific demonstrated that 95% of these women have nonspecific abdominal symptoms many months before diagnosis.abdominal symptoms many months before diagnosis.

Approximately 70% of patients with epithelial cancers of the Approximately 70% of patients with epithelial cancers of the ovary present with stage III or IV disease, whereas 70% of ovary present with stage III or IV disease, whereas 70% of patients with germ cell ovarian malignancies present with patients with germ cell ovarian malignancies present with stage I disease.stage I disease.

Abdominal discomfort and bloating are the most Abdominal discomfort and bloating are the most common symptoms experienced by women with common symptoms experienced by women with epithelial ovarian cancers, followed by vaginal epithelial ovarian cancers, followed by vaginal bleeding, gastrointestinal symptoms, and urinary tract bleeding, gastrointestinal symptoms, and urinary tract symptoms. symptoms.

Patients presenting with nonspecific lower abdominal Patients presenting with nonspecific lower abdominal discomfort and bloating require at least a prompt and discomfort and bloating require at least a prompt and careful pelvic and rectovaginal examination. careful pelvic and rectovaginal examination.

The most common physical signs are ascites and a The most common physical signs are ascites and a pelvic mass. The mass is frequently firm, hard, and pelvic mass. The mass is frequently firm, hard, and fixed with multiple nodularities palpable in the cul-de-fixed with multiple nodularities palpable in the cul-de-sac. sac.

Level of the cancer antigen 125 (CA 125) Level of the cancer antigen 125 (CA 125) tumor biomarker is elevated in more than tumor biomarker is elevated in more than 80% of serous epithelial ovarian cancers, 80% of serous epithelial ovarian cancers, but it can also be elevated in a variety of but it can also be elevated in a variety of benign conditions and other nongynecologic benign conditions and other nongynecologic malignancies. Furthermore, in early-stage malignancies. Furthermore, in early-stage ovarian cancers, CA 125 level is elevated in ovarian cancers, CA 125 level is elevated in less than half of cases. Other tumor less than half of cases. Other tumor markers, such as CA 19-9 markers, such as CA 19-9

Transvaginal ultrasonography (TVS) and abdominal Transvaginal ultrasonography (TVS) and abdominal ultrasonography are the most useful ultrasonography are the most useful

Some of the sonographic characteristics associated Some of the sonographic characteristics associated with ovarian cancer include irregular ovarian cyst with ovarian cancer include irregular ovarian cyst borders, solid elements within the cysts, papillary borders, solid elements within the cysts, papillary projections, bilateral ovarian involvement, and the projections, bilateral ovarian involvement, and the presence of ascites.presence of ascites.

Cross-sectional imaging, such as computed Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging, tomography (CT) and magnetic resonance imaging, may be helpful in characterizing the liver, identifying may be helpful in characterizing the liver, identifying lymph node involvement, peritoneal studding, and lymph node involvement, peritoneal studding, and omentum caking, and characterizing the mesentery of omentum caking, and characterizing the mesentery of the bowel the bowel

Clinicopathologic findings determined to be clinically Clinicopathologic findings determined to be clinically useful include the following: useful include the following: FIGO stage FIGO stage Histologic subtype Histologic subtype Histologic grade Histologic grade Factors associated with tumor dissemination Factors associated with tumor dissemination Malignant ascites or malignant peritoneal washings Malignant ascites or malignant peritoneal washings Tumor excrescences on ovarian surface or ruptured capsule Tumor excrescences on ovarian surface or ruptured capsule Volume of residual disease after cytoreductive surgery Volume of residual disease after cytoreductive surgery