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In 2002, approximately 26,800 women were diagnosed with overian cancer. Of these women, an estimated 14,200 will die of the disease, which represents 55% of all deaths from gynecologic cancer. The risk of a woman developing overian cancer during her lifetime is 1-2%. The incidence varies with age and is 1.4 per 100,000 in women under age 40 years and 38 per 100,000 in women older than age 60 years uterine cancer, uterus cancer. Figure 4 illustrates the prevalence of different types of overian cancer by age. Ovarian cancer is more common in Northern European and North American countries than in ovarian cancer, uterine cancer, uterus cancer, ovary cancer, overian
The etiology is not known, but risk of uterine cancer factors include infertility, low parity, or both; use of talc on the perineum; high-fat diet; lactose intolerance; history of breast or colon cancer; and a family history of. Smoking, alcohol use, coffee consumption, estro-gen replacement therapy, and viral infections (such as mumps) have not been associated with increased risk. Use of oral
Figure 5 illustrates the relationship of ovarian cancer to the other gynecologic cancers for both incidence and mortality. Table 6 illustrates the uterine cancer, uterus cancer relative stage at diagnosis and the survival by stage for overian cancer in relation to other gynecologic cancers. The 5-year survival rate for overian cancer by stage is not significantly dif-
ferent from the 5-year survival rate for other gynecologic cancers; however, there is a significant difference in stages, usually having spread into the abdomen in about two thirds of patients at the time of diagnosis. It is clear from these data that the single most important factor in the large number of deaths from ovarian cancer is the failure to diagnosis the disease at an early stage. The reasons for this failure correspond to the growth and spread patterns of the disease. Because the ovary floats freely in the pelvic cavity, a tumor can grow for some time without producing symptoms associated with involvement of, or pressure on, other organs.
One of the most significant ways to improve survival for patients would be to find a way to screen women for and detect the disease before it spreads beyond the ovary. Currently available methods for screening for ovarian cancer are pelvic examination, serum CA 125 level measurements, and pelvic or transvaginal ul-trasonography. To date, there is no evidence that routine pelvic examination is effective in the early diagnosis. Sernm CA 125 levels have also shown to be ineffective because of the high false-negative rates. A review of the literature found that only about 50% of patients with stage I ovarian cancer have an abnormal serum CA 125 level. To substantiate this point further, the only study to look at CA 125 screening for ovarian cancer reported that in the six cancers of the ovary diagnosed by CA 125 screening, four had spread beyond the ovary. However, in three studies, pelvic or transvaginal ultrasonography screenings of 7,576 patients diagnosed 10 cancers, all stage I. Unfortunately, this technique has a high false-positive rate, and between
13 and 65 patients underwent surgical exploration for each cancer detected in these studies. If some additional test could be discovered that would allow determination of which patient with an enlarged ovary actually needs exploration, trans-vaginal ultrasonography might turn out to be an effective screening tool. Current research in this area centers around developing a more precise morphology index, a more specific color flow Doppler pattern, and more specific serum markers.
TABLE 6. Stage at Diagnosis and 5-Year Survival Rate of