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One in 70 women will develop ovarian cancer during her lifetime. Patients of low parity, decreased fertility, and delayed cancer of the ovary childbearing are at greater risk if they have not been using oral contraceptives. Most ovarian cancers occur in women over 50. Most patients present with advanced-stage disease--only 30% of cases are confined to the ovaries. Careful yearly pelvic examination remains the most effective screening method.
Clinical Diagnosis
In early ovarian cancer there are usually no symptoms. Symptoms occur late and include fatigue, abdominal distention, anorexia, early satiety, nausea, constipation, urinary frequency, and shortness of breath caused by pleural effusion or Estrogen production by certain stromal tumors may cause abnormal uterine The most frequently noted physical symptoms are pelvic pain and ascites associated with a pelvic mass. An adnexal mass that is bilateral, irregular, solid, or fixed is suggestive of malignancy. Ascites or a nodular cul-de-sac also suggest
The risk of ovarian cancer is significantly higher in premenarcheal and postmenopausal women with an adnexal mass than in women of reproductive age. Rarely, a testosterone-secreting tumor will produce physical findings of virilization.
Diagnostic Workup of Suspected Ovarian Cancer
In patients over 45 years of age, colonoscopy or a barium enema and proctoscopy is done to rule out the presence of colonic involvement or colon cancer. Chest x-ray should be obtained to detect pleural effusion or metastatic disease. Cervical cytology is completed to rule out cervical cancer. Endocervical and endometrial sampling is necessary if there is abnormal uterine bleeding.
Mammography is appropriate to exclude primary breast, which may metastasize to the ovaries. Ultrasound, CT, or MRI may be useful for preoperative evaluation or for assessment of disease status.
Tumor Markers
Blood plasma should be assayed for levels of circulating tumor markers in patients suspected or known to have ovarian cancer. CA 125 levels are elevated in more than 80% of patients with nonmucinous epithelial cancer.
Treatment Advances