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Ovarian cancer

Ovarian cancer
Micrograph of a mucinous ovarian carcinoma stained by H&E
SpecialtyOncology, gynecology
SymptomsEarly: vague[1]
Later: bloating, pelvic pain, constipation, abdominal swelling, loss of appetite[1]
Usual onsetUsual age of diagnosis 63 years old[2]
Types
Risk factorsNever having children, hormone therapy after menopause, fertility medication, obesity, genetics[4][5][6]
Diagnostic methodTissue biopsy[1]
TreatmentSurgery, radiation therapy, chemotherapy[1]
PrognosisFive-year survival rate c. 49% (US)[7]
Frequency1.2 million (2015)[8]
Deaths161,100 (2015)[9]

Ovarian cancer is a cancerous tumor of an ovary.[10] It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen.[3][11] The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells.[12] When these cells become abnormal, they have the ability to divide and form tumors. These cells can also invade or spread to other parts of the body.[13] When this process begins, there may be no or only vague symptoms.[1] Symptoms become more noticeable as the cancer progresses.[1][14] These symptoms may include bloating, vaginal bleeding, pelvic pain, abdominal swelling, constipation, and loss of appetite, among others.[1] Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.[15]

The risk of ovarian cancer increases with age. Most cases of ovarian cancer develop after menopause.[16] It is also more common in women who have ovulated more over their lifetime.[17] This includes those who have never had children, those who began ovulation at a younger age and those who reach menopause at an older age.[5] Other risk factors include hormone therapy after menopause, fertility medication, and obesity.[4][6] Factors that decrease risk include hormonal birth control, tubal ligation, pregnancy, and breast feeding.[6] About 10% of cases are related to inherited genetic risk; women with mutations in the genes BRCA1 or BRCA2 have about a 50% chance of developing the disease.[5] Some family cancer syndromes such as hereditary nonpolyposis colon cancer and Peutz-Jeghers syndrome also increase the risk of developing ovarian cancer.[16] Epithelial ovarian carcinoma is the most common type of ovarian cancer, comprising more than 95% of cases.[5] There are five main subtypes of ovarian carcinoma, of which high-grade serous carcinoma (HGSC) is the most common.[5] Less common types of ovarian cancer include germ cell tumors[18] and sex cord stromal tumors.[5] A diagnosis of ovarian cancer is confirmed through a biopsy of tissue, usually removed during surgery.[1]

Screening is not recommended in women who are at average risk, as evidence does not support a reduction in death and the high rate of false positive tests may lead to unneeded surgery, which is accompanied by its own risks.[19] Those at very high risk may have their ovaries removed as a preventive measure.[4] If caught and treated in an early stage, ovarian cancer is often curable.[1] Treatment usually includes some combination of surgery, radiation therapy, and chemotherapy.[1] Outcomes depend on the extent of the disease, the subtype of cancer present, and other medical conditions.[5][20] The overall five-year survival rate in the United States is 49%.[7] Outcomes are worse in the developing world.[5]

In 2020, new cases occurred in approximately 313,000 women.[21] In 2019 it resulted in 13,445 deaths in the United States.[22] Death from ovarian cancer increased globally between 1990 and 2017 by 84.2%.[23] Ovarian cancer is the second-most common gynecologic cancer in the United States. It causes more deaths than any other cancer of the female reproductive system.[24] Among women it ranks fifth in cancer-related deaths.[25] The typical age of diagnosis is 63.[2] Death from ovarian cancer is more common in North America and Europe than in Africa and Asia.[5] In the United States, it is more common in White and Hispanic women than Black or American Indian women.[22]

  1. ^ a b c d e f g h i j "Ovarian Epithelial Cancer Treatment". NCI. 12 May 2014. Archived from the original on 5 July 2014. Retrieved 1 July 2014.
  2. ^ a b "What are the risk factors for ovarian cancer?". www.cancer.org. 4 February 2016. Archived from the original on 17 May 2016. Retrieved 18 May 2016.
  3. ^ a b c Žilovič D, Čiurlienė R, Sabaliauskaitė R, Jarmalaitė S (July 2021). "Future Screening Prospects for Ovarian Cancer". Cancers. 13 (15): 3840. doi:10.3390/cancers13153840. PMC 8345180. PMID 34359740.
  4. ^ a b c "Ovarian Cancer Prevention". NCI. 6 December 2013. Archived from the original on 6 July 2014. Retrieved 1 July 2014.
  5. ^ a b c d e f g h i World Cancer Report 2014. World Health Organization. 2014. Chapter 5.12. ISBN 978-92-832-0429-9. Archived from the original on 19 September 2016.
  6. ^ a b c "Ovarian Cancer Prevention". NCI. 20 June 2014. Archived from the original on 6 July 2014. Retrieved 1 July 2014.
  7. ^ a b "SEER Stat Fact Sheets: Ovary Cancer". NCI. Archived from the original on 6 July 2014. Retrieved 18 June 2014.
  8. ^ GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  9. ^ GBD 2015 Mortality and Causes of Death Collaborators (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  10. ^ WHO Classification of Tumours Editorial Board, ed. (2020). "1. Tumours of the ovary: introduction". Female genital tumours: WHO Classification of Tumours. Vol. 4 (5th ed.). Lyon (France): International Agency for Research on Cancer. pp. 32–35. ISBN 978-92-832-4504-9.
  11. ^ "Basic Information About Ovarian Cancer". Centers for Disease Control and Prevention. 24 October 2023. Archived from the original on 12 August 2024. Retrieved 12 August 2024.
  12. ^ "What is Ovarian Cancer | Ovarian Tumors and Cysts". www.cancer.org. Retrieved 2 November 2022.
  13. ^ "Defining Cancer". National Cancer Institute. 17 September 2007. Archived from the original on 25 June 2014. Retrieved 10 June 2014.
  14. ^ Ebell MH, Culp MB, Radke TJ (March 2016). "A Systematic Review of Symptoms for the Diagnosis of Ovarian Cancer". American Journal of Preventive Medicine. 50 (3): 384–394. doi:10.1016/j.amepre.2015.09.023. PMID 26541098.
  15. ^ Ruddon RW (2007). Cancer Biology (4th ed.). Oxford University Press. p. 223. ISBN 978-0-19-517543-1. Archived from the original on 15 September 2015.
  16. ^ a b "Ovarian Cancer Risk Factors". www.cancer.org. Retrieved 2 November 2022.
  17. ^ Armstrong DK (2020). "189. Gynaecologic cancers: ovarian cancer". In Goldman L, Schafer AI (eds.). Goldman-Cecil Medicine. Vol. 1 (26th ed.). Philadelphia: Elsevier. pp. 1332–5. ISBN 978-0-323-55087-1.
  18. ^ Maoz A, Matsuo K, Ciccone MA, Matsuzaki S, Klar M, Roman LD, et al. (May 2020). "Molecular Pathways and Targeted Therapies for Malignant Ovarian Germ Cell Tumors and Sex Cord-Stromal Tumors: A Contemporary Review". Cancers. 12 (6): 1398. doi:10.3390/cancers12061398. PMC 7353025. PMID 32485873.
  19. ^ Grossman DC, Curry SJ, Owens DK, Barry MJ, Davidson KW, Doubeni CA, et al. (February 2018). "Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement". JAMA. 319 (6): 588–594. doi:10.1001/jama.2017.21926. PMID 29450531.
  20. ^ Gibson SJ, Fleming GF, Temkin SM, Chase DM (2016). "The Application and Outcome of Standard of Care Treatment in Elderly Women with Ovarian Cancer: A Literature Review over the Last 10 Years". Frontiers in Oncology. 6: 63. doi:10.3389/fonc.2016.00063. PMC 4805611. PMID 27047797.
  21. ^ "Ovarian cancer statistics". World Cancer Research Fund International. Retrieved 2 November 2022.
  22. ^ a b "USCS Data Visualizations". gis.cdc.gov. Archived from the original on 25 January 2019. Retrieved 3 November 2022.
  23. ^ Zhou Z, Wang X, Ren X, Zhou L, Wang N, Kang H (2021). "Disease Burden and Attributable Risk Factors of Ovarian Cancer From 1990 to 2017: Findings From the Global Burden of Disease Study 2017". Front Public Health. 9: 619581. doi:10.3389/fpubh.2021.619581. PMC 8484795. PMID 34604147.
  24. ^ "Ovarian Cancer Statistics | CDC". www.cdc.gov. 18 May 2022. Retrieved 2 November 2022.
  25. ^ "Ovarian Cancer Statistics | How Common is Ovarian Cancer". www.cancer.org. Retrieved 2 November 2022.

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