Chapter 28: Ovarian Cancer

Epidemiology

Pathology

WHO classification of malignant ovarian tumors

1. Common epithelial tumors (60% of all neoplasms of ovary; 90% of all malignant neoplasms of ovary)

2. Sex cord–stromal tumor (5% of malignant neoplasms of ovary)

3. Lipid (lipoid) cell tumors (rare)

4. Gonadoblastoma (rare)

Tumor Grade

• Grade 1—Well differentiated

• Grade 2—Moderately differentiated

• Grade 3—Poorly differentiated

Note: Serous carcinoma can be classified into either low grade or high grade

Ozols RF, Schwartz PE, Eifel PJ. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:1596–1632

5-year Relative Survival by Stage at Diagnosis

Treatment and survival by stage cannot be summarized simply for ovarian cancer. Each stage is strongly influenced by whether the disease is amenable to surgery, by the histologic type and grade, by the bulk of residual disease after the completion of surgery, and by other factors

Differences in survival among patients with the same stage of disease may indicate incomplete staging. When comprehensive staging is performed, a substantial number of patients initially believed to have disease confined to the pelvis will be staged upward

Work-up

1. Personal and family history, physical examination

2. Liver function tests, BUN, creatinine, LDH

3. CBC with platelets, PT, PTT, INR

4. Tumor markers (CA-125, α-fetoprotein (AFP), HCG)

5. CT scan of abdomen and pelvis, and chest x-ray. CT of chest if chest x-ray is abnormal

6. Radiographic tests of unclear utility: MRI of abdomen and pelvis, PET scan

Staging