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Chapter 28: Ovarian Cancer

Eddie Reed

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INTRODUCTION

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Epidemiology

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Epidemiology
Incidence: 21,980 (Estimated new cases for 2014 in the United States) Stage at presentation
Deaths: Estimated 14,270 in 2014 Limited (Stage I-II): 25–30%
Median age: 63 years Advanced (Stage III-IV): 70–75%

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2014)

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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

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5-year Relative Survival by Stage at Diagnosis

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5-year Relative Survival by Stage at Diagnosis
Stage at Diagnosis 5-year Relative Survival (%)
Localized (confined to primary site) 91.9
Regional (spread to regional lymph nodes) 72.0
Distant (cancer has metastasized) 27.3

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

 

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

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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

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Staging

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Staging
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Primary Tumor (T)
TNM FIGO  
Category Stage
TX   Primary tumor cannot be assessed
T0   No evidence of primary tumor
T1 I Tumor limited to ovaries (one or both)
T1a IA Tumor limited to one ovary; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings
T1b IB Tumor limited to both ovaries; capsules intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings
T1c IC Tumor limited to one or both ovaries with any of the following: capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings
T2 II

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