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INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 21,750 (Estimated new cases in 2020 in the United States) Stage at presentation
Deaths: Estimated 13,940 in 2020 Limited (stage I–II): 31%
Median age: 63 years Advanced (stage III–IV): 60%
    Unstaged/unknown 8%

American Cancer Society. Cancer Facts & Figures 2020. Atlanta, GA: American Cancer Society; 2020

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed 3 October 2019]

Pathology

WHO classification of malignant ovarian tumors

The World Health Organization histologic classification for ovarian tumors separates ovarian neoplasms according to the most probable tissue of origin

  1. Surface epithelial (65%, 90% of malignant tumors)

    Further classified by:

    • Cell type (serous, mucinous, endometrioid, etc)

    • Atypia (benign, borderline [atypical proliferation, low malignant potential] or malignant)

    • Malignant may be invasive or non-invasive

  2. Germ cell (15%)

  3. Sex cord–stromal (10%)

  4. Metastases (5%); miscellaneous (5%)

    Tumor Grade

    • Grade 1—Well differentiated

    • Grade 2—Moderately differentiated

    • Grade 3—Poorly differentiated

Ozols RF et al (editors). Cancer: Principles & Practice of Oncology, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:1596–1632

  1. Surface epithelial–stromal tumors

    • Serous tumors:

      • Benign (cystadenoma)

      • Borderline tumors (serous borderline tumor)

      • Malignant (serous adenocarcinoma)

    • Mucinous tumors, endocervical-like and intestinal type:

      • Benign (cystadenoma)

      • Borderline tumors (mucinous borderline tumor)

      • Malignant (mucinous adenocarcinoma)

    • Endometrioid tumors:

      • Benign (cystadenoma)

      • Borderline tumors (endometrioid borderline tumor)

      • Malignant (endometrioid adenocarcinoma)

    • Clear cell tumors:

      • Benign

      • Borderline tumors

      • Malignant (clear cell adenocarcinoma)

    • Transitional cell tumors:

      • Brenner tumor

      • Brenner tumor of borderline malignancy

      • Malignant Brenner tumor

      • Transitional cell carcinoma (non-Brenner type)

    • Epithelial-stromal:

      • Adenosarcoma

      • Carcinosarcoma (formerly mixed Müllerian tumors)

  2. Germ cell tumors

    • Teratoma:

      • Immature

      • Mature

      • Solid

      • Cystic (dermoid cyst)

    • Monodermal (eg, struma ovarii, carcinoid)

    • Dysgerminoma

    • Yolk sac tumor (endodermal sinus tumor)

    • Mixed germ cell tumors

  3. Sex cord–stromal tumors

    • Granulosa tumors:

      • Fibromas

      • Fibrothecomas

      • Thecomas

    • Sertoli cell tumors:

      • Leydig cell tumors

    • Sex cord tumor with annular tubules

    • Gynandroblastoma

    • Steroid (lipid) cell tumors

  4. Malignant, not otherwise specified

    • Metastatic cancer from nonovarian primary:

      • Colonic, appendiceal

      • Gastric

      • Breast

Percentage of Cases by Stage

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Percentage of Cases by Stage
Localized (confined to primary site) 16%
Regional (spread to regional lymph nodes) 21%
Distant (cancer has metastasized) 58%
Unknown 5%
Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed in 2020]

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) 92.6
Regional (spread to regional lymph nodes) 74.8
Distant (cancer has metastasized) 30.2
Unknown 25.5

Note: 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 ...

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