ovarian%20cancer
OVARIAN CANCER
Ovarian cancer is a type of cancer that begins in the ovaries.
It is the 7th most common cancer in women (excluding skin cancer) and the leading cause of death from gynecologic cancer in developed countries.
The 3 histologic types of ovarian cancer are epithelial (primarily seen in women >50 years of age), germ cell (most commonly seen in women <20 years of age) and sex cord stromal (rare and produces steroid hormones).
The median age at the time of diagnosis is 63 years old and >70% present with advanced disease.

    Ovarian%20cancer Signs and Symptoms

    Introduction

    • Seventh most common cancer in women (excluding skin cancer)
    • Leading cause of death from gynecologic cancer in developed countries
    • Has 3 histologic types:
      • Epithelial ovarian cancer - primarily seen in women >50 years of age; seen in >90% of patients with ovarian neoplasms
      • Germ cell ovarian cancer - more commonly seen in women <20 years of age
      • Sex cord-stromal ovarian cancer - rare; produces steroid hormones 
    • Median age at the time of diagnosis is 63 years and >70% present with advanced disease
    • Less common ovarian histopathologies (LCOH):
      • Carcinosarcomas - malignant mixed Müllerian tumors of the ovary
      • Clear cell carcinomas
      • Mucinous carcinomas
      • Low grade/grade 1 serous carcinomas/endometrioid epithelial carcinomas
      • Borderline epithelial tumors - also known as low malignant potential tumors

    Risk Factors

    Increased Risk

    • Family history
      • Associated with an early-onset disease
        • Patients having ≥2 first-degree relatives with ovarian cancer
        • Male breast cancer
        • Bilateral or early-onset (<50 years old) breast cancer
        • Personal or family history of colon or endometrial cancer
    • Genetic syndromes
      • Associated with early-onset disease
        • BRCA 1 mutations have a lifetime risk of 26-51% of developing ovarian cancer
        • BRCA 2 mutations have a lifetime risk of 10-23% of developing ovarian cancer
        • Lynch syndrome (hereditary nonpolyposis colorectal cancer) has a lifetime risk of 10%
        • Cowden’s disease has increased risk of ovarian cancer due to mutations in PTEN gene
        • Peutz-Jeghers syndrome secondary to mutations in STK11 gene
        • MUTYH-associated polyposis secondary to mutations in gene MUTYH
    • Age
      • Risk of developing ovarian cancer gets higher with age and is most prevalent in the eighth decade of life
    • Reproductive history
      • Nulliparity or age >35 years at first childbirth
      • Early menarche
      • Late menopause
    • Personal history of breast cancer
      • Risk of ovarian cancer after breast cancer is highest in women with a family history of breast cancer
    • Obesity
      • Obese women with a body mass index of at least 30 kg/m2 have a higher risk of developing ovarian cancer
    • Fertility drugs
      • Some studies show that using the fertility drug Clomiphene citrate for >1 year increased the risk of developing low malignant-potential ovarian tumors
      • Risk was shown to be highest in women who did not get pregnant while receiving the drug
    • Estrogen therapy
      • Studies have shown that postmenopausal women using estrogen monotherapy for at least 5-10 years have a higher risk of developing ovarian cancer
    • Pelvic inflammatory disease (PID)
      • May increase the risk for ovarian cancer
    • In vitro fertilization (IVF)
      • The risk of borderline ovarian cancer may be increased after ovarian stimulation for IVF
    • Androgens
      • A study had shown that women who took androgens were found to have a higher risk of ovarian cancer
    • Talcum powder
      • Some studies suggest a very slight increase in risk of ovarian cancer in women who used talc on their genital area

    Decreased Risk

    • Reproductive history
      • Younger age at pregnancy and at first childbirth (≤25 years old) has 30-60% lower risk
    • Oral contraceptive use for >5 years significantly lowers the risk of ovarian cancer
    • Breastfeeding has 30-60% lower risk
    • Diet
      • A study had shown that low fat diet for at least 4 years had a lower risk for ovarian cancer
    • Gynecologic surgery (eg hysterectomy, prophylactic oophorectomy, tubal ligation)
      • Tubal ligation may reduce the chance of developing ovarian cancer for up to 67%
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