Ovarian cancer

Epithelial ovarian cancer is the most common histologic subtype of ovarian cancer, and is the primary focus of this topic.

Patients often present with vague, nonspecific symptoms such as abdominal bloating, early satiety, and dyspepsia (suggestive of upper abdominal disease). Other symptoms are more suggestive of pelvic disease, such as pelvic pain, abdominal or pelvic pressure, low back pain, and urinary urgency.

Women with a suspicious pelvic mass should be referred to a gynecologic oncologist for further evaluation.

Definitive diagnosis typically entails pathologic analysis of a surgical specimen. Fine-needle aspiration (FNA) is not routinely recommended for definitive diagnosis as this procedure can disseminate tumor cells into the peritoneal cavity.

Surgery is typically required for definitive diagnosis, staging, and tumor debulking.

Adjuvant chemotherapy may be required to eradicate residual disease following debulking surgery. Bevacizumab and/or a poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor may be considered for maintenance therapy following initial treatment.

The primary focus of this topic is epithelial ovarian cancer, the most common histologic subtype of ovarian cancer (accounting for approximately 90% of cases).[1]Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin. 2018 Jul;68(4):284-96. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21456 http://www.ncbi.nlm.nih.gov/pubmed/29809280?tool=bestpractice.com

Epithelial ovarian cancer develops when there is malignant transformation of the epithelium covering the ovarian capsule and distal fallopian tube.[2]Fleming GF, Ronette BM, Seidman J, et al. Epithelial ovarian cancer. In: Barakat RR, Markman M, Randall ME, eds. Principles and practice of gynecologic oncology. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2009.[3]Ducie J, Dao F, Considine M, et al. Molecular analysis of high-grade serous ovarian carcinoma with and without associated serous tubal intra-epithelial carcinoma. Nat Commun. 2017 Oct 17;8(1):990. https://www.nature.com/articles/s41467-017-01217-9 http://www.ncbi.nlm.nih.gov/pubmed/29042553?tool=bestpractice.com [4]Labidi-Galy SI, Papp E, Hallberg D, et al. High grade serous ovarian carcinomas originate in the fallopian tube. Nat Commun. 2017 Oct 23;8(1):1093. https://www.nature.com/articles/s41467-017-00962-1 http://www.ncbi.nlm.nih.gov/pubmed/29061967?tool=bestpractice.com The epithelium covering the ovary and fallopian tubes consists of the same epithelial cells that line the peritoneal cavity. Thus, epithelial ovarian cancer and primary peritoneal cancer occur via the same pathophysiology and are treated with the same basic principles.

For the purpose of this topic, ovarian cancer also refers to fallopian tube cancer and primary peritoneal cancer.

Nonepithelial ovarian cancers (e.g., germ cell tumors and sex cord stromal tumors) are not specifically addressed in this topic.