Epithelial ovarian cancer is the most common histologic subtype of ovarian cancer, and is the primary focus of this topic.
The incidence of epithelial ovarian cancer is relatively low compared with breast, colon, and lung cancer.
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.
If an ovarian mass is detected, biopsy and fine-needle aspiration are not routinely recommended as they can disseminate tumor cells into the peritoneal cavity. These procedures are also prone to sampling error and potential bleeding complications.
Surgery is typically required for definitive diagnosis, staging, and tumor debulking. Adjuvant chemotherapy may be required to eradicate residual disease following debulking surgery.
The primary focus of this topic is epithelial ovarian cancer, the most common histologic subtype of ovarian cancer (accounting for approximately 90% of cases).
Epithelial ovarian cancer develops when there is malignant transformation of the epithelium covering the ovarian capsule and distal fallopian tube. 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.
History and exam
Sareena Singh, MD
Aultman Medical Group
Northeast Ohio Medical University
SS declares that she has no competing interests.
Dr Sareena Singh would like to gratefully acknowledge Dr Justin C. Chura and Dr Allison E. Axtell, previous contributors to this topic.
JCC and AEA declare that they have no competing interests.
Michael P. Hopkins, MD, MEd
Obstetrics and Gynecology
Northeast Ohio Universities of Medicine (NEOMED)
MPH declares that he has no competing interests.
Ritu Salani, MD
Gynecologic Oncology Fellow
Johns Hopkins Medical Institutions
RS declares that she has no competing interests.
Susan A. Davidson, MD
Chief, Gynecologic Oncology
Department of Obstetrics & Gynecology (UCD)
University of Colorado Cancer Center
SAD declares that she has no competing interests.
Khadra Galaal, MBChB, MPH, MRCOG
Consultant Gynaecological Oncologist
Northern Gynaecological Oncology Centre
Queen Elizabeth Hospital
KG is co-author of a systematic review of follow-up strategies after primary treatment in ovarian cancer. This is not referenced in this topic.
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