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.
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. 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).
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
Key diagnostic factors
- pelvic mass
- pleural effusion
Other diagnostic factors
- gastrointestinal symptoms
- urinary urgency or frequency
- symptom duration >3 months
- abdominal distention
- pelvic/abdominal pain or pressure
- BRCA1 mutation
- BRCA2 mutation
- increasing age
- family history of ovarian cancer
- family history of breast cancer
- never used combined oral contraceptives
- Lynch syndrome
- hormone therapy
1st investigations to order
- pelvic ultrasound
Investigations to consider
- PET, PET-CT, or PET/MRI
- CT scan
- OVA1 assay
surgical candidate, intraoperative histology confirmed disease
poor surgical candidate, biopsy confirmed disease
platinum-sensitive recurrent disease
platinum-resistant recurrent or refractory disease
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.
Jill Tseng, MD
Assistant Clinical Professor of Gynecologic Oncology
University of California, Irvine
JT declares that she has no competing interests.
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