Ovarian cancer
After cancer of the lung, breast, and colon, primary ovarian cancer ranks as the most common cause of cancer deaths among American women. In women with previously treated breast cancer, metastatic ovarian cancer is more common than cancer at any other site.
The prognosis varies with the histologic type and stage of the disease but is generally poor because ovarian tumors
produce few early signs and are usually advanced at diagnosis.
produce few early signs and are usually advanced at diagnosis.
Three main types of ovarian cancer exist:
Primary epithelial tumors account for 90% of all ovarian cancers and include serous cystoadenocarcinoma, mucinous cystoadenocarcinoma, and endometrioid and mesonephric malignancies. Serous cystoadenocarcinoma is the most common type and accounts for 50% of all cases.
Germ cell tumors include endodermal sinus malignancies, embryonal carcinoma (a rare ovarian cancer that appears in children), immature teratomas, and dysgerminoma.
Sex cord (stromal) tumors include granulosa cell tumors (which produce estrogen and may have feminizing effects), granulosa-theca cell tumors, and the rare arrhenoblastomas (which produce androgen and have virilizing effects).
Causes
The exact cause of ovarian cancer is unknown, but its incidence is noticeably higher in women of upper socioeconomic levels between the ages of 20 and 54. However, it can occur during childhood. Certain genes, including BRCA1 and BRCA2, may increase risk. Other contributing factors include age at menopause; infertility; celibacy; high-fat diet; exposure to asbestos, talc, and industrial pollutants; nulliparity; familial tendency; and history of breast or uterine cancer.
Primary epithelial tumors arise in the müllerian epithelium; germ cell tumors, in the ovum itself; and sex cord tumors, in the ovarian stroma (the ovary’s supporting framework).
Ovarian tumors spread rapidly intraperitoneally by local extension or surface seeding and, occasionally, through the lymphatics and the bloodstream. Generally, extraperitoneal spread is through the diaphragm into the chest cavity, which may cause pleural effusions. Other types of metastasis are rare.
Signs and symptoms
Typically, symptoms vary with the size of the tumor. Occasionally, in the early stages, ovarian cancer causes vague abdominal discomfort, dyspepsia, and other mild GI disturbances. As it progresses, it causes urinary frequency, constipation, pelvic discomfort, abdominal distention, and weight loss.
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