A11. Ovarian cancer; classification, symptoms and diagnosis

Last updated on June 9, 2021 at 09:36

Definition and epidemiology

Ovarian cancer is the second most common gynaecological cancer (after endometrial), but the most common cause of gynaecological cancer death due to its poor prognosis. It has no early symptoms, it has potential to grow very large, and it has aggressive behaviour. There is no effective screening for it in the general population.

It is mostly a disease of postmenopausal women in the 55 – 65 age group.

The 5-year survival is 30 – 35%. The only real opportunity for survival is early diagnosis with complete surgical excision.

Etiology

Risk factors include:

  • Old age
  • BRCA1/BRCA2 mutation
  • Family history
  • Early menarche
  • Late menopause

Protective factors include:

  • Oral contraceptive pills
  • Multiparity
  • Breastfeeding

Classification

We can distinguish multiple histological types of ovarian cancer:

  • Epithelial ovarian carcinoma – arise from ovarian surface epithelium
    • Serous type
    • Endometrioid type
    • Clear cell type
    • Mucinous type
  • Germ cell tumours
    • Dysgerminoma
    • Brenner tumour
    • Teratoma
  • Sex cord-stromal tumours
  • Krukenberg tumour
    • Bilateral ovarian metastatic spread from gastric cancer

The epithelial type is the most common, accounting for 90%.

Clinical features

Ovarian cancer is characteristically asymptomatic until the late stages, which is part of the reason for the poor prognosis.

When symptoms do appear, these are the most common:

  • Abdominal enlargement
    • Sometimes due to ascites
  • Symptoms of pressure on surrounding organs
    • Dysuria
    • Constipation
    • UTI
  • Symptoms relating to complications of the tumour (usually acute)
    • Torsion – acute pain and vomiting
    • Rupture – generalised abdominal pain
    • Haemorrhage – abdominal pain and haemorrhagic shock

Diagnosis and evaluation

Physical examination should be performed for an adnexal mass as well as inguinal and cervical lymphadenopathy. Ultrasound of the adnexal mass can reveal a solid mass, ascites. Chest, abdominal, and pelvic CT or MRi are used to look for ascites and diseases spread.

There are some tumour markers which may be elevated in ovarian cancer. These are mainly used for follow-up rather than for diagnosis:

  • CA-125
  • HE4
  • β-hCG
  • AFP

The diagnosis of ovarian cancer is histological and is generally made based on the excised tumour after exploratory laparotomy. Biopsy causes tumour seeding and is not performed, so histology can only be performed after surgical excision.

Screening

As already stated, there is no screening for it in the general population. However, we do screen people who have hereditary ovarian cancer or hereditary breast cancer. In these people, we can use serum markers, ultrasound, and frequent pelvic examination to screen them.

In some cases of high-risk patients, we can do prophylactic bilateral salpingo-oophorectomy after the age of 35.


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A10. Endometrial cancer; symptoms and diagnosis

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A12. Acute abdomen in gynecology

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