Ovarian Cancer
Ovarian cancer accounts for 3-4% of cancer in women. It is the leading cause of death in women diagnosed with gynecologic cancers. It is the fifth most frequent cause of death in women, in general. It is a disease of postmenopausal woman, with highest incidence at 65-74 years. The 5-year relative survival rate is 45%. Around 75% present in advanced stage.
Types
Type I: Includes low grade serous, endometrioid, clear cell and mucinous carcinomas. Mostly arise from atypical proliferative (borderline) tumours. They are diagnosed early, have low proliferative activity and carry a good prognosis.
Type II: More common and fatal variant with high proliferative activity. Includes high grade variants of serous, endometrioid, carcinosarcoma, undifferentiated carcinoma. Arise from STIC (serous tubal intraepithelial cancer).
RISK FACTORS
1. Age: postmenopausal
2. nulliparous
3. Family history: strongest risk factor
4. Late menopause, early menarche
5. Protective factors: multiparity, OCP use, tubal ligation, hysterectomy, BSO, lactation
PATHOLOGY
Three main types:
1. Epithelial (95%): serous, mucinous, endometrioid, clear cell, transitional cell, undifferentiated
2. Germ cell(3-4%): dysgerminoma, yolk sac tumour, teratoma, embryonal, choriocarcinoma, mixed
3. Stromal cell (1%): granulosa cell, sertoli-leydig cell tumour
DIAGNOSIS
- History & physical examination: history of nonspecific gastrointestinal complaints like nausea, dyspepsia, altered bowel habits, abdominal distension due to ascites.
- Tumour markers: CA125 ( may be elevated in non malignant conditions, less frequently elevated in mucinous, clear cell and borderline tumours), LDH (dysgerminoma), HCG(choriocarcinoma), AFP( yolk sac tumour)
- Imaging: CT/MRI/PETCT (metastatic work up)
TREATMENT
- SURGERY: Mainstay of treatment. Aim is complete cytoreduction with hysterectomy, removal of tubes and ovaries, lymph node evaluation, omentectomy, peritoneal stripping. May include intestinal resection, stoma formation, splenectomy, urinary diversion.
- CHEMOTHERAPY: Platinum based, most commonly combination of carboplatin & paclitaxel (three weekly). For germ cell tumours- BEP (bleomycin, etoposide, cisplatin).
- RADIATION THERAPY: For oligometastatic recurrent disease.
