What you need to know:
Ovarian cancer is a primary cause of cancer deaths among women in the United States, behind lung and breast cancers. In 2018, it is predicted that more than 22,000 cases of ovarian cancer will be diagnosed, with just over 14,000 deaths. Ovarian cancer is more common among white females than Asian American or African American women and occurs most often after age 40, with a mean age of 63 at time of diagnosis.
Ninety percent of ovarian cancers are comprised of epithelial tumors with a common histologic subtype of high-grade serous carcinoma. Fifty percent of epithelial tumors are benign, while 33% are malignant, and 16% are borderline. Benign tumors typically coincide with younger patients, while malignancy is more often associated with older patients.
Risk factors for ovarian cancer include obesity, a high fat diet, infertility treatments, never giving birth, and potentially, hormone replacement therapy. Regular use of talcum powder is being researched as a possible risk. Protective factors against ovarian cancer include aspirin use, tubal ligation, breast feeding, giving birth to multiple children, and the use of oral contraceptives. Mechanisms of action related to these protective factors are poorly understood, but researchers theorize they include the reduction of ovarian inflammation, modulation of progestins and gonadotropins, and suppression of ovulation.
Symptoms of ovarian cancer can mimic symptoms of other primary care health concerns, which may cause the patient or provider to dismiss them, or attribute them to other non-serious conditions. Symptoms are more likely to present when tumors are confined to the ovary and may include pelvic discomfort, bloating, an increase in urinary urgency or frequency, or a change in bowel habits. Ovarian tumors usually do not cause pain unless they experience torsion.
Ovarian cancer is curable when diagnosed in early stages, but is rarely curable in advanced stages. Routine screening to diagnose ovarian cancer early would seem logical; however, there is currently no scientific proof that routine screening with any methodology (pelvic examination, ultrasound, serum markers) decreases mortality. There is no test available that can accurately detect ovarian cancer in asymptomatic women at average risk, despite the hundreds of diagnostic markers that have been discovered. In women with a family history of increased risk for harmful mutations of BRCA1 or 2 genes, the United States Preventive Services Task Force (USPSTF) recommends a referral for genetic counseling and evaluation for BRCA testing. Routine screening is not recommended for this group.
Read more about ovarian cancer:
The MD Anderson Manual of Medical Oncology: Chapter 31. Ovarian Cancer
Williams Gynecology, 3e: Chapter 35. Epithelial Ovarian Cancer
Harrison’s Principles of Internal Medicine, 20e: Chapter 85. Gynecologic Malignancies > Ovarian Cancer
Centers for Disease Control and Prevention: Ovarian Cancer