Ovarian%20cancer Signs and Symptoms

Signs and Symptoms

Introduction

Seventh most common cancer in women (excluding skin cancer)
Leading cause of death from gynecologic cancer in developed countries
Has 3 histologic types:
- Epithelial ovarian cancer - primarily seen in women >50 years of age; seen in >90% of patients with ovarian neoplasms
- Germ cell ovarian cancer - more commonly seen in women <20 years of age
- Sex cord-stromal ovarian cancer - rare; produces steroid hormones

Median age at the time of diagnosis is 63 years and >70% present with advanced disease
Less common ovarian histopathologies (LCOH):
- Carcinosarcomas - malignant mixed Müllerian tumors of the ovary
- Clear cell carcinomas
- Mucinous carcinomas
- Low grade/grade 1 serous carcinomas/endometrioid epithelial carcinomas
- Borderline epithelial tumors - also known as low malignant-potential tumors

Risk Factors

Increased Risk

Family history
- Associated with an early-onset disease
  - Patients having ≥2 first-degree relatives with ovarian cancer
  - Male breast cancer
  - Bilateral or early-onset (<50 years old) breast cancer
  - Personal or family history of colon or endometrial cancer

Genetic syndromes
- Associated with early-onset disease
  - BRCA1 and BRCA2 mutations have an absolute lifetime risk of 39-58% and 13-29% of developing ovarian cancer, respectively
  - PALB2 mutations have an absolute risk of 3-5% of developing ovarian cancer
  - BRIP1, RAD51C and RAD51D mutations have an absolute risk of >10% of developing ovarian cancer
  - MLH1 and MSH2 mutations have an absolute risk of >10% of developing epithelial ovarian cancer
  - Lynch syndrome (hereditary nonpolyposis colorectal cancer) has a lifetime risk of 10%
  - Cowden’s disease has increased risk of ovarian cancer due to mutations in PTEN gene
  - Peutz-Jeghers syndrome secondary to mutations in STK11 gene
  - MUTYH-associated polyposis secondary to mutations in gene MUTYH

Age
- Risk of developing ovarian cancer gets higher with age and is most prevalent in the eighth decade of life

Reproductive history
- Nulliparity or age >35 years at first childbirth
- Early menarche
- Late menopause

Personal history of breast cancer or epithelial ovarian cancer
- Risk of ovarian cancer after breast cancer is highest in women with a family history of breast cancer

Obesity
- Obese women with a body mass index of at least 30 kg/m² have a higher risk of developing ovarian cancer

Fertility drugs
- Some studies show that using the fertility drug Clomiphene citrate for >1 year increased the risk of developing low malignant-potential ovarian tumors
- Risk was shown to be highest in women who did not get pregnant while receiving the drug

Estrogen therapy
- Studies have shown that postmenopausal women using Estrogen monotherapy for at least 5-10 years have a higher risk of developing ovarian cancer

Pelvic inflammatory disease (PID)
- May increase the risk for ovarian cancer

In vitro fertilization (IVF)
- The risk of borderline ovarian cancer may be increased after ovarian stimulation for IVF

Androgens
- A study had shown that women who took androgens were found to have a higher risk of ovarian cancer

Talcum powder
- Some studies suggest a very slight increase in risk of ovarian cancer in women who used talc on their genital area
Smoking is associated with increased risk for mucinous carcinomas

Decreased Risk

Reproductive history
- Younger age at pregnancy and at first childbirth (≤25 years old) has 30-60% lower risk

Oral contraceptive use for >5 years significantly lowers the risk of ovarian cancer
Breastfeeding has 30-60% lower risk
Diet
- A study had shown that low fat diet for at least 4 years had a lower risk for ovarian cancer

Gynecologic surgery (eg hysterectomy, prophylactic oophorectomy, tubal ligation)
- Tubal ligation may reduce the chance of developing ovarian cancer for up to 67%
Smoking is associated with decreased risk for clear cell carcinoma

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