title: Genital Cancers in Women: Ovarian Cancer.
abstract: More than 20,000 US women are diagnosed with ovarian cancer each year. The average lifetime risk is 1.3%, but risk increases with BRCA1 or BRCA2 gene mutations (40% and 18% risk, respectively, by age 70 years) or hereditary nonpolyposis colorectal cancer syndrome (12% lifetime risk). Other risk factors include smoking, possibly past clomiphene use, and more years of ovulation. Symptoms are nonspecific. Abdominal pain is most common; others include pelvic pain, bloating, and early satiety. When ovarian cancer is suspected, evaluation should begin with transvaginal ultrasonography with Doppler studies. Cancer antigen 125 testing can be obtained, but levels are not elevated in all patients. Other biomarkers (eg, OVA1) and scoring systems can be used to help determine if cancer is present. When diagnosed early (stage I), the 5-year survival rate is 90% for epithelial ovarian cancer. However, most patients with epithelial ovarian cancer are diagnosed in stage III or later, with a 5-year survival rate of 17% to 39%. Treatment involves total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without chemotherapy. Fertility-preserving options can be considered in some early-stage cancers, followed by more definitive surgical procedures. There is no evidence that routine screening is beneficial and it is associated with significant harms from unnecessary procedures. Women with genetic syndromes that increase risk should be considered for prophylactic bilateral salpingo-oophorectomy.
authors.affiliation: Georgetown University-Providence Hospital Family Medicine Residency, 4000 Reservoir Road NW, Washington, DC 20007.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Kuznia
authors.affiliation: Fort Lincoln Family Medicine Center, 4151 Bladensburg Road, Colmar Manor, MD 20722.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Roett
mesh_terms: D015415:Biomarkers; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen