Introduction

Ovarian cancer is the fifth most common malignancy in females. The peak age of incidence is 60 years and it generally carries a poor prognosis due to late diagnosis.

Epidemiology

  • Incidence: 12.00 cases per 100,000 person-years
  • Peak incidence: 60-70 years
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Risk factors
  • family history: mutations of the BRCA1 or the BRCA2 gene
  • many ovulations*: early menarche, late menopause, nulliparity

*It is traditionally taught that infertility treatment increases the risk of ovarian cancer, as it increases the number of ovulations. Recent evidence however suggests that there is not a significant link. The combined oral contraceptive pill reduces the risk (fewer ovulations) as does having many pregnancies.

Pathophysiology

  • around 90% of ovarian cancers are epithelial in origin, with 70-80% of cases being due to serous carcinomas
  • interestingly, it is now increasingly recognised that the distal end of the fallopian tube is often the site of origin of many 'ovarian' cancers

Clinical features

Clinical features are notoriously vague

Investigations

  • NICE recommend a CA125 test is done initially. Endometriosis, menstruation, benign ovarian cysts and other conditions may also raise the CA125 level
  • if the CA125 is raised (35 IU/mL or greater) then an urgent ultrasound scan of the abdomen and pelvis should be ordered

Diagnosis

Diagnosis is difficult and usually involves diagnostic laparotomy

Management

- usually a combination of surgery and platinum-based chemotherapy

Prognosis

  • 80% of women have advanced disease at presentation
  • the all stage 5-year survival is 46%