Ovarian Cancer
After cancers of the lung, breast, and colon, primary ovarian cancer ranks as
the most common cause of cancer death among American females. In those who were previously treated for breast cancer, metastatic ovarian cancer is more common than cancer of any other organ.
the most common cause of cancer death among American females. In those who were previously treated for breast cancer, metastatic ovarian cancer is more common than cancer of any other organ.
The prognosis varies with the histologic type and stage of the disease, but it’s often poor because ovarian tumors progress rapidly and are difficult to diagnose. However, about 40% of females with ovarian cancer survive for 5 years.
Causes
Environmental and lifestyle factors seem to play a role in ovarian cancer. Females who live in industrialized nations are at greater risk, as are those whose diet is high in saturated fat. Other risk factors include infertility problems or nulliparity, celibacy, exposure to asbestos and talc, a history of breast or uterine cancer, and a family history of ovarian cancer.
Primary epithelial tumors arise in the maullerian epithelium; germ cell tumors, in the ovum itself; and sex cord tumors, in the ovarian stroma. Ovarian tumors rapidly spread intraperitoneally by local extension or surface seeding and, occasionally, through the lymphatics and the bloodstream. In most cases, extraperitoneal spread is through the diaphragm into the chest cavity, which may cause pleural effusions. Other metastasis is rare.
The three main types of ovarian cancer are:
Primary epithelial tumors—these account for 90% of all ovarian cancers and include serous cystadenocarcinoma, mucinous cystadenocarcinoma, and endometrioid and mesonephric malignant tumors.
Germ cell tumors—these include endodermal sinus malignant tumors, embryonal carcinoma (a rare ovarian cancer that occurs in children), immature teratomas, and dysgerminoma.
Sex cord (stromal) tumors—these include granulosa cell tumors (which produce estrogen and may have feminizing effects), thecomas, and the rare arrhenoblastomas (which produce androgen and have virilizing effects).
Complications
Fluid and electrolyte imbalance, leg edema, ascites, and intestinal obstruction, causing nausea, malnutrition, and hunger, are common complications of progressive disease. Profound cachexia and recurrent malignant effusions, such as pleural effusions, may also occur.
Assessment
Because ovarian cancer lacks obvious signs, it’s seldom diagnosed early. Usually, the cancer has metastasized before a diagnosis is made. Signs and symptoms vary with the tumor’s size and the extent of metastasis.
In later stages, the history may disclose urinary frequency, constipation, pelvic discomfort, distention, and weight loss. The patient may complain of pain, possibly associated with tumor rupture, torsion, or infection. In a young patient, the pain may mimic that of appendicitis.
Inspection reveals a patient who is alert but gaunt. It commonly discloses a grossly distended abdomen accompanied by ascites—typically the sign that prompts the patient to seek treatment.
Palpation of the abdominal organs and peritoneum may disclose masses. On palpation, an ovarian tumor may vary from a rocky hardness to a rubbery or cystlike quality. Postmenopausal females who have palpable, premenopausal-size ovaries require further evaluation for an ovarian tumor.
Diagnostic tests
Many tests may be ordered to help assess the patient’s condition, including a complete blood count, blood chemistries, and electrocardiography. Others include the following.
Exploratory laparotomy, including lymph node evaluation and tumor resection, is required for accurate diagnosis and staging.
Abdominal ultrasonography, computed tomography scan, or X-rays delineate tumor size.
Excretory urography provides information on renal function and possible urinary tract obstruction.
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