OVARIAN CANCER Worldwide incidence

1
OVARIAN CANCERWorldwide incidence
Incidence per 100,000 population.
Parkin DM, et al. CA Cancer J Clin. 19994961.
2
OVARIAN CANCERAge-adjusted mortality rates,
1930-1995
40
Lung Bronchus
Uterus
Breast
20
Rate per 100,000 Female Population
Colon Rectum
Stomach
Ovary
Pancreas
0
1930
1940
1950
1960
1970
1980
1990
Per 100,000, age-adjusted to the 1970 US
standard population. Uterus cancer death
rates are for uterine cervix and uterine corpus
combined. Note Due to changes in ICD coding,
numerator information has changed over time.
Rates for cancer of the uterus, ovary, lung and
bronchus, and colon and rectum are affected
by these coding changes.
American Cancer Society. Cancer Facts
Figures19993.
3
OVARIAN CANCERRisk factors

• Increasing age
• Nulliparous history
• Non-use of oral contraceptives
• Personal history of breast cancer
• Family history
• Genetic cancer syndrome
• BRCA 1
• BRCA 2
• Hereditary non-polyposis colon cancer

American Cancer Society. Cancer Facts
Figures199913. Lynch HT et al. Semin Oncol.
199825265-280.
4
OVARIAN CANCEREarly detection

• Early detection is rare due to
• Lack of accurate screening methods
• Late appearance of signs and symptoms
• Insidious, nonspecific symptoms
• Periodic, thorough pelvic examination is
  recommended
• Recommended, although not shown to decrease
  mortality
• Pap test rarely reveals early-stage disease
• Transvaginal ultrasound CA 125 evaluation
• May be useful in diagnosis
• Not recommended for routine screening
• Being studied in large NCI-sponsored clinical
  trial (PLCO trial)

American Cancer Society. Cancer Facts
Figures199913. NCI. A 16-year randomized
screening study for prostate, lung, colorectal,
and ovarian cancerPLCO trial. http//Cancernet.nc
i.nih.gov/ Rosenthal A, Jacobs I. Semin Oncol.
199825315-325. Stern JL. Everyones Guide to
Cancer Therapy. 1997602.
5
OVARIAN CANCERPrevention

• Target high-risk women
• Prophylactic oophorectomy
• Studies in progress
• High-risk women still at risk for peritoneal
  carcinomatosis
• Oral contraceptives
• May decrease risk in general population by as
  much as 60

Ozols RF, et al. Cancer Principles Practice of
Oncology. 5th ed. 19971509. Berchuck A, et al.
Cancer. 1999862517-2524.
6
OVARIAN CANCERScreening

• Currently available techniques
• Pelvic exam
• Transvaginal ultrasound
• Serum CA 125
• None sufficiently accurate for general screening
• Routine screening not recommended
• Evaluation of a panel of more sensitive tumor
  markers (eg, CA 125, M-CSF, OVX-1) may improve
  detection of early-stage disease
• NCI PLCO trial evaluating TVUS CA 125

Ozols RF, et al. Cancer Principles Practice of
Oncology. 5th ed. 19971509. NCI. A 16-year
randomized screening study for prostate, lung,
colorectal, and ovarian cancerPLCO trial.
http//Cancernet.nci.nih.gov/
7
OVARIAN CANCERPathogenesis

• Common epithelial tumors account for
• 60 of ovarian neoplasms
• 80-90 of ovarian malignancies
• Most common form of tumor spread exfoliation of
  malignant cells through the epithelial surface of
  ovarian capsule
• Malignant cells circulate in peritoneal fluid and
  through lymphatics
• Late presentation with metastatic disease outside
  the peritoneum

Ozols RF, et al. Cancer Principles Practice of
Oncology. 5th ed. 19971503-1504. Berek JS,
Hacker NF. Cancer Treatment. 4th ed. 1995628-661.
8
OVARIAN CANCERHistologic classification

• Papillary serous
• Most common
• Endometrioid
• Occasionally associated with endometrial
  carcinoma
• Mucinous
• Often associated with normal CA 125
• Clear cell
• Worst prognosis stage for stage
• Rare tumors
• Sex cord stromal
• Lipoid

Cannistra SA. N Engl J Med. 19933291551-1559. Be
rek JS, Hacker NF. Cancer Treament. 4th ed.
1995628-661.
9
OVARIAN CANCERSymptoms

• Often only present with advanced disease
• Insidious
• Vague
• Include
• Abdominal distension
• Abdominal pain
• Early satiety
• Nausea
• Constipation

Cannistra SA. N Engl J Med. 19933291550-1559. Be
rek JS, Hacker NF. Cancer Treament. 4th ed.
1995628-661.
10
OVARIAN CANCERDiagnosis

• CT scan
• CA 125 evaluation
• Barium/Hypaque enema

Ozols RF, et al. Cancer Principles Practice of
Oncology. 5th ed. 19971506.
11
OVARIAN CANCERParaneoplastic syndromes

• Hypercalcemia
• Cerebellar degeneration
• Seborrheic keratosis
• Chronic intravascular coagulation

Cannistra SA. N Engl J Med. 19933291550-1559.
12
OVARIAN CANCERFIGO stage grouping in primary
ovarian cancer
FIGO Stage Description Stage I Growth limited to
ovaries Stage IA Growth limited to one ovary,
no ascites no tumor on the external surface
capsule intact Stage IB Growth limited to both
ovaries, no ascites no tumor on the external
surface capsules intact Stage IC Tumor
limited to one or both ovaries but with tumor on
the surface, with capsule ruptured, with ascites
present containing malignant cells, or with
positive peritoneal washings Stage II Growth
involving one or both ovaries with pelvic
extension Stage IIA Extension or metastases to
the uterus or tubes Stage IIB Growth involving
one or both ovaries with pelvic extension
Stage IIC Tumor either stage IIA or IIB but with
tumor on the surface of one or both ovaries, with
capsules ruptured, with ascites present
containing malignant cells, or with positive
peritoneal washings
Adapted from Ozols RF, et al. Cancer Principles
Practice of Oncology. 5th ed. 19971502-1539.
13
OVARIAN CANCERFIGO stage grouping in primary
ovarian cancer (contd)
FIGO Stage Description Stage III Tumor involving
one or both ovaries with peritoneal implants
outside the pelvis or positive retroperitoneal or
inguinal nodes, superficial liver metastases
equal stage III tumor limited to the true pelvis
but with histologically verified malignant
extension to small bowel or omentum Stage
IIIA Tumor grossly limited to the true pelvis
with negative nodes but with histologically
confirmed microscopic seeding of abdominal
peritoneal surfaces Stage IIIB Tumor of one or
both ovaries with histologically confirmed
implants of abdominal peritoneal surfaces, none
exceeding 2 cm in diameter nodes negative Stage
IIIC Abdominal implants greater than 2 cm in
diameter, or positive retroperitoneal or inguinal
nodes Stage IV Growth involving one or both
ovaries with distant metastasis if pleural
effusion is present, there must be positive
cytologic test results to allot a case to stage
IV parenchymal liver metastasis equals stage IV
Adapted from Ozols RF, et al. Cancer Principles
Practice of Oncology. 5th ed. 19971502-1539.
14
OVARIAN CANCERPrognostic factors

• FIGO Stage
• Patients age
• Postsurgical volume of residual disease
• Postsurgical CA 125
• Histologic subtype
• Histologic grade

Ozols RF, et al. Cancer Principles Practice of
Oncology. 5th ed. 19971510.
15
OVARIAN CANCERSurvival by stage
Ozols RF, et al. Cancer Principles Practice of
Oncology. 5th ed. 19971510-1511.