Ovarian cancer

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.

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

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.

Clinical features are notoriously vague

• abdominal distension and bloating
• abdominal and pelvic pain
• urinary symptoms e.g. Urgency
• early satiety
• diarrhoea

Investigations

• CA125
  • NICE recommends 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
  • a CA125 should not be used for screening for ovarian cancer in asymptomatic women
• ultrasound

Diagnosis is difficult and usually involves diagnostic laparotomy