Ovarian Cancer

Ovarian carcinoma is the second most common malignancy of the female genital tract, at least in the United States. It accounts for about 25,200 cases a year, currently. The important figure is here; 14,500 deaths. This represents 62% of all deaths due to cancers of the female genital tract, and underlines the fact that ovarian carcinoma remains the only one of the three major gynecologic malignancies for which we do not have, as yet, an effective early diagnostic test. For that reason this lesion has, among the gynecologic malignancies, has been seen by more medical oncologists than any other gynecologic tumor.

Pathologically we are talking about several different neoplasms. Our focus for the next hour is going to be what you are going to see on the Boards, most likely, and that is the coelomic epithelial carcinomas of the ovary, which is which is what everybody really means when they say ovarian cancer. These lesions arise from coelomic epithelium that invest the ovary during development, and also lines the entire peritoneal cavity. They account for about 90% of all malignancies that arise in the ovary. Everything I will say will also apply to primary peritoneal neoplasms. That is, coelomic epithelial carcinomas arising elsewhere in the peritoneal cavity. By the best evidence we have to date the treatment of coelomic epithelial carcinomas arising elsewhere in the peritoneal cavity in a female should be exactly the same as that applied to coelomic epithelial carcinoma arising on the ovary. Germ cell neoplasms account for about 5% of ovarian cancers. The terminology here is the same as that for testicular carcinomas, with one exception. Seminomas are not called seminomas in the ovary. They are called dysgerminomas but their response to radiation and chemotherapy mirrors that that is seen in testicular seminomas.

Stromal tumors account for about 4% of all these tumors. These are granulosa thecal cell tumors primarily but include a variety of other tumors. We know relatively little about these tumors other than to take them out if you can and diagnose them early enough. Everything after that becomes anecdotal. Then finally, there will be a variety of other tumors such as mixed mesodermal sarcomas that will arise in the ovary also. Everything else that we will be discussing or aimed at is coelomic epithelial carcinomas of the ovary.

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