1. Factors that decrease risk
1.1. Factors that suppress ovulation
1.1.1. Pregnancies
1.1.2. Prolonged lactation
1.1.3. Hormonal contraceptives
2. Pathogenesis
2.1. 90% sporadic
2.2. 5-10% familial inherited
2.2.1. BRCA1 and BRCA2 genes
3. Pathophysiology of major types
3.1. Epithelial ovarian neoplasms
3.1.1. Develop from surface epithelium of ovary or from cells that migrated from fallopian tubes or uterus
3.1.2. Arise from single cell
3.1.2.1. Due to loss of tumor-supressing genes and activation of oncogenes
3.1.3. Classified as type I or type II tumor (Based on cellular type)
3.1.3.1. Type I
3.1.3.1.1. Grow more slowly
3.1.3.1.2. Resistant to chemotherapy
3.1.3.2. Type II
3.1.3.2.1. Grows rapidly and aggressively
3.1.3.2.2. Responds well to chemotherapy
3.1.4. Tumors contain large amount of pro-inflammatory cytokines and chemokines
3.1.4.1. Cytokines
3.1.4.1.1. Tumor necrosis factor and interleukins
3.1.4.1.2. Produced by tumor or activated immune cells
3.1.4.1.3. Stimulates cancer growth
3.1.4.1.4. influences clinical disease status and prognosis
3.1.4.1.5. Cytokine antagonist may play role in treatment
3.1.5. Thought to be caused by inflammation of ovarian surface epithelium
3.1.5.1. Occurs during ovulation, pelvic inflammatory diseases, and endometriosis
3.2. Germ-cell neoplasms
3.2.1. Comes from primitive germ cells of embryonic gonad
3.2.2. Benign
3.2.2.1. Accounts for 10% of ovarian tumors
3.2.2.2. Error in meiosis resulting in formation of ectoderm, endoderm, and mesoderm cell lines
3.2.2.3. Referred to as Cystic Tetromas
3.2.2.4. Contain hair, teeth, and skin
3.2.3. Malignant
3.2.3.1. Highly aggressive
3.2.3.2. Rapid growth
3.2.3.3. Poor prognosis
3.2.3.4. Can occur in female children
4. Common findings
4.1. Often asymptomatic until tumors very large
4.2. First symptoms often vague
4.2.1. Persistant abdominal distention
4.2.2. Loss of appetite
4.2.3. Early satiety
4.2.4. Pelvic pain
4.2.5. Many women miss the first signs due to being vague and common in older women
4.3. Commonly diagnosed after cancer has spread
4.3.1. Ovarian cancer often called "silent killer"
4.4. Advanced disease symptoms
4.4.1. Pain
4.4.2. Abdominal swelling
4.4.3. From primary ovarian mass or ascites
4.4.4. Gastrointestinal symptoms
4.4.4.1. dyspepsia
4.4.4.2. Vomiting
4.4.4.3. Changes in bowel habits
4.4.4.3.1. From mechanical obstruction
4.4.5. Abnormal vaginal bleeding
4.4.6. Pelvic pressure
4.4.7. Leg pain
4.4.8. Venous or arterial thrombosis
4.4.9. Pleural effusion
4.4.9.1. From metastasis
4.4.10. Changes in coagubility
4.4.10.1. Clot formation
5. Diagnostic tests
5.1. No sensitive and specific test for low risk women
5.2. Routine screenings for low-risk women not shown to be beneficial
5.2.1. May cause more harm from unnecessary surgical procedures
5.3. Screening recommended in women with new onset of vague symptoms occurring more than 12 days each month
5.4. No cost effective screenings for early detection
5.5. CA-125 blood test
5.5.1. Looks for specific cancer markers
5.5.1.1. Increased levels found in 78-80% nonmucinous ovarian cancers
5.5.2. Elevated levels associated with other conditions
5.5.2.1. 29% non-gynecological tumors
5.5.2.2. endometriosis
5.5.2.3. myomas
5.5.2.4. pregnancy
5.5.2.5. benign ovarian cysts
5.5.2.6. Pelvic inflammatory disease
5.6. Transvaginal ultrasound
5.7. Women less than 40 more likely to have non-epithelial cell tumors
5.7.1. Blood tests
5.7.1.1. CA-125
5.7.1.2. Alpha fetoprotein
5.7.1.3. Beta-human chorionic growth hormone
5.8. Diagnosis confirmed with biopsy
5.9. Extent of disease determined by CT scan, ultrasound, or MRI
6. Treatment
6.1. Surgery
6.1.1. Remove tumor
6.1.2. Stage disease
6.1.2.1. Stage I
6.1.2.1.1. Tumor limited to ovaries
6.1.2.2. Stage II
6.1.2.2.1. Tumor involving 1 or both ovaries with pelvic extension
6.1.2.3. Stage III
6.1.2.3.1. Tumor involving 1 or both ovaries with intraperitoneal metastases outside pelvis, or positive retroperitoneal nodes or both, extension to small bowl or omentum
6.1.2.4. Stage IV
6.1.2.4.1. Tumor involving one or both ovaries with distant metastases
6.2. Further treatment dictated by stage of cancer, women's wishes, cell type and sensitivity of cancer cells
6.2.1. Radiation
6.2.2. Chemotherapy
6.2.2.1. Agent containing platinum
7. Prognosis
7.1. 55-75% women relapse after successful treatments
7.2. Less than 20% survive long term with stage Iii or IV disease
8. Causative factors
8.1. asbestos
8.2. Tobacco smoking
8.3. Estrogen menopausal therapy
8.4. Remains largely unknown
8.5. Genetics
9. Risk factors
9.1. Increased ovulation over lifetime (women over 40)
9.1.1. early menarche
9.1.2. late menopause
9.1.3. nulliparity
9.1.4. use of fertility drugs