1. 3.4.2016 Mark Browning, M.D. IUSME

2.  22,000 Cases  14,000 Deaths  Overall Survival Rate is 35%  Survival Rate Depends on Stage

3.  Epithelial Cancer 90% of Cases  Surface of Ovary or Special Cells in Fallopian Tubes  High Grade Serous Tumors  Low Grade Serous Tumors  Germ Cell Tumor  Stromal Cell Tumor

4.  Usually presents with advanced disease  ¾ have disease beyond the ovary at diagnosis  Pelvic exams are helpful in diagnosing large masses  Premenopausal adnexal mass usually a cyst that regresses over time (7% are cancer)  Postmenopausal adnexal mass is worrisome (30% are cancer)

5.  95% of women DO report symptoms.  Symptoms can be vague and not gynecologic:  Abdominal bloating  Swollen abdomen  Fatigue  Diarrhea or constipation  Urinary symptoms  Abdominal/pelvic pain  Menstrual irregularities

6.  Spread by direct exfoliation of cells onto peritoneal surface/cavity  Most common mode of spread  Follow path of peritoneal fluid circulation into pericolic gutter and hemidiaphragm (develop a pleural effusion)  Peritoneal mets/adhesions

7.  Pelvic Exam, Transvaginal Ultrasound, CA 125  CT Scan, MRI, PET  Biopsy

8.  Surgical staging is mandatory  CA-125 is non-specific marker  AFP and b-HCG if suspect germ cell tumor (younger woman)

9.  Adenocarcinomas  Primary peritoneal carcinoma  Germ Cell Tumors  Rare  Low malignant potential (LMP)  “borderline tumors”  Single ovary, confined, younger age, pre- menopausal

10.  Salpingo-oophorectomy  Hysterectomy  Lymph Node Dissection  Omentectomy  Cytoreductive/Debulking Surgery  Chemo…Adjuvant…Neoadjuvant  Chemo for Recurrence

11.  Ovarian cancer originates from the cells that cover the ovary (epithelium).  Ovarian epithelium represents < 1% of the ovary.

12.  Women who carry a known mutation that predisposes to ovarian cancer (BRCA gene mutation)  Women who have a family history of ovarian or breast cancer  These women should be followed closely (CA125, gynecologic exam and ultrasound)  These women should consider removal of ovaries (oophorectomy) preventively.

13.  559 women, carriers of BRCA 1 or 2 259 women surgery: 6 diagnosed with stage 1 ovarian cancer 2 developed primary peritoneal cancer 292 no surgery: 58 developed ovarian cancer Risk reduction: 96% (Rebbeck, NEMJ, 2002)

15.  Family history and parity are most impt risk factors  BRCA-1 is a strong risk factor (50% risk)  BRCA-2 also a risk factor, but much less so  Lynch II syndrome (DNA mismatch repair defect): HNPCC, ovarian, breast, endometrial ca  Prophylactic oophorectomy reduces risk 96%  Incessant ovulation hypothesis: risk decreases with decreasing ovulation  Use of OCP that suppress ovulation reduces lifetime risk by as much as 50%