1. 22/10/1436. Addar Professor Gyneoncologist OB/GYN Dept. KKUH and College of Medicine MKing Saud University

2. Professor Mohammed Hassan Addar

3. Introduction  It is the most lethal gynecological malignancy  >25,000 women in USA annually  14,000 deaths annually  Incidence has increased by 30% over the past decade  Deaths from ovarian cancer increased by 18%  60% of patients present with advanced-stage disease  The overall survival rate is 38% at 5 years

4. Epidemiology  The etiologies of epithelial ovarian cancer are not known  Age  The mean age at diagnosis is 59 years  15.7 per 100,000 women at age 40 years  54 per 100,000mwomen at age 79 years  One women in 70 in the USA will develop ovarian cancer  Ov ca is a disease of postmenopausal women, women with a family history of breast ca and ov.ca may be diagnosed with ov.ca up to 10 years earlier than the average women

5. Family history The strongest risk factor A women with a single first-degree relative with ov.Ca has a relative risk (RR) of approximately 3.6 for developing ov.ca compared with general population Her life time risk approx. 5% 5-10% of ov.ca are linked to identifiable, inherited mutations in certain genes Families in which three or more first-degree relatives have ovarian or ovarian plus breast cancer are likley to have a cancer-susceptibility genetic mutation that is transmitted in an autosomal-dominant inheritance pattern

6. Family history  Three familial ovarian cancer syndromes:  The site specific ovarian ov.ca syndrome # only ov.ca is seen # account for 10-15% of hereditary ov.ca  The hereditary breast/ovarian cancer syndrome  #associated with 65-75% of hereditary ov.ca

7. Family history`  In the hereditary nonpolyposis colorectal cancer syndrome (HNPCC), affected individuals may have colon, endometrial, breast, ovarian or other cancers  HNPCC kindred's account for an additional 10- 15% of hereditary ovarian cancer  The hereditary breast/ovarian cancer syndrome and perhaps less frequently the site –specific ovarian cancer syndrome are linked to mutations in the BRCA1 and BRCA2 genes

8. Ethnicity  Higher in white women  Higher in north America and northern Europe than Japan  Difference related to genetics, diet, or environmental exposure or a combination  BRCA1 and BRCA2 genes are more common among white women of Ashkenazi descent  Incidence of ov.ca is higher in countries with higher in countries with higher per capita consumption of animal fat

9. Reproduction factors  Nulliparous  First childbirth after age 35 years  Involuntary infertility  Late menopause and early menarche  RR (2.0-5.0)  Pts. With prolonged period or uninterrupted ovulation

10. Exogenous hormones  OCP decreased risk of epithelial tumors  RR 0.5 in 5 years or more users  HRT

11.  Hysterectomy Decrease the risk  Smoking no relation

12. Symptoms and Signs  Early stage asymptomatic  10-12 cm  Bloating, abdominal discomfort, pelvic pressure, urinary and rectal symptoms  Ascites, pleural effusion and shortness of breath  cashecsia

13. Ovarian Cancer 22/10/1436

16. Ovarian Cancer 22/10/1436