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LEARNING OBJECTIVES

At the conclusion of the chapter, readers should be able to describe:

  1. Risk factors for developing ovarian cancer.

  2. Screening recommendations for the average-risk and high-risk population.

  3. Methods for diagnosing ovarian cancer.

  4. Standard treatment of ovarian cancer including surgery and chemotherapy.

INTRODUCTION

Ovarian cancer is the fifth-leading cause of cancer mortality in women and the most common cause of death among gynecologic malignancies in the United States. In 2017, there were 22,240 cases of ovarian cancer and 14,070 ovarian cancer-related deaths;1 representing 1.3% of all new cancer cases yet disproportionately more (2.3%) deaths.2 It is expected that about 1 in 71 women will be diagnosed during her lifetime; both incidence and mortality rate increase with age. Unfortunately, most patients with ovarian cancer are diagnosed at a late stage, as symptoms are often vague and overlooked by both patients and health care providers. Contrary to the its misnomer as the “silent killer,” ovarian cancer does harbor early signs and symptoms, and a public health effort is underway to increase awareness in both patients and health care providers.3 Unfortunately, screening tests remain ineffective, with inadequate sensitivity and specificity, and cause increased patient anxiety. Consequently, the United States Preventive Services Task Force (USP-STF) does not currently recommend the routine screening of asymptomatic patients, as intensified screening has little effect on mortality and has in fact proven detrimental.4,5

Patient Case (Part 1)

J.J. is a 60-year-old African American woman who presented to her primary physician with a 6-month history of dyspepsia, new onset early satiety, and increased abdominal girth.

HPI: She complained of ulcer-like symptoms and blamed aspirin use. Despite an increase in clothing size, she experienced a 10-pound weight loss in the month prior to presentation with no change in physical activity. She attributed this to eating less due to the abdominal discomfort.

PMH: Her past medical history was significant for osteoarthritis and hypertension. Medications included hydrochlorothiazide, aspirin, a multivitamin, and glucosamine/chondroitin. Menarche occurred at age 9 and she was diagnosed with infertility at age 30 (gravida 0, para 0).

Social History: She denied tobacco, alcohol, or recreational drug use. She had a family history of hypertension and both her mother and maternal grandmother were diagnosed with breast cancer prior to menopause.

Lab Values: Complete blood count, electrolytes, liver function tests, and urinalysis were within normal limits. Baseline CA-125 level was 632 U/mL. (Normal CA-125 <35 U/mL)

Physical Examination: Height 160 cm; weight 80 kg; blood pressure 130/75 mm Hg; resting pulse 85 beats per minute; temperature 99°F; respiratory rate 20 breaths per minute. Abdominal examination showed an abdominal distention and a fluid wave consistent with ascites, with fullness in the upper abdomen. Upon rectovaginal examination, a fixed mass was noted to fill the pelvis and involve the rectovaginal septum.

Diagnostic Tests: Abdominal pelvic CT and transvaginal ultrasound (TVUS) revealed bilateral adnexa masses, an omental cake, and ...

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