Ovarian carcinoma

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Ovarian carcinoma is the second most commonly diagnosed and deadliest gynecologic malignancy, as well as the fourth leading cause of cancer-related deaths in women in the USA. About 1 in 70 women eventually develops ovarian cancer, and 1 in 100 women dies of it. It often does not have an early stage. This is mostly since a malignant process of the surface of the ovary is not contained by any soft tissue barrier. As such, a tumour on the ovaries will not produce pain unless there is torsion, hemorrhage, or rupture, all of which are unlikely in cancer.

Ovarian neoplasms can be classified by the presumed cell of origin. The main categories are surface epithelial-stromal tumours, sex cord-stromal tumours, germ cell tumours, and secondary or metastatic tumours.

Secondary tumours represent 6-7% of the tumours found in the ovaries, and may have spread hematogenously, transcoelomicly, by direct extension, or through the fallopian tubes. Tumours metastatic to the ovary are typically bilateral (70%) and composed of multiple nodules within the ovary and on its surface. Common sites of origin are the stomach, intestine, endometrium, appendix, pancreas and breast.

The symptoms of ovarian carcinoma are the same as those of pelvic masses. Pain is rare despite growing over the course of weeks to months. Instead, widespread microscopic intraperitoneal spread is the norm — the so-called "omental caking".

Investigations

A pelvic examination would yield a fixed pelvic mass that is irregular, large, and firm, though not necessarily tender. An abdominal exam would reveal ascites, an omental mass, or distended bowel. Examination of the chest would reveal tachypnea, or pleural effusion The extremities may have edema.

In general, the patient may be tired, weak, or thin in the face.

Management

Because ovarian carcinoma is usually detected late, the prognosis is bad. Management for ovarian carcinoma can include surgical removal or chemotherapy, though radiation therapy is not traditionally useful due to the dose required for a therepeutic effect. Usually, surgical debulking is carried out, followed by chemotherapy.

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