Krukenberg tumors are uncommon metastatic signet ring cell adenocarcinomas representing approximately half of all metastatic masses to the ovaries, comprising 1%-2% of all ovarian tumors.

The tumors present in bilateral ovaries in 80% of cases. The most common primary site, in 70% of instances, is the stomach, followed by the colon, appendix, breast, and biliary tract. Sometimes a primary tumor is never discovered.

The exact mechanism of spread is unknown, although it may be determined by the location of the primary cancer site. Gastric tumors are thought to spread via the lymphatic system because of the lymphatic-rich gastrointestinal mucosa and submucosa. Colon adenocarcinoma is thought to spread to the ovaries via a hematogenous route due to the increased vasculature when compared to the stomach.

Krukenberg tumors tend to occur in younger women in their 5th decade of life, with an average age of 45, whereas diagnosis of primary ovarian cancers occurs at a more advanced age. This is thought to be because diffuse infiltrative gastric adenocarcinoma occurs in women younger than age 40. Asian countries have a higher prevalence of gastric carcinoma, and Krukenberg tumors are responsible for a significant amount (17.8%) of all ovarian cancers.

As with other types of ovarian cancer, patients are often diagnosed with advanced disease because the presenting symptoms are often generic and overlooked. Krukenberg tumors are considered a stage IV disease with a median survival of 14 months.