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Ovarian cancer
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Ovarian cancer

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Contributors: Mary N.W. Towner MD, Mitchell Linder MD
Other Resources UpToDate PubMed

Synopsis

Ovarian cancer most commonly refers to a cancer of the epithelial lining of the ovary, although stromal or germ cell malignancies are also possible. Ovarian epithelial cancer is closely related to fallopian tube and primary peritoneal cancers, both in how they develop and how they behave.

In the United States, ovarian cancer is the deadliest gynecologic malignancy, resulting in more deaths than uterine and cervical cancers combined. It is the second most common gynecologic malignancy.

Ovarian cancer can develop at any age, although it is most common in postmenopausal women, with an average age at diagnosis in the mid-60s. Women of northern European descent are more likely to develop ovarian cancer, although women of African descent are more likely to die of the disease.

Risk factors for ovarian cancer are usually related to frequency and duration of ovulation. Early menarche, late menopause, and nulliparity have been associated with increased risk for ovarian cancer. Factors that decrease the risk of ovarian cancer are those that provide a respite in continuous ovulation, such as pregnancy, breastfeeding, and use of oral contraceptives.

Patients may have a genetic predisposition to development of ovarian cancer. For example, patients with a mutation in the BRCA1 gene have up to a 46% risk of ovarian cancer by age 70, while those with a mutation in the BRCA2 gene have up to a 27% risk. Lynch syndrome (hereditary nonpolyposis colorectal cancer) is an autosomal-dominant syndrome that increases the risk of ovarian cancer, in addition to being associated with endometrial, colorectal, intestinal, or renal cancers.

Patients with ovarian cancer are usually diagnosed with advanced disease, as the symptoms are often dismissed or overlooked by the patient and/or provider.

For more information, see OMIM.

Codes

ICD10CM:
C56.9 – Malignant neoplasm of unspecified ovary

SNOMEDCT:
363443007 – Malignant tumor of ovary

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis depends greatly on the patient's presenting symptoms.

An adnexal mass could represent a benign or malignant lesion of the fallopian tube or ovary, but could also represent an infectious process, such as a tubo-ovarian abscess, and could likewise represent a diverticular abscess.

Ascites or pleural effusion, both of which are seen with advanced ovarian cancer, can be caused by multiple other medical conditions.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 09/29/2017
Last Updated: 10/19/2017
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Ovarian cancer
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Ovarian cancer : Abdominal pain, Nausea/vomiting, Pelvic pain, Pleural effusion, Urinary frequency, Dyspnea, Adnexal mass on pelvic exam
Imaging Studies image of Ovarian cancer
Axial CT image demonstrates a large, heterogeneous, partially solid, and cystic mass involving the left adnexa. Biopsy results were consistent with ovarian carcinoma.
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