Cancers Arising in the Ovary
Summary of Key Points
Types
• Ninety percent of ovarian cancers represent a collection of “epithelial tumors” that increase in incidence with age, with patients diagnosed at a median age of 63 years. Stromal tumors represent less than 10% of malignant tumors arising in the ovary and typically present with symptoms related to sex hormone production. The remaining tumors are germ cell tumors that occur in adolescents and young adults.
Staging Evaluation
• Patients should usually undergo surgical resection of ovarian tumors with comprehensive surgical staging. Most women with epithelial ovarian cancer present with advanced disease and aggressive surgical cytoreduction is recommended. Approximately 10% of these patients will also present with malignant pleural effusions. Comprehensive surgical staging is recommended for stromal and germ cell tumors although the role of lymphadenectomy is unclear when there is no gross lymphadenopathy.
Primary Therapy (and Results)
• Epithelial tumors are typically treated with carboplatin and paclitaxel as well as maximal surgical cytoreduction. A high percentage of women will experience a complete clinical remission; however, the majority who present with advanced disease will relapse within a few years. Median survivals for women with advanced disease are approaching 5 years. Germ cell tumors typically are treated with bleomycin, etoposide, and cisplatin in regimens initially described in the management of testicular carcinoma with the majority of women cured of disease.
