Obstetrics and Gynecology · MU Sofia

55. Ovarian tumors - malignant. Ovarian cancer

Covers ovarian cancer, beginning with its lethality, late diagnosis and epidemiology, then moving through a table of tumour types (epithelial, germ cell, sex cord–stromal and metastatic) with their markers and features. It lists genetic and hormonal risk factors and protective factors, the symptoms and signs, and diagnostic tests including CA-125. A FIGO staging table precedes treatment: debulking surgery, chemotherapy, PARP inhibitors and germ cell regimens, with survival figures and prevention.

Inside: 6 sections · 2 tables · 16 flashcards · 2 min

Topic 55 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 6 sections, about 239 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Types
  3. Risk factors
  4. Clinical picture
  5. Diagnosis and staging
  6. Treatment

Introduction

Ovarian cancer is the most lethal gynaecological cancer: symptoms are vague, so about 70% are diagnosed at stage III–IV. Lifetime risk is about 1.5%; peak age is 60–70.

Risk factors

  • BRCA1 (lifetime risk 40–60%) and BRCA2 (10–30%) mutations, Lynch syndrome, family history.
  • Increasing age, nulliparity, infertility, early menarche and late menopause (more ovulations), endometriosis.
  • Protective: combined pill (risk halves after 5+ years), pregnancy, breastfeeding, tubal ligation, salpingectomy.

Clinical picture

Persistent, frequent: abdominal bloating and distension, early satiety, loss of appetite, pelvic or abdominal pain, urinary frequency, change in bowel habit, weight loss. Signs: pelvic mass (often fixed, bilateral, nodular), ascites, pleural effusion, omental cake.

Diagnosis and staging

  • CA-125 (raised in about 80% of advanced epithelial cancers; also raised in endometriosis, PID, pregnancy, fibroids), ultrasound, RMI, CT chest–abdomen–pelvis.
  • Histology from surgery or image-guided biopsy; cytology of ascites.

Treatment

  • Cytoreductive (debulking) surgery: total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, removal of all visible disease; no residual disease is the strongest prognostic factor.
  • Chemotherapy: carboplatin + paclitaxel after surgery, or 3 cycles before (neoadjuvant) and after interval surgery.
  • Maintenance: PARP inhibitors (olaparib, niraparib) especially with BRCA mutation or HRD; bevacizumab.
  • Germ cell tumours: fertility-sparing surgery + BEP chemotherapy; cure rates are high.
  • Five-year survival: about 90% in stage I, 30–40% in stage III–IV.

Prevention

No effective screening for the general population. BRCA carriers are offered risk-reducing bilateral salpingo-oophorectomy (about 35–40 for BRCA1, 40–45 for BRCA2).

Persistent bloating in a woman over 50 should prompt a CA-125 and a pelvic ultrasound.

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