Ovarian Cancer

What it is

Overview

Ovarian cancer is the fifth leading cause of cancer death in women and the deadliest of the gynecologic cancers. Over 75% of cases are diagnosed at stage III or IV, when the cancer has already spread within the abdomen — largely because early-stage disease produces few or no specific symptoms and there is no reliable screening test. High-grade serous carcinoma is the most common and lethal subtype.

Biology

How It Develops

Most high-grade serous ovarian cancers actually originate in the fallopian tube epithelium and spread to the ovary. TP53 mutation is universal; BRCA1/BRCA2 germline mutations drive hereditary cases (~20%). Homologous recombination deficiency (HRD) is a central molecular feature, which is why PARP inhibitors have transformed treatment.

Warning signs

Symptoms

• —Bloating, pelvic pressure, or abdominal pain
• —Difficulty eating or feeling full quickly
• —Urinary urgency or frequency
• —Changes in bowel habits
• —Unexplained fatigue and weight changes

Detection

Diagnosis Methods

• —Pelvic exam and transvaginal ultrasound
• —CA-125 blood test (not a reliable screening tool)
• —CT of abdomen and pelvis
• —MRI
• —Surgical staging and biopsy
• —BRCA1/BRCA2 and HRD germline and somatic testing

Medical care

Treatment Options

• —Surgical debulking (cytoreduction — extent of residual disease is key prognostic factor)
• —Platinum-based chemotherapy (carboplatin + paclitaxel)
• —Bevacizumab (anti-VEGF)
• —PARP inhibitors (olaparib, niraparib, rucaparib — especially for BRCA-mutated disease)
• —Immunotherapy (clinical trials)

Data

Statistics

Prevention

Risk Factors

• —BRCA1/BRCA2 mutations
• —Lynch syndrome
• —Family history of ovarian, breast, or colorectal cancer
• —Nulliparity and endometriosis
• —Postmenopausal hormone therapy

Further reading

Resources