Ovarian cancer

Ovarian cancer
Name	Ovarian neoplasm
Field	Oncology, Gynecology, Pathology
Symptoms	Abdominal bloating, pelvic pain, early satiety
Complications	Ascites, intestinal obstruction, metastasis
Onset	Most commonly postmenopausal
Causes	Genetic mutations, hormonal influences
Risks	Age, family history, infertility treatments
Diagnosis	Pelvic ultrasound, CA-125, histopathology
Treatment	Surgery, chemotherapy, targeted therapy
Frequency	One of the leading gynecologic malignancies

Ovarian cancer is a malignant neoplasm arising from ovarian tissue, most commonly epithelial cells of the ovary, and presents insidiously in many patients. It is managed by multidisciplinary teams combining gynecologic oncology, medical oncology, and pathology and is a leading cause of gynecologic cancer mortality in developed and developing countries. Clinical pathways for management and research involve institutions, guideline bodies, and pharmaceutical companies worldwide.

Signs and symptoms

Patients frequently report nonspecific complaints such as abdominal bloating, pelvic pain, early satiety, and urinary urgency, often leading to delayed presentation; clinicians at Mayo Clinic, Johns Hopkins Hospital, Royal Marsden Hospital, Memorial Sloan Kettering Cancer Center, and Cleveland Clinic develop symptom checklists to improve recognition. Progressive symptoms include abdominal distension due to ascites, weight loss, and changes in bowel habits noted by teams at MD Anderson Cancer Center, Addenbrooke's Hospital, Karolinska University Hospital, Institut Curie, and UCLA Medical Center. Advanced disease can cause pleural effusion, venous thromboembolism, and paraneoplastic phenomena that are evaluated in case series from Massachusetts General Hospital, Stanford Hospital, Toronto General Hospital, Seoul National University Hospital, and Royal Victoria Hospital.

Causes and risk factors

Major hereditary risks include pathogenic variants in BRCA1, BRCA2, and mismatch repair genes associated with Lynch syndrome; genetic counseling programs at St. Jude Children's Research Hospital, Dana-Farber Cancer Institute, Guy's and St Thomas' NHS Foundation Trust, Peter MacCallum Cancer Centre, and The Francis Crick Institute coordinate testing. Reproductive history elements such as nulliparity, early menarche, late menopause, and endometriosis are highlighted in cohort studies from Framingham Heart Study, Nurses' Health Study, EPIC study, NHS, and Health Professionals Follow-up Study. Use of oral contraceptives, tubal ligation, and breastfeeding confer protective effects documented by investigators at Imperial College London, University of Oxford, University of Cambridge, Harvard School of Public Health, and Yale School of Medicine. Environmental, hormonal, and inflammatory contributors are explored in investigations by World Health Organization, International Agency for Research on Cancer, National Cancer Institute, European Medicines Agency, and Food and Drug Administration.

Pathology and classification

Most tumors are epithelial and subtyped as serous, mucinous, endometrioid, clear cell, and transitional (Brenner) types per consensus from panels at World Health Organization, International Federation of Gynecology and Obstetrics, College of American Pathologists, Royal College of Pathologists, and European Society of Pathology. High-grade serous carcinomas commonly harbor TP53 mutations described in landmark papers from The Cancer Genome Atlas, with histologic correlation studies at Memorial Sloan Kettering Cancer Center, Johns Hopkins University, Cold Spring Harbor Laboratory, Broad Institute, and Sanger Institute. Germ cell tumors and sex cord–stromal tumors, including granulosa cell tumors, are classified in pediatric and adult series from Great Ormond Street Hospital, Birmingham Women's and Children's Hospital, Children's Hospital of Philadelphia, Royal Children's Hospital Melbourne, and Peter MacCallum Cancer Centre. Grading and staging use protocols from FIGO, AJCC, NCCN, ESMO, and regional cancer networks.

Diagnosis and screening

Diagnosis combines clinical assessment, transvaginal ultrasonography, serum biomarkers such as CA‑125, and histopathologic confirmation obtained via laparotomy or laparoscopy, approaches refined at Royal College of Obstetricians and Gynaecologists, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, European Society of Gynaecological Oncology, and tertiary centers like Mayo Clinic and MD Anderson Cancer Center. Screening trials including UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), randomized studies funded by National Institutes of Health, and cohort work at NHS Blood and Transplant investigated multimodal strategies but have not established population-wide screening recommendations endorsed by USPSTF and World Health Organization. Imaging modalities such as CT, MRI, and PET-CT are used for staging and surveillance in protocols from ESMO, NCCN, EORTC, JCOG, and major university hospitals.

Treatment

Primary cytoreductive surgery performed by gynecologic oncology surgeons and perioperative care teams at centers like Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, Gustave Roussy, Tokyo Women's Medical University, and Royal Marsden Hospital remains foundational, often followed by platinum‑based combination chemotherapy regimens developed through trials by GOG (Gynecologic Oncology Group), ICON Group, AGO, JGOG, and cooperative groups. Targeted therapies including PARP inhibitors (studied by AstraZeneca, Clovis Oncology, Pfizer, Roche, and academic consortia) and antiangiogenic agents like bevacizumab (developed by Genentech) have become standard in selected populations per guidelines from NCCN, ESMO, ASCO, SGO, and national health services. Recurrent disease management employs cytotoxic, targeted, and immunotherapeutic approaches evaluated in clinical trials coordinated by European Organisation for Research and Treatment of Cancer (EORTC), NCI, Translational Research in Oncology (TRO), Cancer Research UK, and pharmaceutical partnerships. Palliative care integration and survivorship programs are delivered through networks including Macmillan Cancer Support, Hospice UK, American Cancer Society, Canadian Cancer Society, and local oncology centers.

Prognosis and epidemiology

Prognosis depends on stage, histologic subtype, residual disease after cytoreduction, and molecular features; survival data are reported by registries such as SEER, European Cancer Registry (EUREG), IARC, Cancer Research UK, and national cancer registries of Japan, Australia, Canada, Germany, and France. Incidence and mortality vary by region and are influenced by age distribution, reproductive patterns, and genetic testing uptake documented by public health agencies including CDC, Public Health England, Health Canada, Ministry of Health, Japan, and Australian Institute of Health and Welfare. Longitudinal outcomes and quality-of-life research are published in journals indexed by The Lancet, New England Journal of Medicine, Journal of Clinical Oncology, British Journal of Cancer, and Cancer, with ongoing international trials sponsored by consortia such as ICON, GOG, AGO, JGOG, and industry partners.

Category:Gynecologic oncology