Ovarian epithelial cancer
Ovarian epithelial cancer, also known as epithelial carcinoma, is a malignant tumor that arises from the cells on the outer surface of the ovaries. This type of cancer constitutes approximately 85 to 90 percent of all ovarian cancer cases. Major risk factors include a family history of ovarian cancer, inherited mutations in the BRCA1 and BRCA2 genes, and prior diagnoses of breast or colon cancer, with higher incidence rates in women over 40 and those who have undergone hormone therapy after menopause. Symptoms often manifest late and may include abdominal bloating, pain, and gastrointestinal issues.
Diagnosis typically involves a physical examination, imaging tests like ultrasound or CT scans, and blood tests for cancer markers. Definitive diagnosis is made through biopsy. The cancer is staged from I to IV based on its spread, with advanced stages indicating a poorer prognosis. Treatment generally involves surgery to remove affected tissues followed by chemotherapy, particularly with drugs like carboplatin and paclitaxel. While the overall five-year survival rate is about 50%, early detection can significantly improve outcomes, leading to a survival rate of around 93% with aggressive treatment. Preventive measures, including maintaining a healthy lifestyle and considering surgical options for those at high risk, can also help reduce the likelihood of developing this cancer.
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Subject Terms
Ovarian epithelial cancer
ALSO KNOWN AS: Epithelial carcinoma
RELATED CONDITIONS: Abdominal cancer, breast cancer, colon cancer, lymphatic cancer, peritoneal cancer, fallopian tube cancer
DEFINITION: Epithelial ovarian cancer results from the development of a malignant tumor that originates in the cells on the outer surface of an ovary. Between 85 and 90 percent of all ovarian cancers are epithelial ovarian cancers.
Risk factors: A history of ovarian cancer within a family, particularly in a woman’s mother, sister, or daughter, increases the risk of developing epithelial ovarian cancer. Inherited gene mutations, specifically the mutated breast cancer genes BRCA1 and BRCA2, are responsible for between 5 and 15 percent of all epithelial ovarian cancer. The lifetime risk of developing ovarian cancer is about one in seventy-eight, and 90 percent of those are ovarian epithelial cancers. Those with the BRCA1 mutation have a 39 to 40 percent risk, and those with the BRCA2 mutation have a 17 percent risk.
The risk of developing epithelial ovarian cancer is also higher in women who have had breast cancer or colon cancer and is highest among women over forty. Taking hormone therapy after menopause increases one's risk.
Etiology and the disease process: The exact cause of ovarian epithelial cancer is unknown but originates in the cells of tissue covering an ovary. Epithelial ovarian cancer cells can be readily distinguished under a microscope. These cells are differentiated and classified as serous, mucinous, endometrioid, or clear cell types. Serous epithelial cancer cells are the most common. Undifferentiated epithelial ovarian cancer cells tend to grow and spread more rapidly than the four differentiated types. Epithelial ovarian cancers are classified by cell type and graded from 1 to 3. Grade 1 cells look similar to normal tissue and are less dangerous to the patient. Grade 3 cells look different from normal tissue and have the worst prognosis.
Epithelial ovarian cancer cells often metastasize by spreading into the abdominal cavity, where they can implant in the uterus, intestines, omentum, or bladder. Sometimes, they metastasize to the lungs. On rare occasions, epithelial ovarian cancer cells spread into the bloodstream or lymphatic system and move to many other body parts.
Incidence: Epithelial ovarian cancer is one of the leading causes of cancer-related deaths in women. Each year, ovarian epithelial cancer accounts for around 3.7 percent of cancer diagnoses and nearly 5 percent of deaths in women. Around 20,000 women are diagnosed annually.
Symptoms: Epithelial ovarian cancer is often not detected until it has progressed to an advanced stage. Symptoms include bloating, swelling, or pain in the abdominal area and gastrointestinal problems involving nausea, diarrhea, or constipation.
Screening and diagnosis: If epithelial ovarian cancer is suspected, a doctor will conduct a thorough physical examination of the pelvic region. The shape, size, and position of the uterus and ovaries are assessed. If any growths or abnormal areas are found, they will be further investigated with ultrasonic imaging and computed tomography (CT) scans. The level of cancer antigen 125 (CA 125), which is raised with ovarian cancer, is measured with a blood test. Levels of other cancer-related proteins in the blood are being evaluated for diagnosing ovarian epithelial cancer.
A definitive diagnosis of epithelial ovarian cancer is made through biopsy. Usually, when the tumor is removed, a tissue sample is analyzed, and the stage of the disease is assessed. The staging of epithelial ovarian cancer is as follows:
- Stage I: The cancer is limited to one or both ovaries.
- Stage II: The cancer has metastasized into other parts of the pelvic region.
- Stage III: The cancer has spread to areas outside of the pelvis or has extended into the small intestine or omentum.
- Stage IV: The cancer has metastasized outside the peritoneal cavity.
Depending on the degree of seriousness, these stagings are further broken down into categories ranging from A to C.
Treatment and therapy: Depending on the stage of epithelial ovarian cancer, surgery is often performed to remove the ovaries, uterus, omentum, and associated lymph nodes. After recovery, the patient typically undergoes a regimen of chemotherapy. The most effective chemotherapy drugs used in treating ovarian epithelial cancers are carboplatin and paclitaxel (Taxol), administered intravenously. A combination of intravenous chemotherapy and intraperitoneal therapy, the pumping of chemotherapy drugs directly into a patient’s abdomen, is recommended by the National Cancer Institute (NCI) in the treatment of epithelial ovarian cancer patients.
Prognosis, prevention, and outcomes: Because epithelial ovarian cancer is not usually detected until it is in an advanced stage, the prognosis is not promising. The five-year survival rate for all stages of epithelial ovarian cancer is about 50 percent. With early diagnosis, aggressive surgery, and chemotherapy, the five-year survival rate is around 93 percent, and the long-term survival rate approaches 70 percent. However, approximately 60 percent of ovarian cancer patients are diagnosed in distant stages, with five-year survival rates of around 30 percent.
The risk of developing ovarian epithelial cancer can be reduced with a good diet, exercise, and proper management of stress. Other factors that reduce the risk are bearing children and breast-feeding them if possible. Women with a high risk of developing ovarian epithelial cancer may consider removal of the ovaries as a preventive measure.
Bibliography
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