Ovarian Cancer

S. Shahabi and A. Sohaib

Introduction

Ovarian cancer constitutes nearly 4% of all cancers among women and is the leading cause of death from gynaecological malignancies in the Western world. It was estimated that 24 400 new cases of ovarian cancer would be diagnosed and 14 300 deaths would occur from ovarian cancer in the USA in 2003. The overall incidence rate in the USA is 17.1 per 100 000 women and has been fairly stable over time.1 The age-specific incidence of ovarian cancer increases with age and peaks in the eighth decade. The median age of diagnosis is 63 years. Tumours of the ovary form a heterogeneous group of neoplasms. The surface epithelium, stroma and germ cells each cause an array of histogenetically distinctive tumours that can occur in pure or combined forms.2 Malignant epithelial tumours account for approximately 85% of ovarian cancers. Age at diagnosis, race, stage of the disease, tumour grade and histological type of tumour have all been shown to have a significant impact on prognosis. An improved relative survival of women with primary epithelial ovarian cancer over the past three decades has been reported.1

Staging

A cancer staging system must reflect the biological behaviour of the cancer by dividing the patients into prognostic subgroups based on disease extent and other factors. Staging also facilitates treatment planning and the comparison of data between institutions.

The International Federation of Gynecology and Obstetrics (Federation Internationale Gynecologique Obstetrique or FIGO) system is the most commonly used staging system. It is based on the current understanding of the major patterns of disease spread: direct extension, exfoliation and lymphatic dissemination.2 The extent of the tumour spread is determined by a systematic surgical procedure.3 Stage I is tumour confined to the ovaries, stage II includes peritoneal metastasis within the true pelvis, stage III consists of abdominal peritoneal implants or retroperitoneal lymphadenopathy and stage IV involves other sites or the liver parenchyma. An alternative staging system is the American Joint Committee on Cancer (AJCC) TNM (tumour, node, metastasis) classification.

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