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Chapter 093. Gynecologic Malignancies

Ovarian cancer can develop from three distinctive cell types (germ cells, stromal cells, and epithelial cells), and each of these presents with distinctive features and outcomes and requires widely different management approaches. Epithelial ovarian cancer is the most common of the three and the leading cause of death from gynecologic cancer in the United States. In 2007, 22,430 new cases were diagnosed, and 15,280 women died from ovarian cancer. | Chapter 093. Gynecologic Malignancies Ovarian cancer can develop from three distinctive cell types germ cells stromal cells and epithelial cells and each of these presents with distinctive features and outcomes and requires widely different management approaches. Epithelial ovarian cancer is the most common of the three and the leading cause of death from gynecologic cancer in the United States. In 2007 22 430 new cases were diagnosed and 15 280 women died from ovarian cancer. Epithelial ovarian cancer accounts for 5 of all cancer deaths in women in the United States more women die of this disease than from cervical and endometrial cancer combined. The age-specific incidence of the common epithelial type of ovarian cancer increases progressively and peaks in the eighth decade. Epithelial tumors unlike germ cell and stromal tumors are uncommon before the age of 40. Epidemiologic studies suggest higher incidences in women with a family history in those who have been exposed to asbestos or talc in industrialized nations and in women with disordered ovarian function including infertility nulliparity and frequent miscarriages. The use of ovulation-inducing drugs such as clomiphene has been implicated but the studies have produced mixed results. Reduction in ovarian cancer risk is associated with pregnancy each pregnancy reduces the ovarian cancer risk by about 10 breast-feeding and tubal ligation. Oral contraceptives reduce the risk of ovarian cancer in patients with a family history of cancer and in the general population. Many of these risk-reduction factors support the quot incessant ovulation quot hypothesis for ovarian cancer etiology which implies that an aberrant repair process of the surface epithelium is central to ovarian cancer development. Estrogen replacement after menopause does not appear to increase the risk of ovarian cancer although its use has declined substantially since the HRT trials demonstrated an increased cardiovascular risk. Familial cases .