Epidemiology
Ovarian cancer is the fourth most common cancer in the UK, accounting for 5% of all deaths in women aged 40–60 years. The average age at presentation is 60 years. Fallopian tube and peritoneal cancer can share histological features with ovarian cancer and are treated in a similar approach.
Aetiology
Suppressed ovulation appears to protect against the development of ovarian cancer, so pregnancy, prolonged breastfeeding and the high-oestrogen contraceptive pill have all been shown to reduce the risk of ovarian cancer.
Up to 7% of women with ovarian cancer have a positive family history. Patients with Peutz–Jeghers syndrome have a 10% risk of ovarian cancer. Two well-recognised familial patterns occur:
- hereditary breast/ovarian cancer families, which have mutations in the BRCA1 or BRCA2 gene;
- Lynch type II families, which have an increased risk of ovarian, endometrial, colorectal and gastric tumours and carry mutations in mismatch repair enzymes (see Chapter 8).
Pathophysiology
Epithelial tumours are the most common cancer of the ovary (90%). They include adenocarcinoma, which can have a variety of histological appearances including serous (46%), mucinous (36%), endometrioid (8%), clear cell (3%) and squamous cell carcinomas (<1%).
Other rare types of ovarian tumours include:
- germ cell tumours, which resemble testicular germ cell tumours in histology and clinical management (see Chapter 40);
- carcinosarcomas, which are aggressive and more susceptible to haematogenous spread;
- sex cord tumours, including granulosa cell tumours, thecomas, Sertoli–Leydig cell tumours and gonadoblastomas. These occasionally produce oestrogens, causing precocious puberty and postmenopausal bleeding, and androgens causing virilisation.
Clinical presentation
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