Ovarian Cancer

Introduction

This article provides an informative guide on ovarian cancer for medical students preparing for the United States Medical Licensing Examination (USMLE). Ovarian cancer is a significant health concern affecting women worldwide. Understanding its epidemiology, risk factors, clinical presentation, diagnosis, and treatment options is vital for physicians.

Epidemiology

• Ovarian cancer is the fifth most common cause of cancer-related deaths in women.
• Incidence increases with age, peaking in the seventh decade of life.
• The majority of cases occur sporadically, while a small proportion has familial or hereditary predisposition.

Risk Factors

• Family history of ovarian, breast, or colorectal cancer, especially in first-degree relatives.
• BRCA1 and BRCA2 gene mutations significantly increase the risk of developing ovarian cancer.
• Personal history of breast, endometrial, or colorectal cancer.
• Increasing age, nulliparity, early menarche, late menopause, and infertility are additional risk factors.

Clinical Presentation

• Ovarian cancer often presents with non-specific symptoms, leading to delayed diagnosis.
• Abdominal bloating, pelvic or abdominal pain, urinary urgency or frequency, and feeling full quickly after eating are common symptoms.
• Ascites, palpable abdominal mass, or signs of metastasis may be present in advanced stages.

Diagnosis

• Transvaginal ultrasound is the initial imaging modality of choice for evaluating adnexal masses.
• CA-125, a tumor marker, is commonly elevated in ovarian cancer but lacks specificity.
• Surgical exploration with histological examination remains the gold standard for definitive diagnosis.

Staging

• Ovarian cancer staging follows the FIGO (International Federation of Gynecology and Obstetrics) system.
• Stages range from I (limited to the ovaries) to IV (distant metastasis).
• Staging involves surgical exploration, histopathological assessment, and imaging studies.

Treatment

• Surgery is the primary treatment modality for ovarian cancer.
• Optimal debulking of tumor masses is associated with improved prognosis.
• Chemotherapy, typically a combination of platinum-based agents and taxanes, is administered pre- or post-operatively.
• Targeted therapies, such as PARP inhibitors, have shown efficacy in specific subsets of patients.

Prognosis

• Ovarian cancer has a relatively poor prognosis due to late-stage diagnosis and aggressive behavior.
• The five-year survival rate varies significantly depending on the stage of the disease at diagnosis.
• Early-stage disease has better outcomes, while advanced-stage disease has a higher mortality rate.

Conclusion

Understanding the epidemiology, risk factors, clinical presentation, diagnosis, and treatment options of ovarian cancer is essential for medical students preparing for the USMLE. Familiarity with the staging system and prognosis enables physicians to provide appropriate management and support for patients with this challenging disease.