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Epithelial Ovarian Cancer
Dr. Urban is a Resident and Dr. Berek is Professor and Chair, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
Ovarian cancer is the most lethal of all cancers that affect only women. Because it is so rarely discovered before it has reached an advanced stage, it is both difficult to treat and difficult to deal with for patients and their families. Detecting early-stage ovarian cancer has proven to be a challenge that modern technology, even high-tech screening methods, have not been able to meet. The vast majority of ovarian tumors begin in the ovarian epithelium, a type of tissue that forms the surface of the ovaries.
By the time most women seek treatment for epithelial ovarian cancer, the disease has already reached an advanced stage, despite the fact that they usually have no more than mild, vague symptoms. Upon diagnosis, the usual next step is surgery to remove all visible tumors, followed by chemotherapy. If the disease is particularly advanced, it may be treated with either intravenous (delivered into the blood through an IV) or intraperitoneal (placed directly inside the abdomen) chemotherapy.
Who Gets Epithelial Ovarian Cancer?
The OddsA contemporary American woman's lifetime risk of developing ovarian cancer is approximately 1 in 70.(1) In 2008, an estimated 21,650 women will be diagnosed with ovarian cancer and 15,520 will die from the disease.(2)
MenopauseMost epithelial ovarian tumors occur in women who are between 56 and 60 and have experienced the physical and hormonal changes of menopause. Nearly 30% of ovarian masses in women who are past menopause are malignant (cancerous), while only 7% are malignant in women of reproductive age.(3)
Patterns of FertilityOvarian cancer is also related to fertility.(4) Early sexual maturity and late menopause both increase a woman's statistical risk of ovarian cancer.(5)
Fertility Drugs, but Not Birth ControlSome have speculated that fertility drugs increase the risk of ovarian cancer, though several studies have found otherwise.(6)(7) One meta-analysis, however, showed that a period of infertility lasting greater than five years was associated with an increased risk of ovarian cancer.(8)
(3) Comments have been made