• Ovarian Cancer
• Vulvar and Vaginal Cancer
• Urinary Incontinence and prolapse
• Uterine Cancer
• Genetic Testing
• Chemotherapy

   

Ovarian Cancer

Ovarian cancer remains one of the most deadliest gynecologic cancers due to limited ability to diagnose the condition at an early stage.  About 24,000 new cases of ovarian cancer occur annually in the United States, and 13, 600 women die annually of ovarian cancer. The lifetime risk is 1.4 %.

Risk factors

• Environmental factors: a high incidence of ovarian cancer is noted in industrialized countries. Obesity and alcohol consumption have been weakly linked, and coffee and tobacco are not associated with ovarian cancer. There are conflicting reports on the effects of mumps, talcum powder, and fat intake.
• Reproductive factors: an increased number of ovulatory cycles correlates with a higher risk of developing ovarian cancer. Conditions that decrease ovulation frequency reduce the risk of cancer, as follows: 1) Birth control pills decrease risks by 50%, when taken more for 5 years. 2) Multiple births, history of breast feeding
• Genetic factors: 5% to10% of ovarian cancers are hereditary.  Hereditary ovarian and breast cancer syndrome may be identified in patients having at least two first-degree relatives with ovarian cancer, or with positive BRCA1 and BRCA2 genetic testing.

Signs and symptoms

Most patients are symptomatic (95%), but symptoms are nonspecific – abdominal discomfort, bloating, increased pelvic pressure or painful intercourse, weight gain related to abdominal fluid ( ascites fluid ) or from a solid tumor mass.

Diagnostic testing

Diagnostic testing includes laboratory tumor markers such as serum CA-125, pelvic examination, and pelvic sonogram.  Increased surveillance testing may be offered every 6 months in patients with hereditary risk factors of positive testing for BRCA mutation.  In this high-risk population, prophylactic surgery may be considered after age 35 years and  when childbearing is complete. Prophylactic surgery such as oophorectomy may significantly reduce the risk for ovarian cancer, though patients undergoing such surgery continue to have an increased lifetime risk of 2% for developing primary peritoneal carcinoma, a rare abdominal malignancy with similarities to ovarian cancer.

Treatment

• Surgery: total abdominal hysterectomy and salpingo-oophorectomy (TAH-BSO), omentectomy, obtaining ascities fluid or peritoneal washings, and attempting optimal debulking (< 1 cm residual tumor), lymph nodes sampling.
• Chemotherapy depending on stage and histology.
• Radiotherapy: for patients with less common histologic types of ovarian cancer such as granulosa cell tumor.

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