Addar. Professor Gyneoncologist .

OB/GYN Dept KKUH and College of Medicine MKing Saud University

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Professor Mohammed Hassan Addar

Introduction
It is the most lethal gynecological

malignancy >25,000 women in USA annually 14,000 deaths annually Incidence has increased by 30% over the past decade Deaths from ovarian cancer increased by 18% 60% of patients present with advancedstage disease

Epidemiology
The etiologies of epithelial ovarian cancer

are not known Age The mean age at diagnosis is 59 years 15.7 per 100,000 women at age 40 years 54 per 100,000mwomen at age 79 years One women in 70 in the USA will develop ovarian cancer Ov ca is a disease of postmenopausal women, women with a family history of breast ca and ov.ca may be diagnosed with ov.ca up to 10 years earlier than the

Family history
The strongest risk factor A women with a single first-degree relative with ov.Ca has a relative risk (RR) of approximately 3.6 for developing ov.ca compared with general population Her life time risk approx. 5% 5-10% of ov.ca are linked to identifiable, inherited mutations in certain genes Families in which three or more first-degree relatives have ovarian or ovarian plus breast cancer are likley to have a cancersusceptibility genetic mutation that is transmitted in an autosomal-dominant inheritance pattern

Family history
Three familial ovarian cancer

syndromes: The site specific ovarian ov.ca syndrome # only ov.ca is seen # account for 10-15% of hereditary ov.ca The hereditary breast/ovarian cancer syndrome #associated with 65-75% of

`Family history
In the hereditary nonpolyposis

colorectal cancer syndrome (HNPCC), affected individuals may have colon, endometrial, breast, ovarian or other cancers HNPCC kindred's account for an additional 10-15% of hereditary ovarian cancer The hereditary breast/ovarian cancer syndrome and perhaps less frequently the site specific ovarian cancer

Ethnicity
Higher in white women Higher in north America and northern

Europe than Japan Difference related to genetics, diet, or environmental exposure or a combination BRCA1 and BRCA2 genes are more common among white women of Ashkenazi descent Incidence of ov.ca is higher in countries with higher in countries with higher per capita consumption of animal fat

Reproduction factors
Nulliparous First childbirth after age 35 years Involuntary infertility Late menopause and early menarche RR (2.0-5.0) Pts. With prolonged period or

uninterrupted ovulation

Exogenous hormones
OCP decreased risk of epithelial

tumors RR 0.5 in 5 years or more users HRT

 Hysterectomy Decrease the risk Smoking

no relation

Symptoms and Signs

Early stage asymptomatic 10-12 cm Bloating, abdominal discomfort,

pelvic pressure, urinary and rectal symptoms Ascites , pleural effusion and shortness of breath cashecsia

Ovarian Cancer

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Ovarian Cancer

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