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{{Ovarian cancer}}
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==Overview==
==Overview==
Ovarian cancer is the fifth leading cause of [[cancer]] death in [[women]], the leading cause of death from [[gynecology|gynecological]] malignancy, and the second most commonly diagnosed gynecologic malignancy.<ref>[http://www.merck.com/mrkshared/mmanual/section18/chapter241/241b.jsp The Merck Manual of Diagnosis and Therapy Section 18. Gynecology And Obstetrics Chapter 241. Gynecologic Neoplasms]</ref>
[[Ovarian cancer]] is the 7th most common type of [[cancer]] in women worldwide and the 8th most common type of [[cancer]] in the [[United States]]. [[Ovarian cancer]] is the second most common [[Gynecologic Malignancies|gynecologic malignancy]] and the most common cause of [[gynecologic cancer]] death in the [[United States]]. [[Ovarian cancer]] is the second most common gynecologic malignancy in developed countries, with an incidence of 9.4 per 100,000 women and a mortality rate of 5.1 per 100,000. In developing countries, it is the third most common gynecologic malignancy (cervical cancer is the most common), with an incidence of 5.0 per 100,000 and a mortality rate of 3.1 per 100,000. The age-adjusted [[prevalence]] of [[ovarian cancer]] in the [[United States]] is 71.3 per 100,000 in 2011. The estimated number of new cases of [[ovarian cancer]] is approximately 22,000.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The exact cause is usually unknown. The disease is more common in industrialized nations, with the exception of Japan. In the United States, females have a 1.4% to 2.5% (1 out of 40-60 women) lifetime chance of developing ovarian cancer.
Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age and approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.
The risk of developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older ages of final pregnancy and the use of low dose [[hormonal contraception]] have also been shown to have a protective effect. Ovarian cancer is reduced in women after [[tubal ligation]].
The link to the use of [[fertility medication]], such as [[Clomiphene citrate]], has been controversial. An analysis in 1991 raised the possibility that use of drugs may increase the risk of ovarian cancer. Several [[cohort]] studies and [[case-control]] studies have been conducted since then without providing conclusive evidence for such a link. <ref>{{cite journal |author=Brinton LA, Moghissi KS, Scoccia B, Westhoff CL, Lamb EJ |title=Ovulation induction and cancer risk |journal=Fertil. Steril. |volume=83 |issue=2 |pages=261-74; quiz 525-6 |year=2005 |pmid=15705362 |doi=10.1016/j.fertnstert.2004.09.016}}</ref> It will remain a complex topic to study as the infertile population differs in [[parity (medicine)|parity]] from the "normal" population.
There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the [[BRCA1]] or the [[BRCA2]] [[gene]] and certain populations (e.g. Ashkenazi Jewish women) are at a higher risk of both [[breast cancer]] and ovarian cancer, often at an earlier age than the general population. Patients with a personal history of breast cancer or a family history of breast and/or ovarian cancer, especially if at a young age, may have an elevated risk. A strong family history of [[uterine cancer]], [[colon cancer]], or other [[gastrointestinal cancer]]s may indicate the presence of a syndrome known as [[hereditary nonpolyposis colorectal cancer]] (HNPCC, also known as [[Hereditary nonpolyposis colorectal cancer|Lynch II syndrome]]), which confers a higher risk for developing ovarian cancer. Patients with strong genetic risk for ovarian cancer may consider the use of [[prophylactic]] i.e. preventative [[oophorectomy]] after completion of child-bearing.
A Swedish study, which followed more than 61,000 women for 13 years, has found a significant link between milk consumption and ovarian cancer. According to the BBC, "[Researchers] found that milk had the strongest link with ovarian cancer - those women who drank two or more glasses a day were at double the risk of those who did not consume it at all, or only in small amounts." <ref>BBC News [http://news.bbc.co.uk/2/hi/health/4051331.stm Milk link to ovarian cancer risk] 29 November 2004</ref> Recent studies have shown that women in sunnier countries have a lower rate of ovarian cancer, which may have some kind of connection with exposure to Vitamin D.
Other factors that have been investigated, such as [[talc]] use, [[asbestos]] exposure, high dietary fat content, and childhood [[mumps]] infection, are controversial and have not been definitively proven.
"Associations were also found between alcohol consumption and cancers of the ovary and prostate, but only for 50 g and 100 g a day."<ref>[http://www.jr2.ox.ac.uk/bandolier/booth/hliving/alccan.html Alcohol consumption and cancer risk]</ref>
===Prevalence===
===Prevalence===
 
*[[Ovarian cancer]] is more common in industrialized nations, with the exception of Japan. In the [[United States]], females have a 1.4% to 2.5% (1 out of 40-60 women) lifetime chance of developing [[ovarian cancer]].<ref name="cancerresearch">[http://www.cancerresearchuk.org/cancer-info/cancerstats/types/ovary/incidence/#source10 Ovarian cancer incidence statistics. Cancer research UK]</ref><ref name="Brett M.Brett M.2017">{{cite journal|last1=Brett M.|first1=Reid|last2=Brett M.|first2=Reid|last3=Jennifer B.|first3=Permuth|last4=Thomas A.|first4=Sellers|last5=Jennifer B.|first5=Permuth|last6=Thomas A.|first6=Sellers|title=Epidemiology of ovarian cancer: a review|journal=Cancer Biology & Medicine|volume=14|issue=1|year=2017|pages=9–32|issn=2095-3941|doi=10.20892/j.issn.2095-3941.2016.0084}}</ref>
* In the United States, the age-adjusted [[prevalence]] of ovarian cancer is 71.3 per 100,000 in 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
*In the United States, the age-adjusted [[prevalence]] of [[ovarian cancer]] is 71.3 per 100,000 in 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


===Incidence===
===Incidence===


* The delay-adjusted [[incidence]] of ovarian cancer in 2011 was estimated to be 12.46 per 100,000 persons in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* The delay-adjusted [[incidence]] of [[ovarian cancer]] in 2011 was estimated to be 12.46 per 100,000 persons in the [[United States]].<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref><ref name="pmid24399786">{{cite journal| author=Siegel R, Ma J, Zou Z, Jemal A| title=Cancer statistics, 2014. | journal=CA Cancer J Clin | year= 2014 | volume= 64 | issue= 1 | pages= 9-29 | pmid=24399786 | doi=10.3322/caac.21208 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24399786  }} </ref>


* In 2011, the age-adjusted [[incidence]] of ovarian cancer was 12.09 per 100,000 persons in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* In 2011, the age-adjusted [[incidence]] of [[ovarian cancer]] was 12.09 per 100,000 persons in the [[United States|United States.]]<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


===Age===
===Age===
* Older women are at highest risk. More than half of the deaths from [[ovarian cancer]] occur in women between 55 and 74 years of age.


* While the overall age-adjusted [[incidence]] of ovarian cancer in the United States between 2007 and 2011 is 12.3 per 100,000, the age-adjusted [[incidence]] of ovarian cancer by age category is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* While the overall age-adjusted [[incidence]] of [[ovarian cancer]] in the [[United States]] between 2007 and 2011 is 12.3 per 100,000, the age-adjusted [[incidence]] of [[ovarian cancer]] by age category is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** Under 65 years: 7.5 per 100,000
** Under 65 years: 7.5 per 100,000
** 65 and over: 45.2 per 100,000
** 65 and over: 45.2 per 100,000


* Shown below is an image depicting the delay-adjusted [[incidence]] and observed [[incidence]] of ovarian cancer by age and race in the United States between 1975 and 2011.  These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* Shown below is an image depicting the delay-adjusted [[incidence]] and observed [[incidence]] of [[ovarian cancer]] by [[age]] and [[race]] in the [[United States]] between 1975 and 2011.  These graphs are adapted from [[SEER]]: The Surveillance, [[Epidemiology]], and End Results Program of the [[National Cancer Institute]].<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


[[Image:Incidence of ovarian cancer by age and race.png|Delay-adjusted [[incidence]] and observed [[incidence]] of ovarian cancer by age and race in the United States between 1975 and 2011]]
[[Image:Incidence of ovarian cancer by age and race.png|Delay-adjusted [[incidence]] and observed [[incidence]] of ovarian cancer by age and race in the United States between 1975 and 2011]]
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* Shown below is an image depicting the [[incidence]] of ovarian cancer by race in the United States between 1975 and 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* Shown below is an image depicting the [[incidence]] of [[ovarian cancer]] by race in the [[United States]] between 1975 and 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


[[Image:Incidence of ovarian cancer by race.png|Incidence of ovarian cancer by race in the United States between 1975 and 2011]]
[[Image:Incidence of ovarian cancer by race.png|Incidence of ovarian cancer by race in the United States between 1975 and 2011]]
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===Percent Distribution of Ovarian Cancer by Histology===
===Percent Distribution of Ovarian Cancer by Histology===
Among patients with histologically confirmed cases of ovarian cancer, the percent distribution of the types of the disease between 2007 and 2011 in the United States are:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
Among patients with [[histologically]] confirmed cases of [[ovarian cancer]], the percent distribution of the types of the [[disease]] between 2007 and 2011 in the [[United States]] are:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


* Carcinoma: 91.7%
*[[Carcinoma]]: 91.7%
** [[Epidermoid carcinoma]]: 0.7%
**[[Epidermoid carcinoma]]: 0.7%
** [[Adenocarcinoma]]: 84%
**[[Adenocarcinoma]]: 84%
*** [[Adenocarcinoma]], not otherwise specified: 12.3%
***[[Adenocarcinoma]], not otherwise specified: 12.3%
*** Papillary adenocarcinoma: 1,5%
*** Papillary adenocarcinoma: 1,5%
*** Clear cell adenocarcinoma: 5.2%
*** Clear cell adenocarcinoma: 5.2%
*** Endometrioid carcinoma: 9.7%
***[[Endometrioid tumor|Endometrioid carcinoma]]: 9.7%
*** Cystadenocarcinoma, not otherwise specified: 0.4%
*** Cystadenocarcinoma, not otherwise specified: 0.4%
*** Serous cystadenocarcinoma: 20.9%
*** Serous cystadenocarcinoma: 20.9%
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Latest revision as of 19:19, 14 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2] Huda A. Karman, M.D.

Overview

Ovarian cancer is the 7th most common type of cancer in women worldwide and the 8th most common type of cancer in the United States. Ovarian cancer is the second most common gynecologic malignancy and the most common cause of gynecologic cancer death in the United States. Ovarian cancer is the second most common gynecologic malignancy in developed countries, with an incidence of 9.4 per 100,000 women and a mortality rate of 5.1 per 100,000. In developing countries, it is the third most common gynecologic malignancy (cervical cancer is the most common), with an incidence of 5.0 per 100,000 and a mortality rate of 3.1 per 100,000. The age-adjusted prevalence of ovarian cancer in the United States is 71.3 per 100,000 in 2011. The estimated number of new cases of ovarian cancer is approximately 22,000.

Epidemiology and Demographics

Prevalence

Incidence

Age

  • Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age.

Delay-adjusted incidence and observed incidence of ovarian cancer by age and race in the United States between 1975 and 2011

Race

  • Shown below is a table depicting the age-adjusted prevalence of ovarian cancer by race in 2011 in the United States.[3]
All Races White Black Asian/Pacific Islander Hispanic
Age-adjusted prevalence 71.3 per 100,000 76.2 per 100,000 44.2 per 100,000 63.2 per 100,000 59.1 per 100,000

Incidence of ovarian cancer by race in the United States between 1975 and 2011

API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native

Percent Distribution of Ovarian Cancer by Histology

Among patients with histologically confirmed cases of ovarian cancer, the percent distribution of the types of the disease between 2007 and 2011 in the United States are:[3]

  • Carcinoma: 91.7%
    • Epidermoid carcinoma: 0.7%
    • Adenocarcinoma: 84%
      • Adenocarcinoma, not otherwise specified: 12.3%
      • Papillary adenocarcinoma: 1,5%
      • Clear cell adenocarcinoma: 5.2%
      • Endometrioid carcinoma: 9.7%
      • Cystadenocarcinoma, not otherwise specified: 0.4%
      • Serous cystadenocarcinoma: 20.9%
      • Papillary serous cystadenocarcinoma: 23.5%
      • Mucinous cystadenocarcinoma: 1.5%
      • Mucinous adenocarcinoma: 3.5%
      • Mucin-producing adenocarcinoma: 0.2%
      • Other adenocarcinoma: 5.3%
    • Other specific carcinoma: 2.3%
      • Stromal cell tumor: 1.6%
      • Other: 0.7%
    • Unspecified carcinoma, not otherwise specified: 4.6%
  • Sarcoma and other soft tissues: 0.4%
  • Other specific types: 6.9%
    • Mullerian mixed tumor: 3%
    • Malignant teratoma: 1.5%
    • Other: 2.4%
  • Unspecified: 1.1%

References

  1. ↑ Ovarian cancer incidence statistics. Cancer research UK
  2. ↑ Brett M., Reid; Brett M., Reid; Jennifer B., Permuth; Thomas A., Sellers; Jennifer B., Permuth; Thomas A., Sellers (2017). "Epidemiology of ovarian cancer: a review". Cancer Biology & Medicine. 14 (1): 9–32. doi:10.20892/j.issn.2095-3941.2016.0084. ISSN 2095-3941.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  4. ↑ Siegel R, Ma J, Zou Z, Jemal A (2014). "Cancer statistics, 2014". CA Cancer J Clin. 64 (1): 9–29. doi:10.3322/caac.21208. PMID 24399786.


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