Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis
- Lee-may Chen, MD
Lee-may Chen, MD
- Professor of Obstetrics, Gynecology, & Reproductive Sciences
- Division of Gynecologic Oncology
- UCSF Helen Diller Family Comprehensive Cancer Center
- Jonathan S Berek, MD, MMS
Jonathan S Berek, MD, MMS
- Laurie Kraus Lacob Professor
- Stanford University School of Medicine
- Fellow, Stanford Distinguished Careers Institute
- Director, Stanford Women's Cancer Center
- Senior Scientific Advisor, Stanford Cancer Institute
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Head of Women's Cancers, Lifespan Cancer Institute
- Director of Medical Oncology, Rhode Island Hospital
- Associate Professor of Medicine, Warren Alpert Medical School of Brown University
Ovarian cancer is the second most common gynecologic malignancy and the most common cause of gynecologic cancer death in the United States (see "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Epidemiology and risk factors", section on 'Epidemiology'). The majority of ovarian malignancies (95 percent) are derived from epithelial cells; the remainder arise from other ovarian cell types (germ cell tumors, sex cord-stromal tumors) (figure 1) .
High-grade serous epithelial ovarian carcinoma (EOC), fallopian tubal, and peritoneal carcinomas are considered a single clinical entity due to their shared clinical behavior and treatment. There is also accumulating evidence of a common pathogenesis for these carcinomas. We will use the term EOC to refer this group of malignancies in the discussion that follows. Distinctions between these conditions, where present, will be addressed. (See "Pathogenesis of ovarian, fallopian tubal, and peritoneal serous carcinomas".)
The clinical features and diagnosis of EOC are reviewed here. An overview of these neoplasms can be found separately. (See "Overview of epithelial carcinoma of the ovary, fallopian tube, and peritoneum".) Related topics are discussed in detail separately, including:
●Screening of asymptomatic women (See "Screening for ovarian cancer".)
●Pathogenesis (See "Pathogenesis of ovarian, fallopian tubal, and peritoneal serous carcinomas".)
- Lacey JV, Sherman ME. Ovarian neoplasia. In: Robboy's Pathology of the Female Reproductive Tract, 2nd ed., Robboy SL, Mutter GL, Prat J, et al. (Eds), Churchill Livingstone Elsevier, Oxford 2009. p.601.
- White RH, Chew HK, Zhou H, et al. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med 2005; 165:1782.
- Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343:1846.
- Goff BA, Mandel L, Muntz HG, Melancon CH. Ovarian carcinoma diagnosis. Cancer 2000; 89:2068.
- Olson SH, Mignone L, Nakraseive C, et al. Symptoms of ovarian cancer. Obstet Gynecol 2001; 98:212.
- Vine MF, Ness RB, Calingaert B, et al. Types and duration of symptoms prior to diagnosis of invasive or borderline ovarian tumor. Gynecol Oncol 2001; 83:466.
- Yawn BP, Barrette BA, Wollan PC. Ovarian cancer: the neglected diagnosis. Mayo Clin Proc 2004; 79:1277.
- Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA 2004; 291:2705.
- Goff BA, Mandel LS, Drescher CW, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer 2007; 109:221.
- http://www.wcn.org/articles/types_of_cancer/ovarian/symptoms/index.html (Accessed on May 26, 2011).
- Friedrich M, Villena-Heinsen C, Schweizer J, et al. Primary tubal carcinoma: a retrospective analysis of four cases with a literature review. Eur J Gynaecol Oncol 1998; 19:138.
- Hippisley-Cox J, Coupland C. Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm. BMJ 2011; 344:d8009.
- Hamilton W, Peters TJ, Bankhead C, Sharp D. Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ 2009; 339:b2998.
- SINHA AC. Hydrops tubae profluens as a presenting symptom in primary carcinoma of the fallopian tube: report of two cases and review of literature. Br Med J 1959; 2:996.
- Ou YC, Huang HY, Huang CC, et al. Primary fallopian tube carcinoma: clinicopathological analysis of 12 cases. Taiwan J Obstet Gynecol 2011; 50:141.
- Schnatz PF, Guile M, O'Sullivan DM, Sorosky JI. Clinical significance of atypical glandular cells on cervical cytology. Obstet Gynecol 2006; 107:701.
- Shanbhogue AK, Shanbhogue DK, Prasad SR, et al. Clinical syndromes associated with ovarian neoplasms: a comprehensive review. Radiographics 2010; 30:903.
- Musto A, Rampin L, Nanni C, et al. Present and future of PET and PET/CT in gynaecologic malignancies. Eur J Radiol 2011; 78:12.
- Diaz JP, Abu-Rustum NR, Sonoda Y, et al. Video-assisted thoracic surgery (VATS) evaluation of pleural effusions in patients with newly diagnosed advanced ovarian carcinoma can influence the primary management choice for these patients. Gynecol Oncol 2010; 116:483.
- Hewitt MJ, Anderson K, Hall GD, et al. Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis. BJOG 2007; 114:46.
- Mehdi G, Maheshwari V, Afzal S, et al. Image-guided fine-needle aspiration cytology of ovarian tumors: An assessment of diagnostic efficacy. J Cytol 2010; 27:91.
- Moore RG, Chung M, Granai CO, et al. Incidence of metastasis to the ovaries from nongenital tract primary tumors. Gynecol Oncol 2004; 93:87.
- de Waal YR, Thomas CM, Oei AL, et al. Secondary ovarian malignancies: frequency, origin, and characteristics. Int J Gynecol Cancer 2009; 19:1160.
- Kondi-Pafiti A, Kairi-Vasilatou E, Iavazzo C, et al. Metastatic neoplasms of the ovaries: a clinicopathological study of 97 cases. Arch Gynecol Obstet 2011; 284:1283.
- Zaino R, Whitney C, Brady MF, et al. Simultaneously detected endometrial and ovarian carcinomas--a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study. Gynecol Oncol 2001; 83:355.
- Soliman PT, Slomovitz BM, Broaddus RR, et al. Synchronous primary cancers of the endometrium and ovary: a single institution review of 84 cases. Gynecol Oncol 2004; 94:456.
- HU CY, TAYMOR ML, HERTIG AT. Primary carcinoma of the fallopian tube. Am J Obstet Gynecol 1950; 59:58.
- Seidman JD, Zhao P, Yemelyanova A. "Primary peritoneal" high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer. Gynecol Oncol 2011; 120:470.
- Prat J, FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014; 124:1.
- CLINICAL PRESENTATION
- Acute presentation
- - Pleural effusion
- - Bowel obstruction
- - Other acute presentations
- Subacute presentation
- - Adnexal mass
- - Pelvic and abdominal symptoms
- - Other symptoms
- - Abdominal distention
- - Atypical glandular cells on cervical cytology
- - Paraneoplastic syndromes
- - Other subacute presentations
- Incidental operative finding
- APPROACH TO EVALUATION OF WOMEN WITH SUSPECTED OVARIAN CANCER
- INITIAL EVALUATION
- SURGICAL EVALUATION
- Preoperative evaluation
- - Assessing for metastatic disease
- Pelvic and abdominal imaging
- Other imaging studies
- Paracentesis, thoracentesis, image-guided biopsy
- - Excluding an extraovarian primary cancer
- - Excluding a synchronous primary cancer
- Surgical evaluation
- DIFFERENTIAL DIAGNOSIS
- TESTING FOR HEREDITARY CANCER SYNDROMES
- REFERRAL TO A SPECIALIST
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS