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
- Director, Stanford Women's Cancer Center
- Stanford Comprehensive Cancer Institute
- Chair, Department of Obstetrics & Gynecology
- Stanford University School of Medicine
- 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
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
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".)
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- 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