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Ebook Gynaecological oncology for the MRCOG: Part 2

Part 2 book “Gynaecological oncology for the MRCOG” has contents: Endometrial cancer, uterine sarcomas, cervical and vaginal cancer, vulval cancer, non-epithelial ovarian tumours and gestational trophoblastic neoplasia, palliative care, living with cancer, communication in gynaecological oncology, and other contents. | 10 Ovarian, Fallopian Tube and Primary Peritoneal Cancer (including Borderline) Hilary Turnbull and Timothy Duncan Introduction cell tumours). High-grade serous epithelial ovarian carcinoma (HGEOC), fallopian tube and peritoneal carcinomas are currently considered to be a single entity due to their similar pathogenesis and clinical characteristics. For the remainder of this chapter, epithelial ovarian cancer (EOC) will refer to this group of malignancies. Ovarian cancer is the sixth commonest cancer affecting women, with over 7,000 new cases diagnosed in the United Kingdom each year. The lifetime risk of developing ovarian cancer is approximately 2%. Despite the availability of newer chemotherapeutic agents and more advanced surgical techniques, mortality rates have changed very little. The number of deaths from ovarian cancer is greater than all other gynaecological cancers combined. Ovarian cancer usually presents at an advanced stage, due to a relative lack of specific signs and symptoms at the early stages, coupled with a lack of reliable screening tools. Currently, statistics show that UK survival rates are significantly worse, with 30–40% 5-year survival rates, compared to other developed countries including Canada, Australia, Norway and Sweden (Figure 10.1). The majority of ovarian cancers arise from epithelial cells, with the remainder originating from other ovarian cell types (i.e. sex cord–stromal tumours, germ Aetiology and Risk Factors Epidemiological data shows that the risk of ovarian cancer increases with greater numbers of ovulation cycles. Conversely, pregnancies and use of oral contraceptives are associated with a lower risk of ovarian cancer. The following theories explain the association between ovarian cancer and number of ovulation cycles: 1. The incessant ovulation theory – Ovulation results in follicular rupture which induces minor trauma, inflammation and subsequent repair to the surface epithelium. Repeated ovulations Average number