eMedicine Specialties > Radiology > Obstetrics/Gynecology

Ovary, Malignant Tumors

Author: Arthur C Fleischer, MD, Professor, Chief of Diagnostic Sonography, Departments of Radiology and Obstetrics/Gynecology, Vanderbilt University Medical Center
Coauthor(s): Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Contributor Information and Disclosures

Updated: Feb 10, 2009

Introduction

Ovarian cancer is a silent killer; however, recent improvements in identification of women at high risk for ovarian cancer, as well as improved imaging techniques, increase the likelihood of early detection.

Transvaginal, color Doppler ultrasonogram shows a...

Transvaginal, color Doppler ultrasonogram shows a solid mass in the left ovary. Low impedance flow is noted within this mass, which is a clear cell carcinoma of the ovary.

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Transvaginal, color Doppler ultrasonogram shows a...

Transvaginal, color Doppler ultrasonogram shows a solid mass in the left ovary. Low impedance flow is noted within this mass, which is a clear cell carcinoma of the ovary.


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Three-dimensional, color Doppler ultrasonogram shows a cystic mass containing a vascular papillary excrescence; this is indicative of ovarian cancer.

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Three-dimensional, color Doppler ultrasonogram sh...

Three-dimensional, color Doppler ultrasonogram shows a cystic mass containing a vascular papillary excrescence; this is indicative of ovarian cancer.


For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Ovarian Cancer.

Related eMedicine topics:

 Adnexal Tumors

Borderline Ovarian Cancer

Malignant Lesions of the Ovaries

Ovarian Cancer

Pathophysiology

The cause of ovarian cancer is not known. A connection between the number of ovulatory events and the risk of ovarian cancer appears to exist. Ovulation suppression has been shown to decrease cancer incidence.

Most theories include the concept that ovarian cancer begins with the dedifferentiation of the cells overlying the ovary. During ovulation, these cells can be incorporated into the ovary, where they then proliferate. Ovarian cancer typically spreads to the peritoneal surfaces and omentum.

Only an estimated 10% of affected patients have a genetic predisposition. The patients at highest risk are women with site-specific inheritance.1 In these patients, ovarian cancer develops early, when they are aged 30-50 years.

Other risk factors include breast carcinoma. The identification of a genetic mutation for breast cancer suggests a greater risk for ovarian cancer. One study revealed that patients with the BRCA gene had a 60% risk of developing ovarian cancer.

Frequency

United States

In the United States, the incidence of ovarian cancer is 33 cases per 100,000 women aged 50 years or older. The average patient age at diagnosis is 57 years. The lifetime risk is 1 case in 70 women, which is a 1.4% lifetime incidence.

International

Internationally, the incidence is 3.1 cases per 100,000 women in Japan and 21 cases per 100,000 women in Sweden.

Mortality/Morbidity

Ovarian cancer is the most deadly gynecologic malignancy, with an overall survival rate of approximately 35%. Approximately 60% of cases of ovarian cancer are lethal. The advent of techniques for earlier detection and more effective treatment may improve the overall survival rate.2,3

Race

Ovarian cancer is more common among American women in the white population than it is among those in the black population.

Sex

Ovarian cancer affects only females.

Age

The average patient age at presentation is 57 years. Women with a site-specific predisposition for ovarian cancer may present with symptoms when they are aged 30-50 years.

Anatomy

Ovarian cancer spreads into the peritoneum, the omentum, and, in rare cases, the liver.

Presentation

No specific signs or symptoms are observed in ovarian cancer. Some investigators report abdominal or pelvic swelling or pressure.

Preferred Examination

Pelvic ultrasonography is the examination of choice, followed by magnetic resonance imaging (MRI) and/or computed tomography (CT) scanning.3,4,5

Limitations of Techniques

The ovary may be difficult to delineate in some women who are postmenopausal because of its relatively small size (<2 × 2 cm), its position deep within the pelvis, and the lack of identifiable contained structures, such as cysts.

Differential Diagnoses

Pelvic Inflammatory Disease/Tubo-ovarian Abscess

More on Ovary, Malignant Tumors

Overview: Ovary, Malignant Tumors
Imaging: Ovary, Malignant Tumors
Multimedia: Ovary, Malignant Tumors
References
Further Reading
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References

  1. Bourne TH, Campbell S, Reynolds KM, et al. Screening for early familial ovarian cancer with transvaginal ultrasonography and colour blood flow imaging. BMJ. Apr 17 1993;306(6884):1025-9. [Medline]. [Full Text].

  2. Chan JK, Teoh D, Hu JM, et al. Do clear cell ovarian carcinomas have poorer prognosis compared to other epithelial cell types? A study of 1411 clear cell ovarian cancers. Gynecol Oncol. Apr 4 2008;[Medline].

  3. Woodward ER, Sleightholme HV, Considine AM, et al. Annual surveillance by CA125 and transvaginal ultrasound for ovarian cancer in both high-risk and population risk women is ineffective. BJOG. Dec 2007;114(12):1500-9. [Medline].

  4. Fleischer A. Ovarian cancer. In: Fleischer AC, Javitt MC, Jeffrey RB Jr, et al, eds. Clinical Gynecologic Imaging. 1996. Philadelphia, Pa: Lippincott Williams & Wilkins; 107.

  5. [Best Evidence] Yazbek J, Raju SK, Ben-Nagi J, et al. Effect of quality of gynaecological ultrasonography on management of patients with suspected ovarian cancer: a randomised controlled trial. Lancet Oncol. Feb 2008;9(2):124-31. [Medline].

  6. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. Sep-Oct 2000;20(5):1445-70. [Medline]. [Full Text].

  7. Buy JN, Ghossain MA, Moss AA, et al. Cystic teratoma of the ovary: CT detection. Radiology. Jun 1989;171(3):697-701. [Medline]. [Full Text].

  8. Kitajima K, Kaji Y, Kuwata Y, et al. Magnetic resonance imaging findings of endometrioid adenocarcinoma of the ovary. Radiat Med. Aug 1 2007;25(7):346-54. [Medline].

  9. Okamoto Y, Tanaka YO, Tsunoda H, et al. Malignant or borderline mucinous cystic neoplasms have a larger number of loculi than mucinous cystadenoma: a retrospective study with MR. J Magn Reson Imaging. Jul 2007;26(1):94-9. [Medline].

  10. Hricak H, Chen M, Coakley FV, et al. Complex adnexal masses: detection and characterization with MR imaging--multivariate analysis. Radiology. Jan 2000;214(1):39-46. [Medline]. [Full Text].

  11. Fleischer AC, Cullinan JA, Peery CV, et al. Early detection of ovarian carcinoma with transvaginal color Doppler ultrasonography. Am J Obstet Gynecol. Jan 1996;174(1 Pt 1):101-6. [Medline].

  12. Schulman H, Conway C, Zalud I, et al. Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler. Ultrasound Obstet Gynecol. Sep 1 1994;4(5):414-20. [Medline].

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Keywords

ovarian cancer, ovarian tumor, ovarian carcinoma, ovarian malignancy, primary ovarian cancer, ovarian neoplasm, gynecologic malignancy, gynecologic cancer

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Contributor Information and Disclosures

Author

Arthur C Fleischer, MD, Professor, Chief of Diagnostic Sonography, Departments of Radiology and Obstetrics/Gynecology, Vanderbilt University Medical Center
Arthur C Fleischer, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Coauthor(s)

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

Medical Editor

Harris L Cohen, MD, FACR, Vice Chairman/Associate Chairman (Research Activities), Director, Division of Body Imaging, Professor of Radiology, Stony Brook School of Medicine; Visiting Professor of Radiology, Johns Hopkins School of Medicine
Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Lawrence M Davis, MD, Assistant Professor of Diagnostic Imaging (Clinical), Department of Diagnostic Imaging, Warren Alpert Medical School at Brown University
Lawrence M Davis, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, Radiological Society of North America, and Rhode Island Medical Society
Disclosure: Nothing to disclose.

 
 
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