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id="toc-Hormones" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hormones"> <div class="vector-toc-text"> 2.1 Hormones </div> </a> <ul id="toc-Hormones-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Genetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genetics"> <div class="vector-toc-text"> 2.2 Genetics </div> </a> <ul id="toc-Genetics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diet" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Diet"> <div class="vector-toc-text"> 2.3 Diet </div> </a> <ul id="toc-Diet-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Environmental_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Environmental_factors"> <div class="vector-toc-text"> 2.4 Environmental factors </div> </a> <ul id="toc-Environmental_factors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other"> <div class="vector-toc-text"> 2.5 Other </div> </a> <ul id="toc-Other-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Protective_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Protective_factors"> <div class="vector-toc-text"> 2.6 Protective factors </div> </a> <ul id="toc-Protective_factors-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> 3 Pathophysiology </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 4 Diagnosis </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Diagnosis subsection </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Examination" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Examination"> <div class="vector-toc-text"> 4.1 Examination </div> </a> <ul id="toc-Examination-sublist" class="vector-toc-list"> <li id="toc-Risk_scoring" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Risk_scoring"> <div class="vector-toc-text"> 4.1.1 Risk scoring </div> </a> <ul id="toc-Risk_scoring-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pathology"> <div class="vector-toc-text"> 4.2 Pathology </div> </a> <ul id="toc-Pathology-sublist" class="vector-toc-list"> <li id="toc-Epithelial_carcinoma" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Epithelial_carcinoma"> <div class="vector-toc-text"> 4.2.1 Epithelial carcinoma </div> </a> <ul id="toc-Epithelial_carcinoma-sublist" class="vector-toc-list"> <li id="toc-Serous_carcinoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Serous_carcinoma"> <div class="vector-toc-text"> 4.2.1.1 Serous carcinoma </div> </a> <ul id="toc-Serous_carcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Small-cell_carcinoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Small-cell_carcinoma"> <div class="vector-toc-text"> 4.2.1.2 Small-cell carcinoma </div> </a> <ul id="toc-Small-cell_carcinoma-sublist" class="vector-toc-list"> <li id="toc-Primary_peritoneal_carcinoma" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Primary_peritoneal_carcinoma"> <div class="vector-toc-text"> 4.2.1.2.1 Primary peritoneal carcinoma </div> </a> <ul id="toc-Primary_peritoneal_carcinoma-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Clear-cell_carcinoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Clear-cell_carcinoma"> <div class="vector-toc-text"> 4.2.1.3 Clear-cell carcinoma </div> </a> <ul id="toc-Clear-cell_carcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Clear-cell_adenocarcinoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Clear-cell_adenocarcinoma"> <div class="vector-toc-text"> 4.2.1.4 Clear-cell adenocarcinoma </div> </a> <ul id="toc-Clear-cell_adenocarcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Endometrioid" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Endometrioid"> <div class="vector-toc-text"> 4.2.1.5 Endometrioid </div> </a> <ul id="toc-Endometrioid-sublist" class="vector-toc-list"> <li id="toc-Malignant_mixed_müllerian_tumor_(carcinosarcoma)" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Malignant_mixed_müllerian_tumor_(carcinosarcoma)"> <div class="vector-toc-text"> 4.2.1.5.1 Malignant mixed müllerian tumor (carcinosarcoma) </div> </a> <ul id="toc-Malignant_mixed_müllerian_tumor_(carcinosarcoma)-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mucinous" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Mucinous"> <div class="vector-toc-text"> 4.2.1.6 Mucinous </div> </a> <ul id="toc-Mucinous-sublist" class="vector-toc-list"> <li id="toc-Mucinous_adenocarcinoma" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Mucinous_adenocarcinoma"> <div class="vector-toc-text"> 4.2.1.6.1 Mucinous adenocarcinoma </div> </a> <ul id="toc-Mucinous_adenocarcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pseudomyxoma_peritonei" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Pseudomyxoma_peritonei"> <div class="vector-toc-text"> 4.2.1.6.2 Pseudomyxoma peritonei </div> </a> <ul id="toc-Pseudomyxoma_peritonei-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Undifferentiated_epithelial" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Undifferentiated_epithelial"> <div class="vector-toc-text"> 4.2.1.7 Undifferentiated epithelial </div> </a> <ul id="toc-Undifferentiated_epithelial-sublist" class="vector-toc-list"> <li id="toc-Malignant_Brenner_tumor" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Malignant_Brenner_tumor"> <div class="vector-toc-text"> 4.2.1.7.1 Malignant Brenner tumor </div> </a> <ul id="toc-Malignant_Brenner_tumor-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transitional_cell_carcinoma" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Transitional_cell_carcinoma"> <div class="vector-toc-text"> 4.2.1.7.2 Transitional cell carcinoma </div> </a> <ul id="toc-Transitional_cell_carcinoma-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Sex_cord-stromal_tumor" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Sex_cord-stromal_tumor"> <div class="vector-toc-text"> 4.2.2 Sex cord-stromal tumor </div> </a> <ul id="toc-Sex_cord-stromal_tumor-sublist" class="vector-toc-list"> <li id="toc-Granulosa_cell_tumor" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Granulosa_cell_tumor"> <div class="vector-toc-text"> 4.2.2.1 Granulosa cell tumor </div> </a> <ul id="toc-Granulosa_cell_tumor-sublist" class="vector-toc-list"> <li id="toc-Adult_granulosa_cell_tumor" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Adult_granulosa_cell_tumor"> <div class="vector-toc-text"> 4.2.2.1.1 Adult granulosa cell tumor </div> </a> <ul id="toc-Adult_granulosa_cell_tumor-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Juvenile_granulosa_cell_tumor" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#Juvenile_granulosa_cell_tumor"> <div class="vector-toc-text"> 4.2.2.1.2 Juvenile granulosa cell tumor </div> </a> <ul id="toc-Juvenile_granulosa_cell_tumor-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Sertoli-Leydig_cell_tumor" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Sertoli-Leydig_cell_tumor"> <div class="vector-toc-text"> 4.2.2.2 Sertoli-Leydig cell tumor </div> </a> <ul id="toc-Sertoli-Leydig_cell_tumor-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Sclerosing_stromal_tumors" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Sclerosing_stromal_tumors"> <div class="vector-toc-text"> 4.2.2.3 Sclerosing stromal tumors </div> </a> <ul id="toc-Sclerosing_stromal_tumors-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Germ_cell_tumor" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Germ_cell_tumor"> <div class="vector-toc-text"> 4.2.3 Germ cell tumor </div> </a> <ul id="toc-Germ_cell_tumor-sublist" class="vector-toc-list"> <li id="toc-Dysgerminoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Dysgerminoma"> <div class="vector-toc-text"> 4.2.3.1 Dysgerminoma </div> </a> <ul id="toc-Dysgerminoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Choriocarcinoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Choriocarcinoma"> <div class="vector-toc-text"> 4.2.3.2 Choriocarcinoma </div> </a> <ul id="toc-Choriocarcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immature_(solid)_teratoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Immature_(solid)_teratoma"> <div class="vector-toc-text"> 4.2.3.3 Immature (solid) teratoma </div> </a> <ul id="toc-Immature_(solid)_teratoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mature_teratoma_(dermoid_cyst)" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Mature_teratoma_(dermoid_cyst)"> <div class="vector-toc-text"> 4.2.3.4 Mature teratoma (dermoid cyst) </div> </a> <ul id="toc-Mature_teratoma_(dermoid_cyst)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Yolk_sac_tumor/endodermal_sinus_tumor" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Yolk_sac_tumor/endodermal_sinus_tumor"> <div class="vector-toc-text"> 4.2.3.5 Yolk sac tumor/endodermal sinus tumor </div> </a> <ul id="toc-Yolk_sac_tumor/endodermal_sinus_tumor-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Embryonal_carcinoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Embryonal_carcinoma"> <div class="vector-toc-text"> 4.2.3.6 Embryonal carcinoma </div> </a> <ul id="toc-Embryonal_carcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Polyembryoma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Polyembryoma"> <div class="vector-toc-text"> 4.2.3.7 Polyembryoma </div> </a> <ul id="toc-Polyembryoma-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Squamous_cell_carcinoma" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Squamous_cell_carcinoma"> <div class="vector-toc-text"> 4.2.4 Squamous cell carcinoma </div> </a> <ul id="toc-Squamous_cell_carcinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mixed_tumors" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Mixed_tumors"> <div class="vector-toc-text"> 4.2.5 Mixed tumors </div> </a> <ul id="toc-Mixed_tumors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Secondary_ovarian_cancer" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Secondary_ovarian_cancer"> <div class="vector-toc-text"> 4.2.6 Secondary ovarian cancer </div> </a> <ul id="toc-Secondary_ovarian_cancer-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Borderline_tumors" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Borderline_tumors"> <div class="vector-toc-text"> 4.2.7 Borderline tumors </div> </a> <ul id="toc-Borderline_tumors-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Staging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Staging"> <div class="vector-toc-text"> 4.3 Staging </div> </a> <ul id="toc-Staging-sublist" class="vector-toc-list"> <li id="toc-FIGO" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#FIGO"> <div class="vector-toc-text"> 4.3.1 FIGO </div> </a> <ul id="toc-FIGO-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-AJCC/TNM" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#AJCC/TNM"> <div class="vector-toc-text"> 4.3.2 AJCC/TNM </div> </a> <ul id="toc-AJCC/TNM-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Grading" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Grading"> <div class="vector-toc-text"> 4.3.3 Grading </div> </a> <ul id="toc-Grading-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> 5 Prevention </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Screening" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Screening"> <div class="vector-toc-text"> 6 Screening </div> </a> <ul id="toc-Screening-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> 7 Management </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Management subsection </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> 7.1 Surgery </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chemotherapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chemotherapy"> <div class="vector-toc-text"> 7.2 Chemotherapy </div> </a> <ul id="toc-Chemotherapy-sublist" class="vector-toc-list"> <li id="toc-Platinum-sensitive_or_platinum-resistant" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Platinum-sensitive_or_platinum-resistant"> <div class="vector-toc-text"> 7.2.1 Platinum-sensitive or platinum-resistant </div> </a> <ul id="toc-Platinum-sensitive_or_platinum-resistant-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Radiation_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Radiation_therapy"> <div class="vector-toc-text"> 7.3 Radiation therapy </div> </a> <ul id="toc-Radiation_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hormonal_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hormonal_therapy"> <div class="vector-toc-text"> 7.4 Hormonal therapy </div> </a> <ul id="toc-Hormonal_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunotherapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunotherapy"> <div class="vector-toc-text"> 7.5 Immunotherapy </div> </a> <ul id="toc-Immunotherapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Follow-up" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Follow-up"> <div class="vector-toc-text"> 7.6 Follow-up </div> </a> <ul id="toc-Follow-up-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Palliative_care" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Palliative_care"> <div class="vector-toc-text"> 7.7 Palliative care </div> </a> <ul id="toc-Palliative_care-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Psychosocial_care" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Psychosocial_care"> <div class="vector-toc-text"> 7.8 Psychosocial care </div> </a> <ul id="toc-Psychosocial_care-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> 8 Prognosis </div> </a> <button aria-controls="toc-Prognosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Prognosis subsection </button> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> <li id="toc-Prognostic_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Prognostic_factors"> <div class="vector-toc-text"> 8.1 Prognostic factors </div> </a> <ul id="toc-Prognostic_factors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Survival_rates" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Survival_rates"> <div class="vector-toc-text"> 8.2 Survival rates </div> </a> <ul id="toc-Survival_rates-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Recurrence_rates" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Recurrence_rates"> <div class="vector-toc-text"> 8.3 Recurrence rates </div> </a> <ul id="toc-Recurrence_rates-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> 9 Epidemiology </div> </a> <button aria-controls="toc-Epidemiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Epidemiology subsection </button> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> <li id="toc-United_States" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#United_States"> <div class="vector-toc-text"> 9.1 United States </div> </a> <ul id="toc-United_States-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-United_Kingdom" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#United_Kingdom"> <div class="vector-toc-text"> 9.2 United Kingdom </div> </a> <ul id="toc-United_Kingdom-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Ethnicity" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Ethnicity"> <div class="vector-toc-text"> 9.3 Ethnicity </div> </a> <ul id="toc-Ethnicity-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Older_women" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Older_women"> <div class="vector-toc-text"> 9.4 Older women </div> </a> <ul id="toc-Older_women-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-In_pregnancy" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#In_pregnancy"> <div class="vector-toc-text"> 10 In pregnancy </div> </a> <ul id="toc-In_pregnancy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_animals" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Other_animals"> <div class="vector-toc-text"> 11 Other animals </div> </a> <ul id="toc-Other_animals-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> 12 Research </div> </a> <button aria-controls="toc-Research-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Research subsection </button> <ul id="toc-Research-sublist" class="vector-toc-list"> <li id="toc-Screening_2" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Screening_2"> <div class="vector-toc-text"> 12.1 Screening </div> </a> <ul id="toc-Screening_2-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prognosis_research" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Prognosis_research"> <div class="vector-toc-text"> 12.2 Prognosis research </div> </a> <ul id="toc-Prognosis_research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunotherapy_2" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunotherapy_2"> <div class="vector-toc-text"> 12.3 Immunotherapy </div> </a> <ul id="toc-Immunotherapy_2-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pharmacology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pharmacology"> <div class="vector-toc-text"> 12.4 Pharmacology </div> </a> <ul id="toc-Pharmacology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hormones_and_radiation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hormones_and_radiation"> <div class="vector-toc-text"> 12.5 Hormones and radiation </div> </a> <ul id="toc-Hormones_and_radiation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Inflammation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Inflammation"> <div class="vector-toc-text"> 12.6 Inflammation </div> </a> <ul id="toc-Inflammation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Clinical_trials" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Clinical_trials"> <div class="vector-toc-text"> 12.7 Clinical trials </div> </a> <ul id="toc-Clinical_trials-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 13 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> 14 Further reading </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 15 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Ovarian cancer</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 60 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-60" aria-hidden="true" > 60 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%B3%D8%B1%D8%B7%D8%A7%D9%86_%D8%A7%D9%84%D9%85%D8%A8%D9%8A%D8%B6" title="سرطان المبيض – Arabic" lang="ar" hreflang="ar" data-title="سرطان المبيض" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-as mw-list-item"><a href="https://as.wikipedia.org/wiki/%E0%A6%85%E0%A6%AD%E0%A6%BE%E0%A7%B0%E0%A6%BF%E0%A6%AF%E0%A6%BC%E0%A6%BE%E0%A6%A8_%E0%A6%95%E0%A7%87%E0%A6%A8%E0%A7%8D%E0%A6%B8%E0%A6%BE%E0%A7%B0" title="অভাৰিয়ান কেন্সাৰ – Assamese" lang="as" hreflang="as" data-title="অভাৰিয়ান কেন্সাৰ" data-language-autonym="অসমীয়া" data-language-local-name="Assamese" class="interlanguage-link-target">অসমীয়া</a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%A1%E0%A6%BF%E0%A6%AE%E0%A7%8D%E0%A6%AC%E0%A6%BE%E0%A6%B6%E0%A6%AF%E0%A6%BC%E0%A7%87%E0%A6%B0_%E0%A6%95%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%A8%E0%A7%8D%E0%A6%B8%E0%A6%BE%E0%A6%B0" title="ডিম্বাশয়ের ক্যান্সার – Bangla" lang="bn" hreflang="bn" data-title="ডিম্বাশয়ের ক্যান্সার" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target">বাংলা</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Rak_jajnika" title="Rak jajnika – Bosnian" lang="bs" hreflang="bs" data-title="Rak jajnika" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-br mw-list-item"><a href="https://br.wikipedia.org/wiki/Krign-bev_ar_vigell" title="Krign-bev ar vigell – Breton" lang="br" hreflang="br" data-title="Krign-bev ar vigell" data-language-autonym="Brezhoneg" data-language-local-name="Breton" class="interlanguage-link-target">Brezhoneg</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/C%C3%A0ncer_d%27ovari" title="Càncer d'ovari – Catalan" lang="ca" hreflang="ca" data-title="Càncer d'ovari" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Rakovina_vaje%C4%8Dn%C3%ADk%C5%AF" title="Rakovina vaječníků – Czech" lang="cs" hreflang="cs" data-title="Rakovina vaječníků" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Canser_ofaraidd" title="Canser ofaraidd – Welsh" lang="cy" hreflang="cy" data-title="Canser ofaraidd" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Ovarialkarzinom" title="Ovarialkarzinom – German" lang="de" hreflang="de" data-title="Ovarialkarzinom" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%84%DE%A8%DE%90%DE%B0%DE%83%DE%A6%DE%88%DE%A6%DE%87%DE%A8%DE%8E%DE%AC_%DE%86%DE%AC%DE%82%DE%B0%DE%90%DE%A6%DE%83%DE%AA" title="ބިސްރަވައިގެ ކެންސަރު – Divehi" lang="dv" hreflang="dv" data-title="ބިސްރަވައިގެ ކެންސަރު" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target">ދިވެހިބަސް</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9A%CE%B1%CF%81%CE%BA%CE%AF%CE%BD%CE%BF%CF%82_%CF%84%CF%89%CE%BD_%CF%89%CE%BF%CE%B8%CE%B7%CE%BA%CF%8E%CE%BD" title="Καρκίνος των ωοθηκών – Greek" lang="el" hreflang="el" data-title="Καρκίνος των ωοθηκών" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/C%C3%A1ncer_de_ovario" title="Cáncer de ovario – Spanish" lang="es" hreflang="es" data-title="Cáncer de ovario" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Obulutegiko_minbizi" title="Obulutegiko minbizi – Basque" lang="eu" hreflang="eu" data-title="Obulutegiko minbizi" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B3%D8%B1%D8%B7%D8%A7%D9%86_%D8%AA%D8%AE%D9%85%D8%AF%D8%A7%D9%86" title="سرطان تخمدان – Persian" lang="fa" hreflang="fa" data-title="سرطان تخمدان" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Cancer_de_l%27ovaire" title="Cancer de l'ovaire – French" lang="fr" hreflang="fr" data-title="Cancer de l'ovaire" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-fy mw-list-item"><a href="https://fy.wikipedia.org/wiki/Aaist%C3%B4kkanker" title="Aaistôkkanker – Western Frisian" lang="fy" hreflang="fy" data-title="Aaistôkkanker" data-language-autonym="Frysk" data-language-local-name="Western Frisian" class="interlanguage-link-target">Frysk</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Cancro_de_ovario" title="Cancro de ovario – Galician" lang="gl" hreflang="gl" data-title="Cancro de ovario" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%82%9C%EC%86%8C%EC%95%94" title="난소암 – Korean" lang="ko" hreflang="ko" data-title="난소암" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Ciwon_Daji_Na_Ovarian" title="Ciwon Daji Na Ovarian – Hausa" lang="ha" hreflang="ha" data-title="Ciwon Daji Na Ovarian" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target">Hausa</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%81%D5%BE%D5%A1%D6%80%D5%A1%D5%B6%D5%AB_%D6%84%D5%A1%D5%B2%D6%81%D5%AF%D5%A5%D5%B2" title="Ձվարանի քաղցկեղ – Armenian" lang="hy" hreflang="hy" data-title="Ձվարանի քաղցկեղ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%85%E0%A4%82%E0%A4%A1%E0%A4%BE%E0%A4%B6%E0%A4%AF_%E0%A4%95%E0%A5%88%E0%A4%82%E0%A4%B8%E0%A4%B0" title="अंडाशय कैंसर – Hindi" lang="hi" hreflang="hi" data-title="अंडाशय कैंसर" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Kanker_ovarium" title="Kanker ovarium – Indonesian" lang="id" hreflang="id" data-title="Kanker ovarium" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Carcinoma_dell%27ovaio" title="Carcinoma dell'ovaio – Italian" lang="it" hreflang="it" data-title="Carcinoma dell'ovaio" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A1%D7%A8%D7%98%D7%9F_%D7%94%D7%A9%D7%97%D7%9C%D7%94" title="סרטן השחלה – Hebrew" lang="he" hreflang="he" data-title="סרטן השחלה" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-ks mw-list-item"><a href="https://ks.wikipedia.org/wiki/%D8%A8%D9%8E%DA%86%DB%81%D9%95_%D8%AF%D8%A7%D9%86%DB%81%D9%90_%DB%81%D9%8F%D9%86%D9%9B%D8%AF_%DA%A9%D9%8E%D9%86%D8%B3%D9%8E%D8%B1" title="بَچہٕ دانہِ ہُنٛد کَنسَر – Kashmiri" lang="ks" hreflang="ks" data-title="بَچہٕ دانہِ ہُنٛد کَنسَر" data-language-autonym="कॉशुर / کٲشُر" data-language-local-name="Kashmiri" class="interlanguage-link-target">कॉशुर / کٲشُر</a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%90%D0%BD%D0%B0%D0%BB%D1%8B%D2%9B_%D0%B1%D0%B5%D0%B7_%D0%BE%D0%B1%D1%8B%D1%80%D1%8B" title="Аналық без обыры – Kazakh" lang="kk" hreflang="kk" data-title="Аналық без обыры" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target">Қазақша</a></li><li class="interlanguage-link interwiki-ht mw-list-item"><a href="https://ht.wikipedia.org/wiki/Kans%C3%A8_nan_ov%C3%A8_a" title="Kansè nan ovè a – Haitian Creole" lang="ht" hreflang="ht" data-title="Kansè nan ovè a" data-language-autonym="Kreyòl ayisyen" data-language-local-name="Haitian Creole" class="interlanguage-link-target">Kreyòl ayisyen</a></li><li class="interlanguage-link interwiki-hu badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://hu.wikipedia.org/wiki/Petef%C3%A9szekr%C3%A1k" title="Petefészekrák – Hungarian" lang="hu" hreflang="hu" data-title="Petefészekrák" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-mad mw-list-item"><a href="https://mad.wikipedia.org/wiki/Kanker_ovarium" title="Kanker ovarium – Madurese" lang="mad" hreflang="mad" data-title="Kanker ovarium" data-language-autonym="Madhurâ" data-language-local-name="Madurese" class="interlanguage-link-target">Madhurâ</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D0%BD%D0%B0_%D1%98%D0%B0%D1%98%D0%BD%D0%B8%D1%86%D0%B8" title="Рак на јајници – Macedonian" lang="mk" hreflang="mk" data-title="Рак на јајници" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%85%E0%B4%A3%E0%B5%8D%E0%B4%A1%E0%B4%BE%E0%B4%B6%E0%B4%AF_%E0%B4%85%E0%B5%BC%E0%B4%AC%E0%B5%81%E0%B4%A6%E0%B4%82" title="അണ്ഡാശയ അർബുദം – Malayalam" lang="ml" hreflang="ml" data-title="അണ്ഡാശയ അർബുദം" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target">മലയാളം</a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%AC%E0%A5%80%E0%A4%9C%E0%A4%BE%E0%A4%82%E0%A4%A1%E0%A4%BE%E0%A4%82%E0%A4%9A%E0%A4%BE_%E0%A4%95%E0%A4%B0%E0%A5%8D%E0%A4%95%E0%A4%B0%E0%A5%8B%E0%A4%97" title="बीजांडांचा कर्करोग – Marathi" lang="mr" hreflang="mr" data-title="बीजांडांचा कर्करोग" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target">मराठी</a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D8%B3%D8%B1%D8%B7%D8%A7%D9%86_%D8%A7%D9%84%D9%85%D8%A8%D9%8A%D8%B6" title="سرطان المبيض – Egyptian Arabic" lang="arz" hreflang="arz" data-title="سرطان المبيض" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target">مصرى</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Barah_ovari" title="Barah ovari – Malay" lang="ms" hreflang="ms" data-title="Barah ovari" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Ovariumcarcinoom" title="Ovariumcarcinoom – Dutch" lang="nl" hreflang="nl" data-title="Ovariumcarcinoom" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-new mw-list-item"><a href="https://new.wikipedia.org/wiki/%E0%A4%93%E0%A4%AD%E0%A4%B0%E0%A4%BF%E0%A4%AF%E0%A4%A8_%E0%A4%95%E0%A5%8D%E0%A4%AF%E0%A4%BE%E0%A4%A8%E0%A5%8D%E0%A4%B8%E0%A4%B0" title="ओभरियन क्यान्सर – Newari" lang="new" hreflang="new" data-title="ओभरियन क्यान्सर" data-language-autonym="नेपाल भाषा" data-language-local-name="Newari" class="interlanguage-link-target">नेपाल भाषा</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%8D%B5%E5%B7%A3%E8%85%AB%E7%98%8D" title="卵巣腫瘍 – Japanese" lang="ja" hreflang="ja" data-title="卵巣腫瘍" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Eggstokkreft" title="Eggstokkreft – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Eggstokkreft" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%93%E0%AC%AD%E0%AC%BE%E0%AC%B0%E0%AC%BF_%E0%AC%95%E0%AC%B0%E0%AD%8D%E0%AC%95%E0%AC%9F" title="ଓଭାରି କର୍କଟ – Odia" lang="or" hreflang="or" data-title="ଓଭାରି କର୍କଟ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%85%E0%A9%B0%E0%A8%A1%E0%A8%95%E0%A9%8B%E0%A8%B8%E0%A8%BC_%E0%A8%95%E0%A9%88%E0%A8%82%E0%A8%B8%E0%A8%B0" title="ਅੰਡਕੋਸ਼ ਕੈਂਸਰ – Punjabi" lang="pa" hreflang="pa" data-title="ਅੰਡਕੋਸ਼ ਕੈਂਸਰ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target">ਪੰਜਾਬੀ</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Rak_jajnika" title="Rak jajnika – Polish" lang="pl" hreflang="pl" data-title="Rak jajnika" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/C%C3%A2ncer_ovariano" title="Câncer ovariano – Portuguese" lang="pt" hreflang="pt" data-title="Câncer ovariano" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Cancer_ovarian" title="Cancer ovarian – Romanian" lang="ro" hreflang="ro" data-title="Cancer ovarian" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D1%8F%D0%B8%D1%87%D0%BD%D0%B8%D0%BA%D0%B0" title="Рак яичника – Russian" lang="ru" hreflang="ru" data-title="Рак яичника" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Kanceri_ovarian" title="Kanceri ovarian – Albanian" lang="sq" hreflang="sq" data-title="Kanceri ovarian" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target">Shqip</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Ovarian_cancer" title="Ovarian cancer – Simple English" lang="en-simple" hreflang="en-simple" data-title="Ovarian cancer" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Rakovina_vaje%C4%8Dn%C3%ADkov" title="Rakovina vaječníkov – Slovak" lang="sk" hreflang="sk" data-title="Rakovina vaječníkov" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target">Slovenčina</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Rak_jaj%C4%8Dnikov" title="Rak jajčnikov – Slovenian" lang="sl" hreflang="sl" data-title="Rak jajčnikov" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%97%D0%BB%D0%BE%D1%9B%D1%83%D0%B4%D0%BD%D0%B8_%D1%80%D0%B0%D0%BA_%D1%98%D0%B0%D1%98%D0%BD%D0%B8%D0%BA%D0%B0" title="Злоћудни рак јајника – Serbian" lang="sr" hreflang="sr" data-title="Злоћудни рак јајника" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Munasarjasy%C3%B6p%C3%A4" title="Munasarjasyöpä – Finnish" lang="fi" hreflang="fi" data-title="Munasarjasyöpä" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/%C3%84ggstockscancer" title="Äggstockscancer – Swedish" lang="sv" hreflang="sv" data-title="Äggstockscancer" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%9A%E0%AF%82%E0%AE%B2%E0%AF%8D%E0%AE%AA%E0%AF%88%E0%AE%AA%E0%AF%8D_%E0%AE%AA%E0%AF%81%E0%AE%B1%E0%AF%8D%E0%AE%B1%E0%AF%81%E0%AE%A8%E0%AF%8B%E0%AE%AF%E0%AF%8D" title="சூல்பைப் புற்றுநோய் – Tamil" lang="ta" hreflang="ta" data-title="சூல்பைப் புற்றுநோய்" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target">தமிழ்</a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%85%E0%B0%82%E0%B0%A1%E0%B0%BE%E0%B0%B6%E0%B0%AF_%E0%B0%95%E0%B1%8D%E0%B0%AF%E0%B0%BE%E0%B0%A8%E0%B1%8D%E0%B0%B8%E0%B0%B0%E0%B1%8D" title="అండాశయ క్యాన్సర్ – Telugu" lang="te" hreflang="te" data-title="అండాశయ క్యాన్సర్" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target">తెలుగు</a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%A1%E0%B8%B0%E0%B9%80%E0%B8%A3%E0%B9%87%E0%B8%87%E0%B8%A3%E0%B8%B1%E0%B8%87%E0%B9%84%E0%B8%82%E0%B9%88" title="มะเร็งรังไข่ – Thai" lang="th" hreflang="th" data-title="มะเร็งรังไข่" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-tcy mw-list-item"><a href="https://tcy.wikipedia.org/wiki/%E0%B2%85%E0%B2%82%E0%B2%A1%E0%B2%BE%E0%B2%B6%E0%B2%AF%E0%B2%A6_%E0%B2%95%E0%B2%82%E0%B2%A1%E0%B3%86%E0%B2%B2%E0%B3%81" title="ಅಂಡಾಶಯದ ಕಂಡೆಲು – Tulu" lang="tcy" hreflang="tcy" data-title="ಅಂಡಾಶಯದ ಕಂಡೆಲು" data-language-autonym="ತುಳು" data-language-local-name="Tulu" class="interlanguage-link-target">ತುಳು</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Yumurtal%C4%B1k_kanseri" title="Yumurtalık kanseri – Turkish" lang="tr" hreflang="tr" data-title="Yumurtalık kanseri" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D1%8F%D1%94%D1%87%D0%BD%D0%B8%D0%BA%D0%B0" title="Рак яєчника – Ukrainian" lang="uk" hreflang="uk" data-title="Рак яєчника" data-language-autonym="Українська" data-language-local-name="Ukrainian" 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searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Ovarian cancer</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Mucinous_lmp_ovarian_tumour_intermed_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Mucinous_lmp_ovarian_tumour_intermed_mag.jpg/220px-Mucinous_lmp_ovarian_tumour_intermed_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Mucinous_lmp_ovarian_tumour_intermed_mag.jpg/330px-Mucinous_lmp_ovarian_tumour_intermed_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Mucinous_lmp_ovarian_tumour_intermed_mag.jpg/440px-Mucinous_lmp_ovarian_tumour_intermed_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Micrograph" title="Micrograph">Micrograph</a> of a mucinous ovarian carcinoma <a href="/wiki/H%26E_stain" title="H&E stain">stained by H&E</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Oncology" title="Oncology">Oncology</a>, <a href="/wiki/Gynecology" class="mw-redirect" title="Gynecology">gynecology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Early: vague<a href="#cite_note-NCI2014TxPt-1">[1]</a> Later: <a href="/wiki/Bloating" title="Bloating">bloating</a>, <a href="/wiki/Pelvic_pain" title="Pelvic pain">pelvic pain</a>, <a href="/wiki/Constipation" title="Constipation">constipation</a>, abdominal swelling, loss of appetite<a href="#cite_note-NCI2014TxPt-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Usual age of diagnosis 63 years old<a href="#cite_note-NCI2016Onset-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data"> <ul><li>Ovarian origin: <a href="/wiki/Sex-cord_stromal_tumor" class="mw-redirect" title="Sex-cord stromal tumor">sex-cord stromal tumor</a>, <a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">germ cell tumor</a><a href="#cite_note-Zil2021-3">[3]</a></li> <li>Non-ovarian origin: most epithelial ovarian cancers and epithelial–stromal ovarian tumors<a href="#cite_note-Zil2021-3">[3]</a></li></ul> </td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><a href="/wiki/Nulliparity" class="mw-redirect" title="Nulliparity">Never having children</a>, <a href="/wiki/Hormone_therapy" title="Hormone therapy">hormone therapy</a> after <a href="/wiki/Menopause" title="Menopause">menopause</a>, <a href="/wiki/Fertility_medication" title="Fertility medication">fertility medication</a>, <a href="/wiki/Obesity" title="Obesity">obesity</a>, genetics<a href="#cite_note-NCI2014PrePt-4">[4]</a><a href="#cite_note-WCR2014-5">[5]</a><a href="#cite_note-NCI2014PrePro-6">[6]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Tissue_biopsy" class="mw-redirect" title="Tissue biopsy">Tissue biopsy</a><a href="#cite_note-NCI2014TxPt-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Surgery, <a href="/wiki/Radiation_therapy" title="Radiation therapy">radiation therapy</a>, <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a><a href="#cite_note-NCI2014TxPt-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data"><a href="/wiki/Five-year_survival_rate" title="Five-year survival rate">Five-year survival rate</a> c. 49% (US)<a href="#cite_note-SEER2014-7">[7]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">1.2 million (2015)<a href="#cite_note-GBD2015Pre-8">[8]</a></td></tr><tr><th scope="row" class="infobox-label">Deaths</th><td class="infobox-data">161,100 (2015)<a href="#cite_note-GBD2015De-9">[9]</a></td></tr></tbody></table> Ovarian cancer is a <a href="/wiki/Cancerous" class="mw-redirect" title="Cancerous">cancerous</a> <a href="/wiki/Ovarian_tumor" title="Ovarian tumor">tumor</a> of an <a href="/wiki/Ovary" title="Ovary">ovary</a>.<a href="#cite_note-WHOblue2020.1.1-10">[10]</a> It may originate from the ovary itself or more commonly from communicating nearby structures such as <a href="/wiki/Fallopian_tube" title="Fallopian tube">fallopian tubes</a> or the <a href="/wiki/Peritoneum" title="Peritoneum">inner lining of the abdomen</a>.<a href="#cite_note-Zil2021-3">[3]</a><a href="#cite_note-CDC-11">[11]</a> The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells.<a href="#cite_note-:7-12">[12]</a> When these cells become abnormal, they have the ability to divide and form tumors. These cells can also invade or <a href="/wiki/Metastasis" title="Metastasis">spread</a> to other parts of the body.<a href="#cite_note-13">[13]</a> When this process begins, there may be no or only vague symptoms.<a href="#cite_note-NCI2014TxPt-1">[1]</a> Symptoms become more noticeable as the cancer progresses.<a href="#cite_note-NCI2014TxPt-1">[1]</a><a href="#cite_note-Ebell16-14">[14]</a> These symptoms may include <a href="/wiki/Bloating" title="Bloating">bloating</a>, vaginal bleeding, <a href="/wiki/Pelvic_pain" title="Pelvic pain">pelvic pain</a>, <a href="/wiki/Ascites" title="Ascites">abdominal swelling</a>, <a href="/wiki/Constipation" title="Constipation">constipation</a>, and <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">loss of appetite</a>, among others.<a href="#cite_note-NCI2014TxPt-1">[1]</a> Common areas to which the cancer may spread include the <a href="/wiki/Peritoneum" title="Peritoneum">lining of the abdomen</a>, <a href="/wiki/Lymph_node" title="Lymph node">lymph nodes</a>, <a href="/wiki/Lungs" class="mw-redirect" title="Lungs">lungs</a>, and <a href="/wiki/Liver" title="Liver">liver</a>.<a href="#cite_note-15">[15]</a> The risk of ovarian cancer increases with age. Most cases of ovarian cancer develop after menopause.<a href="#cite_note-Ovarian_Cancer_Risk_Factors-16">[16]</a> It is also more common in women who have <a href="/wiki/Ovulate" class="mw-redirect" title="Ovulate">ovulated</a> more over their lifetime.<a href="#cite_note-Goldman2020-17">[17]</a> This includes those who have <a href="/wiki/Nulliparity" class="mw-redirect" title="Nulliparity">never had children</a>, those who began ovulation at a younger age and those who reach menopause at an older age.<a href="#cite_note-WCR2014-5">[5]</a> Other risk factors include <a href="/wiki/Hormone_therapy" title="Hormone therapy">hormone therapy</a> after <a href="/wiki/Menopause" title="Menopause">menopause</a>, <a href="/wiki/Fertility_medication" title="Fertility medication">fertility medication</a>, and <a href="/wiki/Obesity" title="Obesity">obesity</a>.<a href="#cite_note-NCI2014PrePt-4">[4]</a><a href="#cite_note-NCI2014PrePro-6">[6]</a> Factors that decrease risk include <a href="/wiki/Hormonal_birth_control" class="mw-redirect" title="Hormonal birth control">hormonal birth control</a>, <a href="/wiki/Tubal_ligation" title="Tubal ligation">tubal ligation</a>, pregnancy, and <a href="/wiki/Breast_feeding" class="mw-redirect" title="Breast feeding">breast feeding</a>.<a href="#cite_note-NCI2014PrePro-6">[6]</a> About 10% of cases are related to inherited genetic risk; women with mutations in the genes <a href="/wiki/BRCA1" title="BRCA1">BRCA1</a> or <a href="/wiki/BRCA2" title="BRCA2">BRCA2</a> have about a 50% chance of developing the disease.<a href="#cite_note-WCR2014-5">[5]</a> Some family cancer syndromes such as hereditary nonpolyposis colon cancer and Peutz-Jeghers syndrome also increase the risk of developing ovarian cancer.<a href="#cite_note-Ovarian_Cancer_Risk_Factors-16">[16]</a> Epithelial ovarian carcinoma is the most common type of ovarian cancer, comprising more than 95% of cases.<a href="#cite_note-WCR2014-5">[5]</a> There are five main subtypes of ovarian carcinoma, of which <a href="/wiki/High-grade_serous_carcinoma" title="High-grade serous carcinoma">high-grade serous carcinoma</a> (HGSC) is the most common.<a href="#cite_note-WCR2014-5">[5]</a> Less common types of ovarian cancer include <a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">germ cell tumors</a><a href="#cite_note-18">[18]</a> and <a href="/wiki/Sex_cord_stromal_tumor" class="mw-redirect" title="Sex cord stromal tumor">sex cord stromal tumors</a>.<a href="#cite_note-WCR2014-5">[5]</a> A diagnosis of ovarian cancer is confirmed through a <a href="/wiki/Biopsy" title="Biopsy">biopsy</a> of tissue, usually removed during surgery.<a href="#cite_note-NCI2014TxPt-1">[1]</a> <a href="/wiki/Screening_(medicine)" title="Screening (medicine)">Screening</a> is not recommended in women who are at average risk, as evidence does not support a reduction in death and the high rate of <a href="/wiki/False_positives_and_false_negatives" title="False positives and false negatives">false positive tests</a> may lead to unneeded surgery, which is accompanied by its own risks.<a href="#cite_note-Gros2018-19">[19]</a> Those at very high risk may have their ovaries removed as a preventive measure.<a href="#cite_note-NCI2014PrePt-4">[4]</a> If caught and treated in an early stage, ovarian cancer is often curable.<a href="#cite_note-NCI2014TxPt-1">[1]</a> Treatment usually includes some combination of surgery, <a href="/wiki/Radiation_therapy" title="Radiation therapy">radiation therapy</a>, and <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a>.<a href="#cite_note-NCI2014TxPt-1">[1]</a> Outcomes depend on the extent of the disease, the subtype of cancer present, and other medical conditions.<a href="#cite_note-WCR2014-5">[5]</a><a href="#cite_note-Gib2016-20">[20]</a> The overall <a href="/wiki/Five-year_survival_rate" title="Five-year survival rate">five-year survival rate</a> in the United States is 49%.<a href="#cite_note-SEER2014-7">[7]</a> Outcomes are worse in the developing world.<a href="#cite_note-WCR2014-5">[5]</a> In 2020, new cases occurred in approximately 313,000 women.<a href="#cite_note-21">[21]</a> In 2019 it resulted in 13,445 deaths in the United States.<a href="#cite_note-USCS_Data_Visualizations-22">[22]</a> Death from ovarian cancer increased globally between 1990 and 2017 by 84.2%.<a href="#cite_note-Zhou_Z_2017._p_17-23">[23]</a> Ovarian cancer is the second-most common <a href="/wiki/Gynecologic_cancer" title="Gynecologic cancer">gynecologic cancer</a> in the United States. It causes more deaths than any other cancer of the female reproductive system.<a href="#cite_note-24">[24]</a> Among women it ranks fifth in cancer-related deaths.<a href="#cite_note-25">[25]</a> The typical age of diagnosis is 63.<a href="#cite_note-NCI2016Onset-2">[2]</a> Death from ovarian cancer is more common in North America and Europe than in Africa and Asia.<a href="#cite_note-WCR2014-5">[5]</a> In the United States, it is more common in White and Hispanic women than Black or American Indian women.<a href="#cite_note-USCS_Data_Visualizations-22">[22]</a> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=1" title="Edit section: Signs and symptoms">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Early_symptoms">Early symptoms</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=2" title="Edit section: Early symptoms">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Site_of_ovarian_cancer.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0b/Site_of_ovarian_cancer.png/290px-Site_of_ovarian_cancer.png" decoding="async" width="290" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0b/Site_of_ovarian_cancer.png/435px-Site_of_ovarian_cancer.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0b/Site_of_ovarian_cancer.png/580px-Site_of_ovarian_cancer.png 2x" data-file-width="1513" data-file-height="859" /></a><figcaption>Site of ovarian cancer</figcaption></figure> Early <a href="/wiki/Medical_sign" class="mw-redirect" title="Medical sign">signs</a> and <a href="/wiki/Symptoms" class="mw-redirect" title="Symptoms">symptoms</a> of ovarian cancer may be absent or subtle. In most cases, symptoms exist for several months before being recognized and <a href="/wiki/Diagnosis" title="Diagnosis">diagnosed</a>.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-CDCsep2016-27">[27]</a> Symptoms can often be misdiagnosed as <a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">irritable bowel syndrome</a>.<a href="#cite_note-Jayson-28">[28]</a> The early stages of ovarian cancer tend to be painless which makes it difficult to detect it early on. Symptoms can vary based on the subtype.<a href="#cite_note-Harrisons-26">[26]</a> Ovarian <a href="/wiki/Borderline_tumor" title="Borderline tumor">borderline tumors</a>, also known as low malignant potential (LMP) ovarian tumors, do not cause an increase in <a href="/wiki/CA125" class="mw-redirect" title="CA125">CA125</a> levels and are not identifiable with an ultrasound. The typical symptoms of an LMP tumor can include <a href="/wiki/Abdominal_distension" title="Abdominal distension">abdominal distension</a> or pelvic pain. Particularly large masses tend to be benign or borderline.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-Harrisons-26">[26]</a> The most typical symptoms of ovarian cancer include <a href="/wiki/Bloating" title="Bloating">bloating</a>, abdominal or pelvic pain or discomfort, back pain, <a href="/wiki/Irregular_menstruation" title="Irregular menstruation">irregular menstruation</a> or postmenopausal vaginal bleeding, pain or bleeding after or during <a href="/wiki/Sexual_intercourse" title="Sexual intercourse">sexual intercourse</a>, <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">loss of appetite</a>, <a href="/wiki/Fatigue_(medical)" class="mw-redirect" title="Fatigue (medical)">fatigue</a>, <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, <a href="/wiki/Indigestion" title="Indigestion">indigestion</a>, <a href="/wiki/Heartburn" title="Heartburn">heartburn</a>, <a href="/wiki/Constipation" title="Constipation">constipation</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Satiety" title="Satiety">feeling full</a>, and possibly urinary symptoms (including <a href="/wiki/Polyuria" title="Polyuria">frequent urination</a> and <a href="/wiki/Urinary_urgency" class="mw-redirect" title="Urinary urgency">urgent urination</a>).<a href="#cite_note-CDCsep2016-27">[27]</a> <div class="mw-heading mw-heading3"><h3 id="Later_symptoms">Later symptoms</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=3" title="Edit section: Later symptoms">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Mature_cystic_teratoma_of_ovary.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Mature_cystic_teratoma_of_ovary.jpg/220px-Mature_cystic_teratoma_of_ovary.jpg" decoding="async" width="220" height="190" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Mature_cystic_teratoma_of_ovary.jpg/330px-Mature_cystic_teratoma_of_ovary.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Mature_cystic_teratoma_of_ovary.jpg/440px-Mature_cystic_teratoma_of_ovary.jpg 2x" data-file-width="550" data-file-height="474" /></a><figcaption>Mature cystic teratoma of ovary</figcaption></figure> Later symptoms of ovarian cancer are due to the growing mass causing pain by pressing on other abdominopelvic organs or from metastases.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-:0-30">[30]</a><a href="#cite_note-DynaMed15-31">[31]</a> Because of the anatomic location of the ovaries deep in the pelvis, most masses are large and advanced at the time of diagnosis.<a href="#cite_note-Ebell16-14">[14]</a> The growing mass may cause pain if <a href="/wiki/Ovarian_torsion" title="Ovarian torsion">ovarian torsion</a> develops. If these symptoms start to occur more often or more severely than usual, especially after no significant history of such symptoms, ovarian cancer is considered.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Hoffman35-29">[29]</a> Metastases may cause a <a href="/wiki/Sister_Mary_Joseph_nodule" title="Sister Mary Joseph nodule">Sister Mary Joseph nodule</a>.<a href="#cite_note-DynaMed15-31">[31]</a> Rarely, <a href="/wiki/Teratoma" title="Teratoma">teratomas</a> can cause <a href="/wiki/Growing_teratoma_syndrome" title="Growing teratoma syndrome">growing teratoma syndrome</a> or <a href="/w/index.php?title=Peritoneal_gliomatosis&action=edit&redlink=1" class="new" title="Peritoneal gliomatosis (page does not exist)">peritoneal gliomatosis</a>.<a href="#cite_note-DynaMed15-31">[31]</a> Some experience <a href="/wiki/Menometrorrhagia" title="Menometrorrhagia">menometrorrhagia</a> and <a href="/wiki/Dysfunctional_uterine_bleeding" class="mw-redirect" title="Dysfunctional uterine bleeding">abnormal vaginal bleeding</a> after menopause in most cases. Other common symptoms include <a href="/wiki/Hirsutism" title="Hirsutism">hirsutism</a>, abdominal pain, <a href="/wiki/Virilization" title="Virilization">virilization</a>, and an <a href="/wiki/Adnexal_mass" title="Adnexal mass">adnexal mass</a>.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=4" title="Edit section: Children">edit</a>]</div> In adolescents or children with ovarian tumors, symptoms can include severe abdominal pain, irritation of the <a href="/wiki/Peritoneum" title="Peritoneum">peritoneum</a>, or <a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">bleeding</a>.<a href="#cite_note-Current-33">[33]</a> Sex cord stromal tumors produce hormones which can lead to the premature development of secondary sex characteristics. Sex cord-stromal tumors in prepubertal children may be manifested by signs of <a href="/wiki/Precocious_puberty" title="Precocious puberty">early puberty</a>; <a href="/wiki/Abdominal" class="mw-redirect" title="Abdominal">abdominal</a> pain and distension are also common. Adolescents with sex cord-stromal tumors may experience <a href="/wiki/Amenorrhea" title="Amenorrhea">amenorrhea</a>. As the cancer becomes more advanced, it can cause <a href="/wiki/Ascites" title="Ascites">an accumulation of fluid</a> in the abdomen and lead to distension. If the malignancy has not been diagnosed by the time it causes ascites, it is typically diagnosed shortly thereafter.<a href="#cite_note-Harrisons-26">[26]</a> Advanced cancers can also cause abdominal masses, lymph node masses, or <a href="/wiki/Pleural_effusion" title="Pleural effusion">pleural effusion</a>.<a href="#cite_note-DynaMed15-31">[31]</a> <div class="mw-heading mw-heading2"><h2 id="Risk_factors">Risk factors</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=5" title="Edit section: Risk factors">edit</a>]</div> There are many known risk factors that may increase a woman's risk of developing ovarian cancer. The risk of developing ovarian cancer is related to the amount of time a woman spends ovulating.<a href="#cite_note-CRUKRisks-34">[34]</a> Factors that increase the number of ovulatory cycles a woman undergoes may increase the risk of developing ovarian cancer.<a href="#cite_note-CRUKRisks-34">[34]</a> During ovulation, cells are stimulated to divide. If this division is abnormally regulated, tumors may form which can be malignant. Early menarche and late menopause increase the number of ovulatory cycles a woman undergoes in her lifetime and so increases the risk of developing ovarian cancer.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-CRUKRisks-34">[34]</a><a href="#cite_note-Gong13-35">[35]</a> Since ovulation is suppressed during pregnancy, not having children also increases the risk of ovarian cancer.<a href="#cite_note-Gong13-35">[35]</a> Therefore, <a href="/wiki/Nulliparity" class="mw-redirect" title="Nulliparity">women who have not borne children</a> are at twice the risk of ovarian cancer than those who have.<a href="#cite_note-Harrisons-26">[26]</a> Both obesity and hormone replacement therapy also raise the risk.<a href="#cite_note-Harrisons-26">[26]</a> The risk of developing ovarian cancer is less for women who have fewer menstrual cycles, no menstrual cycles, <a href="/wiki/Breast_feeding" class="mw-redirect" title="Breast feeding">breast feeding</a>, take oral contraceptives, have multiple pregnancies, and have a pregnancy at an early age. The risk of developing ovarian cancer is reduced in women who have had <a href="/wiki/Tubal_ligation" title="Tubal ligation">tubal ligation</a> (colloquially known as having one's "tubes tied"), both ovaries removed, or <a href="/wiki/Hysterectomy" title="Hysterectomy">hysterectomy</a> (an operation in which the uterus is removed).<a href="#cite_note-CDCsep2016-27">[27]</a> Age is also a risk factor.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Gib2016-20">[20]</a> Non-genetic factors such as diabetes mellitus, high body mass index, and tobacco use are also risk factors for ovarian cancer.<a href="#cite_note-Zhou_Z_2017._p_17-23">[23]</a> <div class="mw-heading mw-heading3"><h3 id="Hormones">Hormones</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=6" title="Edit section: Hormones">edit</a>]</div> The use of fertility medication may contribute to ovarian <a href="/wiki/Borderline_tumor" title="Borderline tumor">borderline tumor</a> formation, but the link between the two is disputed and difficult to study.<a href="#cite_note-Jayson-28">[28]</a> Fertility drugs may be associated with a higher risk of borderline tumors.<a href="#cite_note-DynaMed15-31">[31]</a> Those who have been treated for infertility but remain nulliparous are at higher risk for epithelial ovarian cancer due to hormonal exposure that may lead to proliferation of cells. However, those who are successfully treated for infertility and subsequently give birth are at no higher risk. This may be due to shedding of precancerous cells during pregnancy, but the cause remains unclear.<a href="#cite_note-Hoffman35-29">[29]</a> The risk factor may instead be infertility itself, not the treatment.<a href="#cite_note-CRUKRisks-34">[34]</a> Hormonal conditions such as <a href="/wiki/Polycystic_ovary_syndrome" title="Polycystic ovary syndrome">polycystic ovary syndrome</a> and <a href="/wiki/Endometriosis" title="Endometriosis">endometriosis</a> are associated with ovarian cancer, but the link is not completely confirmed.<a href="#cite_note-Jayson-28">[28]</a> Postmenopausal hormone replacement therapy (HRT) with estrogen likely increases the risk of ovarian cancer. The association has not been confirmed in a large-scale study,<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-36">[36]</a> but notable studies including the <a href="/wiki/Million_Women_Study" title="Million Women Study">Million Women Study</a> have supported this link. Postmenopausal HRT with combined estrogen and progesterone may increase contemporaneous risk if used for over 5 years, but this risk returns to normal after cessation of therapy.<a href="#cite_note-CRUKRisks-34">[34]</a> Estrogen HRT with or without progestins increases the risk of endometrioid and serous tumors but lowers the risk of mucinous tumors. Higher doses of estrogen increase this risk.<a href="#cite_note-DynaMed15-31">[31]</a> Endometriosis is another risk factor for ovarian cancer,<a href="#cite_note-CRUKRisks-34">[34]</a> as is pain with menstruation. Endometriosis is associated with clear-cell and endometrioid subtypes, low-grade serous tumors, stage I and II tumors, grade 1 tumors, and lower mortality.<a href="#cite_note-DynaMed15-31">[31]</a> Before menopause, obesity can increase a person's risk of ovarian cancer, but this risk is not present after menopause. This risk is also relevant in those who are both obese and have never used HRT. A similar association with ovarian cancer appears in taller women.<a href="#cite_note-CRUKRisks-34">[34]</a> <div class="mw-heading mw-heading3"><h3 id="Genetics">Genetics</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=7" title="Edit section: Genetics">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Hereditary_breast%E2%80%93ovarian_cancer_syndrome" title="Hereditary breast–ovarian cancer syndrome">Hereditary breast–ovarian cancer syndrome</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:PedigreechartC.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/31/PedigreechartC.png/290px-PedigreechartC.png" decoding="async" width="290" height="215" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/31/PedigreechartC.png/435px-PedigreechartC.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/31/PedigreechartC.png/580px-PedigreechartC.png 2x" data-file-width="700" data-file-height="518" /></a><figcaption>Women with ovarian or breast cancer in a pedigree chart of a family</figcaption></figure> A family history of ovarian cancer is a risk factor for ovarian cancer. Women with <a href="/wiki/Hereditary_nonpolyposis_colon_cancer" class="mw-redirect" title="Hereditary nonpolyposis colon cancer">hereditary nonpolyposis colon cancer</a> (Lynch syndrome), and those with BRCA-1 and BRCA-2 genetic abnormalities are at increased risk. The major genetic risk factor for ovarian cancer is a mutation in BRCA1 or BRCA2 genes, or in <a href="/wiki/DNA_mismatch_repair" title="DNA mismatch repair">DNA mismatch repair</a> genes, which is present in 10% of ovarian cancer cases. Only one <a href="/wiki/Allele" title="Allele">allele</a> needs to be mutated to place a person at high risk. The gene can be inherited through either the maternal or paternal line, but has variable <a href="/wiki/Penetrance" title="Penetrance">penetrance</a>.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Hoffman35-29">[29]</a> Though mutations in these genes are usually associated with increased risk of breast cancer, they also carry a substantial lifetime risk of ovarian cancer, a risk that peaks in a person's 40s and 50s. The lowest risk cited is 30% and the highest 60%.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Hoffman35-29">[29]</a> Mutations in BRCA1 have a lifetime risk of developing ovarian cancer of 15–45%.<a href="#cite_note-DynaMed15-31">[31]</a> Mutations in BRCA2 are less risky than those with BRCA1, with a lifetime risk of 10% (lowest risk cited) to 40% (highest risk cited).<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-DynaMed15-31">[31]</a> On average, BRCA-associated cancers develop 15 years before their sporadic counterparts because people who inherit the mutations on one copy of their gene only need one mutation to start the process of carcinogenesis, whereas people with two normal genes would need to acquire two mutations.<a href="#cite_note-Hoffman35-29">[29]</a> In the United States, five of 100 women with a <a href="/wiki/First-degree_relative" class="mw-redirect" title="First-degree relative">first-degree relative</a> with ovarian cancer will eventually get ovarian cancer themselves, placing those with affected family members at triple the risk of women with unaffected family members. Seven of 100 women with two or more relatives with ovarian cancer will eventually get ovarian cancer.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-NCIPrevention-37">[37]</a> In general, 5–10% of ovarian cancer cases have a genetic cause.<a href="#cite_note-Hoffman35-29">[29]</a> BRCA mutations are associated with high-grade serous nonmucinous epithelial ovarian cancer.<a href="#cite_note-DynaMed15-31">[31]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/19/BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg/220px-BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg" decoding="async" width="220" height="137" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/19/BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg/330px-BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/19/BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg/440px-BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg 2x" data-file-width="5945" data-file-height="3705" /></a><figcaption>BRCA1 and BRCA2 mutations and absolute cancer risk</figcaption></figure> A strong family history of <a href="/wiki/Endometrial_cancer" title="Endometrial cancer">endometrial cancer</a>, <a href="/wiki/Colon_cancer" class="mw-redirect" title="Colon cancer">colon cancer</a>, or other <a href="/wiki/Gastrointestinal_cancer" title="Gastrointestinal cancer">gastrointestinal cancers</a> may indicate the presence of a syndrome known as <a href="/wiki/Hereditary_nonpolyposis_colorectal_cancer" title="Hereditary nonpolyposis colorectal cancer">hereditary nonpolyposis colorectal cancer</a> (also known as Lynch syndrome), which confers a higher risk for developing a number of cancers, including ovarian cancer. Lynch syndrome is caused by mutations in mismatch repair genes, including <a href="/wiki/MSH2" title="MSH2">MSH2</a>, <a href="/wiki/MLH1" title="MLH1">MLH1</a>, <a href="/w/index.php?title=MLH6&action=edit&redlink=1" class="new" title="MLH6 (page does not exist)">MLH6</a>, <a href="/wiki/PMS1" title="PMS1">PMS1</a>, and <a href="/wiki/PMS2" class="mw-redirect" title="PMS2">PMS2</a>.<a href="#cite_note-Harrisons-26">[26]</a> The risk of ovarian cancer for an individual with Lynch syndrome is between 10 and 12 percent.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Hoffman35-29">[29]</a> Women of <a href="/wiki/Icelandic_people" class="mw-redirect" title="Icelandic people">Icelandic descent</a>, <a href="/wiki/European_Jews" class="mw-redirect" title="European Jews">European Jewish descent</a>/<a href="/wiki/Ashkenazi_Jews" title="Ashkenazi Jews">Ashkenazi Jewish descent</a>, and <a href="/wiki/Hungarian_people" class="mw-redirect" title="Hungarian people">Hungarian descent</a> are at higher risk for epithelial ovarian cancer.<a href="#cite_note-Hoffman35-29">[29]</a> Estrogen receptor beta gene (<a href="/wiki/ESR2" class="mw-redirect" title="ESR2">ESR2</a>) seems to be a key to pathogenesis and response to therapy.<a href="#cite_note-38">[38]</a> Other genes that have been associated with ovarian cancer are <a href="/wiki/BRIP1" title="BRIP1">BRIP1</a>, <a href="/wiki/MSH6" title="MSH6">MSH6</a>, <a href="/wiki/RAD51C" title="RAD51C">RAD51C</a> and <a href="/wiki/RAD51D" class="mw-redirect" title="RAD51D">RAD51D</a>.<a href="#cite_note-Norquist2015-39">[39]</a> <a href="/wiki/CDH1_(gene)" class="mw-redirect" title="CDH1 (gene)">CDH1</a>, <a href="/wiki/CHEK2" title="CHEK2">CHEK2</a>, <a href="/wiki/PALB2" title="PALB2">PALB2</a> and <a href="/wiki/RAD50_(gene)" class="mw-redirect" title="RAD50 (gene)">RAD50</a> have also been associated with ovarian cancer.<a href="#cite_note-Kuusisto2011-40">[40]</a> Several rare genetic disorders are associated with specific subtypes of ovarian cancer. <a href="/wiki/Peutz%E2%80%93Jeghers_syndrome" title="Peutz–Jeghers syndrome">Peutz–Jeghers syndrome</a>, a rare genetic disorder, also predisposes women to <a href="/wiki/Sex_cord_tumour_with_annular_tubules" title="Sex cord tumour with annular tubules">sex cord tumour with annular tubules</a>.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-Harrisons-26">[26]</a> <a href="/wiki/Ollier_disease" title="Ollier disease">Ollier disease</a> and <a href="/wiki/Maffucci_syndrome" title="Maffucci syndrome">Maffucci syndrome</a> are associated with <a href="/wiki/Granulosa_cell_tumor" class="mw-redirect" title="Granulosa cell tumor">granulosa cell tumors</a> in children and may also be associated with Sertoli-Leydig tumors. Benign fibromas are associated with <a href="/wiki/Nevoid_basal_cell_carcinoma_syndrome" class="mw-redirect" title="Nevoid basal cell carcinoma syndrome">nevoid basal cell carcinoma syndrome</a>.<a href="#cite_note-Harrisons-26">[26]</a> <div class="mw-heading mw-heading3"><h3 id="Diet">Diet</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=8" title="Edit section: Diet">edit</a>]</div> <a href="/wiki/Alcohol_and_cancer" title="Alcohol and cancer">Alcohol consumption</a> does not appear to be related to ovarian cancer.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-41">[41]</a> The American Cancer Society recommends a healthy eating pattern that includes plenty of fruits, vegetables, <a href="/wiki/Whole_grain" title="Whole grain">whole grains</a>, and a diet that avoids or limits red and <a href="/wiki/Processed_meat" title="Processed meat">processed meats</a> and processed sugar.<a href="#cite_note-42">[42]</a> High consumption of total, saturated and trans-fats increases ovarian cancer risk.<a href="#cite_note-43">[43]</a> A 2021 umbrella review found that coffee, egg, and fat intake significantly increases the risk of ovarian cancer.<a href="#cite_note-44">[44]</a> There is mixed evidence from studies on ovarian cancer risk and consumption of <a href="/wiki/Dairy_product" title="Dairy product">dairy products</a>.<a href="#cite_note-Liao20-45">[45]</a><a href="#cite_note-46">[46]</a> <div class="mw-heading mw-heading3"><h3 id="Environmental_factors">Environmental factors</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=9" title="Edit section: Environmental factors">edit</a>]</div> Industrialized nations, with the exception of Japan, have high rates of epithelial ovarian cancer, which may be due to diet in those countries. White women are at a 30–40% higher risk for ovarian cancer when compared to Black women and Hispanic women, likely due to socioeconomic factors; white women tend to have fewer children and different rates of gynecologic surgeries that affect risk for ovarian cancer.<a href="#cite_note-Hoffman35-29">[29]</a> Tentative evidence suggests that <a href="/wiki/Talc" title="Talc">talc</a>, <a href="/wiki/Pesticides" class="mw-redirect" title="Pesticides">pesticides</a>, and <a href="/wiki/Herbicides" class="mw-redirect" title="Herbicides">herbicides</a> increase the risk of ovarian cancer.<a href="#cite_note-47">[47]</a> The American Cancer Society notes that as of now, no study has been able to accurately link any single chemical in the environment, or in the human diet, directly to mutations that cause ovarian cancer.<a href="#cite_note-48">[48]</a> <div class="mw-heading mw-heading3"><h3 id="Other">Other</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=10" title="Edit section: Other">edit</a>]</div> Other factors that have been investigated, such as <a href="/wiki/Smoking" title="Smoking">smoking</a>, low levels of <a href="/wiki/Vitamin_D" title="Vitamin D">vitamin D</a> in the blood,<a href="#cite_note-49">[49]</a> presence of inclusion <a href="/wiki/Ovarian_cysts" class="mw-redirect" title="Ovarian cysts">ovarian cysts</a>, and infection with <a href="/wiki/Human_papilloma_virus" class="mw-redirect" title="Human papilloma virus">human papilloma virus</a> (the cause of some cases of <a href="/wiki/Cervical_cancer" title="Cervical cancer">cervical cancer</a>), have been disproven as risk factors for ovarian cancer.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-DynaMed15-31">[31]</a> The carcinogenicity of <a href="/wiki/Perineum" title="Perineum">perineal</a> <a href="/wiki/Talc" title="Talc">talc</a> is controversial, because it can act as an irritant if it travels through the reproductive tract to the ovaries.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-CRUKRisks-34">[34]</a> <a href="/wiki/Case-control_study" class="mw-redirect" title="Case-control study">Case-control studies</a> have shown that use of perineal talc does increase the risk of ovarian cancer, but using talc more often does not create a greater risk.<a href="#cite_note-DynaMed15-31">[31]</a> Use of <a href="/wiki/Talc" title="Talc">talc</a> elsewhere on the body is unrelated to ovarian cancer.<a href="#cite_note-CRUKRisks-34">[34]</a> <a href="/wiki/Sitting" title="Sitting">Sitting</a> regularly for prolonged periods is associated with higher mortality from epithelial ovarian cancer. The risk is not negated by regular exercise, though it is lowered.<a href="#cite_note-Biswas-50">[50]</a> Increased age (up to the 70s) is a risk factor for epithelial ovarian cancer because more mutations in cells can accumulate and eventually cause cancer. Those over 80 are at slightly lower risk.<a href="#cite_note-Hoffman35-29">[29]</a> <a href="/wiki/Smoking" title="Smoking">Smoking</a> tobacco is associated with a higher risk of <a href="/wiki/Mucinous_tumor" class="mw-redirect" title="Mucinous tumor">mucinous ovarian cancer</a>; after <a href="/wiki/Smoking_cessation" title="Smoking cessation">smoking cessation</a>, the risk eventually returns to normal. Higher levels of <a href="/wiki/C-reactive_protein" title="C-reactive protein">C-reactive protein</a> are associated with a higher risk of developing ovarian cancer.<a href="#cite_note-DynaMed15-31">[31]</a> <div class="mw-heading mw-heading3"><h3 id="Protective_factors">Protective factors</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=11" title="Edit section: Protective factors">edit</a>]</div> Suppression of ovulation, which would otherwise cause damage to the <a href="/wiki/Ovarian_epithelium" class="mw-redirect" title="Ovarian epithelium">ovarian epithelium</a> and, consequently, <a href="/wiki/Inflammation" title="Inflammation">inflammation</a>, is generally protective. This effect can be achieved by <a href="/wiki/Multiparity" class="mw-redirect" title="Multiparity">having children</a>, taking <a href="/wiki/Combined_oral_contraceptive" class="mw-redirect" title="Combined oral contraceptive">combined oral contraceptives</a>, and <a href="/wiki/Breast_feeding" class="mw-redirect" title="Breast feeding">breast feeding</a>, all of which are protective factors.<a href="#cite_note-Harrisons-26">[26]</a> A longer period of breastfeeding correlates with a larger decrease in the risk of ovarian cancer.<a href="#cite_note-CRUKRisks-34">[34]</a> Each birth decreases risk of ovarian cancer more, and this effect is seen with up to five births. Combined oral contraceptives reduce the risk of ovarian cancer by up to 50%, and the protective effect of combined oral contraceptives can last 25–30 years after they are discontinued.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-CRUKRisks-34">[34]</a> Regular use of <a href="/wiki/Aspirin" title="Aspirin">aspirin</a> (MALOVA (MALignant OVArian cancer) study)<a href="#cite_note-51">[51]</a><a href="#cite_note-52">[52]</a> or <a href="/wiki/Paracetamol" title="Paracetamol">acetaminophen</a> (paracetamol) may be associated with a lower risk of ovarian cancer; other <a href="/wiki/NSAIDs" class="mw-redirect" title="NSAIDs">NSAIDs</a> do not seem to have a similar protective effect.<a href="#cite_note-DynaMed15-31">[31]</a> <a href="/wiki/Tubal_ligation" title="Tubal ligation">Tubal ligation</a> is protective because <a href="/wiki/Carcinogen" title="Carcinogen">carcinogens</a> are unable to reach the ovary and <a href="/wiki/Fimbria_(female_reproductive_system)" class="mw-redirect" title="Fimbria (female reproductive system)">fimbriae</a> via the vagina, uterus, and Fallopian tubes.<a href="#cite_note-Harrisons-26">[26]</a> Tubal ligation is also protective in women with the BRCA1 mutation, but not the BRCA2 mutation.<a href="#cite_note-DynaMed15-31">[31]</a> <a href="/wiki/Hysterectomy" title="Hysterectomy">Hysterectomy</a> reduces the risk, and removal of both Fallopian tubes and ovaries (bilateral <a href="/wiki/Salpingo-oophorectomy" title="Salpingo-oophorectomy">salpingo-oophorectomy</a>) dramatically reduces the risk of not only ovarian cancer but breast cancer as well.<a href="#cite_note-Jayson-28">[28]</a> This is still a topic of research, as the link between hysterectomy and lower ovarian cancer risk is controversial. The reasons that hysterectomy may be protective have not been elucidated as of 2015.<a href="#cite_note-CRUKRisks-34">[34]</a> A diet that includes large amounts of <a href="/wiki/Carotene" title="Carotene">carotene</a>, <a href="/wiki/Dietary_fiber" title="Dietary fiber">fiber</a>, and <a href="/wiki/Vitamin" title="Vitamin">vitamins</a> with low amounts of fat—specifically, a diet with non-starchy vegetables (e.g. <a href="/wiki/Broccoli" title="Broccoli">broccoli</a> and <a href="/wiki/Onion" title="Onion">onions</a>) may be protective.<a href="#cite_note-Hoffman35-29">[29]</a> Dietary fiber is associated with a significant reduced risk of ovarian cancer.<a href="#cite_note-53">[53]</a> A 2021 review found that green leafy vegetables, allium vegetables, fiber, <a href="/wiki/Flavanoid" class="mw-redirect" title="Flavanoid">flavanoids</a> and <a href="/wiki/Green_tea" title="Green tea">green tea</a> intake can significantly reduce ovarian cancer risk.<a href="#cite_note-54">[54]</a> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=12" title="Edit section: Pathophysiology">edit</a>]</div> <table class="wikitable sortable" align="right" style="width: 50%"> <caption>Mutations found in ovarian cancer subtypes<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-DeVita100-55">[55]</a> </caption> <tbody><tr> <th>Gene mutated </th> <th>Mutation type </th> <th>Subtype </th> <th>Prevalence </th></tr> <tr> <td><a href="/wiki/AKT1" title="AKT1">AKT1</a> </td> <td>amplification </td> <td> </td> <td>3% </td></tr> <tr> <td><a href="/wiki/AKT2" title="AKT2">AKT2</a> </td> <td>amplification/mutation </td> <td> </td> <td>6%,<a href="#cite_note-Jayson-28">[28]</a> 20%<a href="#cite_note-DeVita100-55">[55]</a> </td></tr> <tr> <td><a href="/wiki/ARID1A" title="ARID1A">ARID1A</a> </td> <td>point mutation </td> <td>endometrioid and clear-cell </td> <td> </td></tr> <tr> <td><a href="/wiki/BECN1" title="BECN1">BECN1</a> </td> <td>deletion </td> <td> </td> <td> </td></tr> <tr> <td><a href="/wiki/BRAF_(gene)" title="BRAF (gene)">BRAF</a> </td> <td>point mutation </td> <td>low-grade serous </td> <td>0.5% </td></tr> <tr> <td><a href="/wiki/BRCA1" title="BRCA1">BRCA1</a> </td> <td>nonsense mutation </td> <td>high-grade serous </td> <td>5% </td></tr> <tr> <td><a href="/wiki/BRCA2" title="BRCA2">BRCA2</a> </td> <td>frameshift mutation </td> <td>high-grade serous </td> <td>3% </td></tr> <tr> <td><a href="/wiki/CCND1" class="mw-redirect" title="CCND1">CCND1</a> </td> <td>amplification </td> <td> </td> <td>4% </td></tr> <tr> <td><a href="/wiki/CCND2" class="mw-redirect" title="CCND2">CCND2</a> </td> <td>upregulation </td> <td> </td> <td>15% </td></tr> <tr> <td><a href="/wiki/CCNE1" class="mw-redirect" title="CCNE1">CCNE1</a> </td> <td>amplification </td> <td> </td> <td>20% </td></tr> <tr> <td><a href="/wiki/CDK12" title="CDK12">CDK12</a> </td> <td> </td> <td>high-grade serous </td> <td> </td></tr> <tr> <td><a href="/wiki/P16_(gene)" class="mw-redirect" title="P16 (gene)">CDKN2A</a> </td> <td>downregulation (30%) and deletion (2%) </td> <td> </td> <td>32% </td></tr> <tr> <td><a href="/wiki/CTNNB1" class="mw-redirect" title="CTNNB1">CTNNB1</a> </td> <td> </td> <td>clear-cell </td> <td> </td></tr> <tr> <td><a href="/wiki/DICER1" class="mw-redirect" title="DICER1">DICER1</a> </td> <td>missense mutation (somatic) </td> <td>nonepithelial </td> <td>29% </td></tr> <tr> <td><a href="/wiki/DYNLRB1" title="DYNLRB1">DYNLRB1</a> (km23) </td> <td>mutation </td> <td> </td> <td>42% </td></tr> <tr> <td><a href="/wiki/Epidermal_growth_factor_receptor" title="Epidermal growth factor receptor">EGFR</a> </td> <td>amplification/overexpression </td> <td> </td> <td>20% </td></tr> <tr> <td><a href="/wiki/ERBB2" class="mw-redirect" title="ERBB2">ERBB2</a> (Her2/neu) </td> <td>amplification/overexpression </td> <td>mucinous and low-grade serous </td> <td>30% </td></tr> <tr> <td><a href="/w/index.php?title=FMS_(gene)&action=edit&redlink=1" class="new" title="FMS (gene) (page does not exist)">FMS</a> </td> <td>coexpression with <a href="/wiki/CSF-1" class="mw-redirect" title="CSF-1">CSF-1</a> </td> <td> </td> <td>50% </td></tr> <tr> <td><a href="/wiki/Forkhead_box_L2" class="mw-redirect" title="Forkhead box L2">FOXL2</a> </td> <td>point mutation (402 C to G) </td> <td>adult granulosa cell </td> <td>~100% </td></tr> <tr> <td><a href="/wiki/JAG1" title="JAG1">JAG1</a> </td> <td>amplification </td> <td> </td> <td>2% </td></tr> <tr> <td><a href="/wiki/JAG2" title="JAG2">JAG2</a> </td> <td>amplification </td> <td> </td> <td>3% </td></tr> <tr> <td><a href="/wiki/KRAS" title="KRAS">KRAS</a> </td> <td>amplification </td> <td>mucinous and low-grade serous </td> <td>11% </td></tr> <tr> <td><a href="/wiki/MAML1" title="MAML1">MAML1</a> </td> <td>amplification and point mutation </td> <td> </td> <td>2% </td></tr> <tr> <td><a href="/wiki/MAML2" title="MAML2">MAML2</a> </td> <td>amplification and point mutation </td> <td> </td> <td>4% </td></tr> <tr> <td><a href="/wiki/MAML3" class="mw-redirect" title="MAML3">MAML3</a> </td> <td>amplification </td> <td> </td> <td>2% </td></tr> <tr> <td><a href="/wiki/MLH1" title="MLH1">MLH1</a> </td> <td> </td> <td> </td> <td>1% </td></tr> <tr> <td><a href="/wiki/Nuclear_factor_1" class="mw-redirect" title="Nuclear factor 1">NF1</a> </td> <td>deletion (8%) and point mutation (4%) </td> <td>high-grade serous </td> <td>12% </td></tr> <tr> <td><a href="/wiki/NOTCH3" title="NOTCH3">NOTCH3</a> </td> <td>amplification and point mutation </td> <td> </td> <td>11% </td></tr> <tr> <td><a href="/wiki/Neuroblastoma_RAS_viral_oncogene_homolog" title="Neuroblastoma RAS viral oncogene homolog">NRAS</a> </td> <td> </td> <td>low-grade serous </td> <td> </td></tr> <tr> <td><a href="/wiki/PIK3C3" title="PIK3C3">PIK3C3</a> (PI3K3) </td> <td>amplification/mutation </td> <td> </td> <td>12–20% </td></tr> <tr> <td><a href="/wiki/PIK3CA" class="mw-redirect" title="PIK3CA">PIK3CA</a> </td> <td>amplification </td> <td>endometrioid and clear-cell </td> <td>18% </td></tr> <tr> <td><a href="/wiki/PPP2R1A" title="PPP2R1A">PPP2R1A</a> </td> <td> </td> <td>endometrioid and clear-cell </td> <td> </td></tr> <tr> <td><a href="/wiki/PTEN_(gene)" title="PTEN (gene)">PTEN</a> </td> <td>deletion </td> <td>endometrioid and clear-cell </td> <td>7% </td></tr> <tr> <td><a href="/wiki/RB1" class="mw-redirect" title="RB1">RB1</a> </td> <td>deletion (8%) and point mutation (2%) </td> <td> </td> <td>10% </td></tr> <tr> <td><a href="/wiki/TGF-%CE%B2" class="mw-redirect" title="TGF-β">TGF-β</a> </td> <td>mutation/overexpression </td> <td> </td> <td>12% </td></tr> <tr> <td><a href="/wiki/TP53" class="mw-redirect" title="TP53">TP53</a> </td> <td>mutation/overexpression </td> <td>high-grade serous </td> <td>20–50% </td></tr> <tr> <td><a href="/w/index.php?title=T%CE%B2RI&action=edit&redlink=1" class="new" title="TβRI (page does not exist)">TβRI</a> </td> <td>mutation </td> <td> </td> <td>33% </td></tr> <tr> <td><a href="/w/index.php?title=T%CE%B2RII&action=edit&redlink=1" class="new" title="TβRII (page does not exist)">TβRII</a> </td> <td>mutation </td> <td> </td> <td>25% </td></tr> <tr> <td><a href="/wiki/USP36" title="USP36">USP36</a> </td> <td>overexpression </td> <td> </td> <td> </td></tr></tbody></table> Ovarian cancer forms when errors in normal ovarian <a href="/wiki/Cell_cycle" title="Cell cycle">cell growth</a> occur. Usually, when cells grow old or get damaged, they <a href="/wiki/Apoptosis" title="Apoptosis">die</a>, and new cells take their place. Cancer starts when new cells form unneeded, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called an <a href="/wiki/Ovarian_tumor" title="Ovarian tumor">ovarian tumor</a> or growth. These abnormal cancer cells have many <a href="/wiki/Genetic_mutation" class="mw-redirect" title="Genetic mutation">genetic abnormalities</a> that cause them to grow excessively.<a href="#cite_note-NCIGenetics-56">[56]</a> When an ovary <a href="/wiki/Ovulation" title="Ovulation">releases an egg</a>, the <a href="/wiki/Ovarian_follicle" title="Ovarian follicle">egg follicle</a> bursts open and becomes the <a href="/wiki/Corpus_luteum" title="Corpus luteum">corpus luteum</a>. This structure needs to be repaired by dividing cells in the ovary.<a href="#cite_note-CRUKRisks-34">[34]</a> Continuous ovulation for a long time means more repair of the ovary by dividing cells, which can acquire mutations in each division.<a href="#cite_note-Hoffman35-29">[29]</a> Overall, the most common gene mutations in ovarian cancer occur in <a href="/wiki/Nuclear_factor_1" class="mw-redirect" title="Nuclear factor 1">NF1</a>, BRCA1, BRCA2, and <a href="/wiki/CDK12" title="CDK12">CDK12</a>. Type I ovarian cancers, which tend to be less aggressive, tend to have <a href="/wiki/Microsatellite_instability" title="Microsatellite instability">microsatellite instability</a> in several genes, including both oncogenes (most notably <a href="/wiki/BRAF_(gene)" title="BRAF (gene)">BRAF</a> and <a href="/wiki/KRAS" title="KRAS">KRAS</a>) and tumor suppressors (most notably <a href="/wiki/PTEN_(gene)" title="PTEN (gene)">PTEN</a>).<a href="#cite_note-Jayson-28">[28]</a> The most common mutations in Type I cancers are KRAS, BRAF, ERBB2, PTEN, PIK3CA, and ARID1A.<a href="#cite_note-DynaMed15-31">[31]</a> Type II cancers, the more aggressive type, have different genes mutated, including <a href="/wiki/P53" title="P53">p53</a>, BRCA1, and BRCA2.<a href="#cite_note-Jayson-28">[28]</a> Low-grade cancers tend to have mutations in KRAS, whereas cancers of any grade that develop from low malignant potential tumors tend to have mutations in p53.<a href="#cite_note-Hoffman35-29">[29]</a> Type I cancers tend to develop from precursor lesions, whereas Type II cancers can develop from a <a href="/w/index.php?title=Serous_tubal_intraepithelial_carcinoma&action=edit&redlink=1" class="new" title="Serous tubal intraepithelial carcinoma (page does not exist)">serous tubal intraepithelial carcinoma</a>.<a href="#cite_note-DynaMed15-31">[31]</a> <a href="/wiki/Serous_cancer" class="mw-redirect" title="Serous cancer">Serous cancers</a> that have BRCA mutations also inevitably have p53 mutations, indicating that the removal of both functional genes is important for cancer to develop.<a href="#cite_note-Hoffman35-29">[29]</a> In 50% of high-grade serous cancers, homologous recombination DNA repair is dysfunctional, as are the <a href="/wiki/Notch_signaling_pathway" title="Notch signaling pathway">notch</a> and <a href="/wiki/FOXM1" title="FOXM1">FOXM1</a> signaling pathways. They also almost always have p53 mutations. Other than this, mutations in high-grade serous carcinoma are hard to characterize beyond their high degree of <a href="/wiki/Genomic_instability" class="mw-redirect" title="Genomic instability">genomic instability</a>. BRCA1 and BRCA2 are essential for homologous recombination DNA repair, and <a href="/wiki/Germline_mutation" title="Germline mutation">germline mutations</a> in these genes are found in about 15% of women with ovarian cancer.<a href="#cite_note-Jayson-28">[28]</a> The most common mutations in BRCA1 and BRCA2 are the <a href="/wiki/Frameshift_mutations" class="mw-redirect" title="Frameshift mutations">frameshift mutations</a> that originated in a small <a href="/wiki/Founder_effect" title="Founder effect">founding population</a> of Ashkenazi Jews.<a href="#cite_note-Hoffman35-29">[29]</a> Almost 100% of rare mucinous carcinomas have mutations in KRAS and amplifications of ERBB2 (also known as Her2/neu).<a href="#cite_note-Jayson-28">[28]</a> Overall, 20% of ovarian cancers have mutations in Her2/neu.<a href="#cite_note-Harrisons-26">[26]</a> Serous carcinomas may develop from <a href="/w/index.php?title=Serous_tubal_intraepithelial_carcinoma&action=edit&redlink=1" class="new" title="Serous tubal intraepithelial carcinoma (page does not exist)">serous tubal intraepithelial carcinoma</a>, rather than developing spontaneously from ovarian tissue. Other carcinomas develop from <a href="/w/index.php?title=Cortical_inclusion_cysts&action=edit&redlink=1" class="new" title="Cortical inclusion cysts (page does not exist)">cortical inclusion cysts</a>, which are groups of epithelial ovarian cells inside the <a href="/wiki/Stroma_(animal_tissue)" class="mw-redirect" title="Stroma (animal tissue)">stroma</a>.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=13" title="Edit section: Diagnosis">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Examination">Examination</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=14" title="Edit section: Examination">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:POvarianCA.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c4/POvarianCA.png/290px-POvarianCA.png" decoding="async" width="290" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c4/POvarianCA.png/435px-POvarianCA.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c4/POvarianCA.png/580px-POvarianCA.png 2x" data-file-width="1152" data-file-height="863" /></a><figcaption>A very large ovarian cancer as seen on CT</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Serous_carcinoma_cytology.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/02/Serous_carcinoma_cytology.jpg/220px-Serous_carcinoma_cytology.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/02/Serous_carcinoma_cytology.jpg/330px-Serous_carcinoma_cytology.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/02/Serous_carcinoma_cytology.jpg/440px-Serous_carcinoma_cytology.jpg 2x" data-file-width="4272" data-file-height="2848" /></a><figcaption><a href="/wiki/Micrograph" title="Micrograph">Micrograph</a> of <a href="/wiki/Serous_carcinoma" class="mw-redirect" title="Serous carcinoma">serous carcinoma</a>, a type of ovarian cancer, diagnosed in <a href="/wiki/Peritoneal_fluid" title="Peritoneal fluid">peritoneal fluid</a></figcaption></figure> Diagnosis of ovarian cancer starts with a physical examination (including a <a href="/wiki/Pelvic_examination" title="Pelvic examination">pelvic examination</a>), a blood test (for <a href="/wiki/CA-125" class="mw-redirect" title="CA-125">CA-125</a> and sometimes other markers), and <a href="/wiki/Transvaginal_ultrasound" class="mw-redirect" title="Transvaginal ultrasound">transvaginal ultrasound</a>.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-57">[57]</a> Sometimes a <a href="/wiki/Rectovaginal_examination" title="Rectovaginal examination">rectovaginal examination</a> is used to help plan a surgery.<a href="#cite_note-Hoffman35-29">[29]</a> The diagnosis must be confirmed with surgery to inspect the <a href="/wiki/Abdominal_cavity" title="Abdominal cavity">abdominal cavity</a>, take <a href="/wiki/Biopsies" class="mw-redirect" title="Biopsies">biopsies</a> (tissue samples for <a href="/wiki/Histopathology" title="Histopathology">microscopic analysis</a>), and look for cancer cells in the abdominal fluid. This helps to determine if an ovarian mass is <a href="/wiki/Benign" class="mw-redirect" title="Benign">benign</a> or malignant.<a href="#cite_note-Harrisons-26">[26]</a> Ovarian cancer's early stages (I/II) are difficult to diagnose because most symptoms are nonspecific and thus of little use in diagnosis; as a result, it is rarely diagnosed until it spreads and advances to later stages (III/IV).<a href="#cite_note-58">[58]</a> Additionally, symptoms of ovarian cancer may appear similar to <a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">irritable bowel syndrome</a>. In women in whom pregnancy is a possibility, <a href="/wiki/BHCG" class="mw-redirect" title="BHCG">BHCG</a> level can be measured during the diagnosis process. Serum <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">alpha-fetoprotein</a>, <a href="/wiki/Neuron-specific_enolase" class="mw-redirect" title="Neuron-specific enolase">neuron-specific enolase</a>, and <a href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">lactate dehydrogenase</a> can be measured in young girls and adolescents with suspected <a href="/wiki/Ovarian_tumor" title="Ovarian tumor">ovarian tumors</a> as younger women with ovarian cancer are more likely to have malignant germ cell tumors.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-DynaMed15-31">[31]</a> A physical examination, including a pelvic examination, and a pelvic ultrasound (transvaginal or otherwise) are both essential for diagnosis: physical examination may reveal increased abdominal girth and/or <a href="/wiki/Ascites" title="Ascites">ascites</a> (fluid within the abdominal cavity), while pelvic examination may reveal an ovarian or abdominal mass.<a href="#cite_note-Jayson-28">[28]</a> An adnexal mass is a significant finding that often indicates ovarian cancer, especially if it is fixed, nodular, irregular, solid, and/or bilateral. 13–21% of adnexal masses are caused by malignancy; however, there are other benign causes of adnexal masses, including <a href="/wiki/Follicular_cyst_of_ovary" title="Follicular cyst of ovary">ovarian follicular cyst</a>, <a href="/wiki/Leiomyoma" title="Leiomyoma">leiomyoma</a>, <a href="/wiki/Endometriosis" title="Endometriosis">endometriosis</a>, <a href="/wiki/Ectopic_pregnancy" title="Ectopic pregnancy">ectopic pregnancy</a>, <a href="/wiki/Hydrosalpinx" title="Hydrosalpinx">hydrosalpinx</a>, <a href="/w/index.php?title=Tuboovarian_abscess&action=edit&redlink=1" class="new" title="Tuboovarian abscess (page does not exist)">tuboovarian abscess</a>, <a href="/wiki/Ovarian_torsion" title="Ovarian torsion">ovarian torsion</a>, <a href="/wiki/Dermoid_cyst" title="Dermoid cyst">dermoid cyst</a>, <a href="/wiki/Cystadenoma" title="Cystadenoma">cystadenoma</a> (serous or mucinous), <a href="/w/index.php?title=Diverticular_abscess&action=edit&redlink=1" class="new" title="Diverticular abscess (page does not exist)">diverticular</a> or <a href="/w/index.php?title=Appendiceal_abscess&action=edit&redlink=1" class="new" title="Appendiceal abscess (page does not exist)">appendiceal abscess</a>, <a href="/wiki/Nerve_sheath_tumor" title="Nerve sheath tumor">nerve sheath tumor</a>, <a href="/wiki/Pelvic_kidney" title="Pelvic kidney">pelvic kidney</a>, <a href="/w/index.php?title=Ureteral_diverticulum&action=edit&redlink=1" class="new" title="Ureteral diverticulum (page does not exist)">ureteral</a> or <a href="/wiki/Bladder_diverticulum" class="mw-redirect" title="Bladder diverticulum">bladder diverticulum</a>, <a href="/w/index.php?title=Benign_cystic_mesothelioma_of_the_peritoneum&action=edit&redlink=1" class="new" title="Benign cystic mesothelioma of the peritoneum (page does not exist)">benign cystic mesothelioma of the peritoneum</a>, <a href="/wiki/Peritoneal_tuberculosis" class="mw-redirect" title="Peritoneal tuberculosis">peritoneal tuberculosis</a>, or <a href="/wiki/Paraovarian_cyst" title="Paraovarian cyst">paraovarian cyst</a>. Ovaries that can be felt are also a sign of ovarian cancer in postmenopausal women. Other parts of a physical examination for suspected ovarian cancer can include a <a href="/wiki/Breast_examination" title="Breast examination">breast examination</a> and a <a href="/wiki/Digital_rectal_exam" class="mw-redirect" title="Digital rectal exam">digital rectal exam</a>. Palpation of the <a href="/wiki/Supraclavicular_lymph_nodes" title="Supraclavicular lymph nodes">supraclavicular</a>, <a href="/wiki/Axillary_lymph_nodes" title="Axillary lymph nodes">axillary</a>, and <a href="/wiki/Inguinal_lymph_node" class="mw-redirect" title="Inguinal lymph node">inguinal</a> <a href="/wiki/Lymph_node" title="Lymph node">lymph nodes</a> may reveal <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">lymphadenopathy</a>, which can be indicative of metastasis. Another indicator may be the presence of a <a href="/wiki/Pleural_effusion" title="Pleural effusion">pleural effusion</a>, which can be noted on <a href="/wiki/Auscultation" title="Auscultation">auscultation</a>.<a href="#cite_note-DynaMed15-31">[31]</a> When an ovarian malignancy is included in a list of diagnostic possibilities, a limited number of laboratory tests are indicated. A complete blood count and serum electrolyte test is usually obtained;<a href="#cite_note-Miller-59">[59]</a> when an ovarian cancer is present, these tests often show <a href="/wiki/Thrombocytosis" class="mw-redirect" title="Thrombocytosis">a high number of platelets</a> (20–25% of patients) and <a href="/wiki/Hyponatremia" title="Hyponatremia">low blood sodium levels</a> due to chemical signals secreted by the tumor.<a href="#cite_note-Hoffman35-29">[29]</a> A positive test for <a href="/wiki/Inhibin_A" class="mw-redirect" title="Inhibin A">inhibin A</a> and <a href="/wiki/Inhibin_B" class="mw-redirect" title="Inhibin B">inhibin B</a> can indicate a granulosa cell tumor.<a href="#cite_note-DynaMed15-31">[31]</a> A blood test for a marker molecule called CA-125 is useful in differential diagnosis and in follow up of the disease, but it by itself has not been shown to be an effective method to screen for early-stage ovarian cancer due to its unacceptable low sensitivity and specificity.<a href="#cite_note-Miller-59">[59]</a> CA-125 levels in premenopausal women over 200 U/mL may indicate ovarian cancer, as may any elevation in CA-125 above 35 U/mL in post-menopausal women. CA-125 levels are not accurate in early stage ovarian cancer, as half of stage I ovarian cancer patients have a normal CA-125 level.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-Hoffman35-29">[29]</a> CA-125 may also be elevated in benign (non-cancerous) conditions, including <a href="/wiki/Endometriosis" title="Endometriosis">endometriosis</a>, <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>, <a href="/wiki/Uterine_fibroids" class="mw-redirect" title="Uterine fibroids">uterine fibroids</a>, <a href="/wiki/Menstruation" title="Menstruation">menstruation</a>, <a href="/wiki/Ovarian_cysts" class="mw-redirect" title="Ovarian cysts">ovarian cysts</a>, <a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">systemic lupus erythematosus</a>, <a href="/wiki/Liver_disease" title="Liver disease">liver disease</a>, <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">inflammatory bowel disease</a>, <a href="/wiki/Pelvic_inflammatory_disease" title="Pelvic inflammatory disease">pelvic inflammatory disease</a>, and <a href="/wiki/Leiomyoma" title="Leiomyoma">leiomyoma</a>.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-60">[60]</a> <a href="/wiki/HE4" class="mw-redirect" title="HE4">HE4</a> is another candidate for ovarian cancer testing, though it has not been extensively tested. Other tumor markers for ovarian cancer include <a href="/wiki/CA19-9" title="CA19-9">CA19-9</a>, <a href="/w/index.php?title=CA72-4&action=edit&redlink=1" class="new" title="CA72-4 (page does not exist)">CA72-4</a>, <a href="/wiki/CA15-3" class="mw-redirect" title="CA15-3">CA15-3</a>, <a href="/w/index.php?title=Immunosuppressive_acidic_protein&action=edit&redlink=1" class="new" title="Immunosuppressive acidic protein (page does not exist)">immunosuppressive acidic protein</a>, <a href="/w/index.php?title=Haptoglobin-alpha&action=edit&redlink=1" class="new" title="Haptoglobin-alpha (page does not exist)">haptoglobin-alpha</a>, <a href="/w/index.php?title=OVX1&action=edit&redlink=1" class="new" title="OVX1 (page does not exist)">OVX1</a>, <a href="/wiki/Mesothelin" title="Mesothelin">mesothelin</a>, <a href="/wiki/Lysophosphatidic_acid" title="Lysophosphatidic acid">lysophosphatidic acid</a>, <a href="/wiki/Osteopontin" title="Osteopontin">osteopontin</a>, and <a href="/wiki/Fibroblast_growth_factor_23" title="Fibroblast growth factor 23">fibroblast growth factor 23</a>.<a href="#cite_note-DynaMed15-31">[31]</a> Use of blood test panels may help in diagnosis.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-Miller-59">[59]</a> The OVA1 panel includes CA-125, <a href="/wiki/Beta-2_microglobulin" title="Beta-2 microglobulin">beta-2 microglobulin</a>, <a href="/wiki/Transferrin" title="Transferrin">transferrin</a>, <a href="/wiki/Apolipoprotein_A1" class="mw-redirect" title="Apolipoprotein A1">apolipoprotein A1</a>, and <a href="/wiki/Transthyretin" title="Transthyretin">transthyretin</a>. OVA1 above 5.0 in premenopausal women and 4.4 in postmenopausal women indicates a high risk for cancer.<a href="#cite_note-Hoffman35-29">[29]</a> A different set of laboratory tests is used for detecting sex cord-stromal tumors. High levels of <a href="/wiki/Testosterone" title="Testosterone">testosterone</a> or <a href="/wiki/Dehydroepiandrosterone_sulfate" title="Dehydroepiandrosterone sulfate">dehydroepiandrosterone sulfate</a>, combined with other symptoms and high levels of <a href="/wiki/Inhibin_A" class="mw-redirect" title="Inhibin A">inhibin A</a> and <a href="/wiki/Inhibin-beta_subunits" class="mw-redirect" title="Inhibin-beta subunits">inhibin B</a> can be indicative of an SCST of any type.<a href="#cite_note-Williams12-32">[32]</a> Current research is looking at ways to consider tumor marker <a href="/wiki/Proteomics" title="Proteomics">proteomics</a> in combination with other indicators of disease (i.e. radiology and/or symptoms) to improve diagnostic accuracy. The challenge in such an approach is that the disparate prevalence of ovarian cancer means that even testing with very high sensitivity and specificity will still lead to a number of false positive results, which in turn may lead to issues such as performing surgical procedures in which cancer is not found intraoperatively.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <a href="/wiki/Genomics" title="Genomics">Genomics</a> approaches have not yet been developed for ovarian cancer.<a href="#cite_note-DynaMed15-31">[31]</a> <a href="/wiki/CT_scanning" class="mw-redirect" title="CT scanning">CT scanning</a> is preferred to assess the extent of the tumor in the abdominopelvic cavity, though <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">magnetic resonance imaging</a> can also be used.<a href="#cite_note-Jayson-28">[28]</a> CT scanning can also be useful for finding <a href="/w/index.php?title=Omental_caking&action=edit&redlink=1" class="new" title="Omental caking (page does not exist)">omental caking</a> or differentiating fluid from solid tumor in the abdomen, especially in low malignant potential tumors. However, it may not detect smaller tumors. Sometimes, a <a href="/wiki/Chest_radiograph" title="Chest radiograph">chest x-ray</a> is used to detect metastases in the chest or <a href="/wiki/Pleural_effusion" title="Pleural effusion">pleural effusion</a>. Another test for metastatic disease, though it is infrequently used, is a <a href="/wiki/Barium_enema" class="mw-redirect" title="Barium enema">barium enema</a>, which can show if the rectosigmoid colon is involved in the disease. <a href="/wiki/Positron_emission_tomography" title="Positron emission tomography">Positron emission tomography</a>, <a href="/wiki/Bone_scan" class="mw-redirect" title="Bone scan">bone scans</a>, and <a href="/wiki/Paracentesis" title="Paracentesis">paracentesis</a> are of limited use; in fact, paracentesis can cause metastases to form at the needle insertion site and may not provide useful results.<a href="#cite_note-Hoffman35-29">[29]</a> However, paracentesis can be used in cases where there is no pelvic mass and ascites is still present.<a href="#cite_note-Hoffman35-29">[29]</a> A physician suspecting ovarian cancer may also perform <a href="/wiki/Mammography" title="Mammography">mammography</a> or an <a href="/wiki/Endometrial_biopsy" title="Endometrial biopsy">endometrial biopsy</a> (in the case of abnormal bleeding) to assess the possibility of breast malignancies and endometrial malignancy, respectively. <a href="/wiki/Vaginal_ultrasonography" title="Vaginal ultrasonography">Vaginal ultrasonography</a> is often the first-line imaging study performed when an adnexal mass is found. Several characteristics of an adnexal mass indicate ovarian malignancy; they usually are solid, irregular, multilocular, and/or large; and they typically have papillary features, central vessels, and/or irregular internal septations.<a href="#cite_note-DynaMed15-31">[31]</a> However, SCST has no definitive characteristics on radiographic study.<a href="#cite_note-Williams12-32">[32]</a> To definitively diagnose ovarian cancer, a surgical procedure to inspect the abdomen is required. This can be an open procedure (<a href="/wiki/Laparotomy" title="Laparotomy">laparotomy</a>, incision through the <a href="/wiki/Abdominal_wall" title="Abdominal wall">abdominal wall</a>) or <a href="/wiki/Keyhole_surgery" class="mw-redirect" title="Keyhole surgery">keyhole surgery</a> (<a href="/wiki/Laparoscopy" title="Laparoscopy">laparoscopy</a>). During this procedure, suspicious tissue is removed and sent for <a href="/wiki/Histopathology" title="Histopathology">microscopic analysis</a>. Usually, this includes a unilateral <a href="/wiki/Salpingo-oophorectomy" title="Salpingo-oophorectomy">salpingo-oophorectomy</a>, removal of a single affected ovary and Fallopian tube. Fluid from the abdominal cavity can also be analyzed for cancerous <a href="/wiki/Cell_(biology)" title="Cell (biology)">cells</a>. If cancer is found, this procedure can also be used to determine the extent of its spread (which is a form of <a href="/wiki/Tumor_staging" class="mw-redirect" title="Tumor staging">tumor staging</a>).<a href="#cite_note-Harrisons-26">[26]</a> <a href="/wiki/Pafolacianine" title="Pafolacianine">Pafolacianine</a> is <a href="/wiki/Indication_(medicine)" title="Indication (medicine)">indicated</a> for use in adults with ovarian cancer to help identify cancerous lesions during surgery.<a href="#cite_note-FDA_PR_20211129-61">[61]</a> It is a diagnostic agent that is administered in the form of an intravenous injection prior to surgery.<a href="#cite_note-FDA_PR_20211129-61">[61]</a> <div class="mw-heading mw-heading4"><h4 id="Risk_scoring">Risk scoring</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=15" title="Edit section: Risk scoring">edit</a>]</div> A widely recognized method of estimating the risk of malignant ovarian cancer is the risk of malignancy index (RMI), calculated based on an initial <a href="/wiki/Medical_diagnosis#Other_diagnostic_procedure_methods" title="Medical diagnosis">workup</a>.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-NICE2011-62">[62]</a> An RMI score of over 200 or 250 is generally felt to indicate high risk for ovarian cancer.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-DynaMed15-31">[31]</a> The RMI is calculated as: <dl><dd>RMI = ultrasound score × menopausal score x CA-125 level in U/ml.<a href="#cite_note-Jayson-28">[28]</a></dd></dl> Two methods can be used to determine the ultrasound score and menopausal score, with the resultant scores being referred to as RMI 1 and RMI 2, respectively, depending on what method is used. <table class="wikitable"> <tbody><tr> <th style="width:32%;">Feature </th> <th style="width:34%;">RMI 1<a href="#cite_note-Jayson-28">[28]</a> </th> <th style="width:34%;">RMI 2<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-63">[63]</a> </th></tr> <tr> <td> Ultrasound abnormalities: <ul><li>multilocular cyst</li> <li>solid areas</li> <li>ascites</li> <li>intra-abdominal metastases</li></ul> </td> <td><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"> <ul><li>0 = no abnormality</li> <li>1 = one abnormality</li> <li>3 = two or more abnormalities</li></ul> </div> </td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"> <ul><li>0 = none</li> <li>1 = one abnormality</li> <li>4 = two or more abnormalities</li></ul> </div> </td></tr> <tr> <td>Menopausal score </td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"> <ul><li>1 = premenopausal</li> <li>3 = postmenopausal</li></ul> </div> </td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"> <ul><li>1 = premenopausal</li> <li>4 = postmenopausal</li></ul> </div> </td></tr> <tr> <td>CA-125 </td> <td>Quantity in U/ml </td> <td>Quantity in U/ml </td></tr></tbody></table> Another method for quantifying risk of ovarian cancer is the Risk of Ovarian Cancer Algorithm (ROCA), which observes levels over time and determines if they are increasing rapidly enough to warrant transvaginal ultrasound.<a href="#cite_note-Hoffman35-29">[29]</a> The Risk of Ovarian Malignancy algorithm uses CA-125 levels and <a href="/wiki/HE4" class="mw-redirect" title="HE4">HE4</a> levels to calculate the risk of ovarian cancer; it may be more effective than RMI. The IOTA models can be used to estimate the probability that an adnexal tumor is malignant.<a href="#cite_note-64">[64]</a> They include LR2 risk model, The Simple Rules risk (SRrisk) calculation and Assessment of Different Neoplasias in the Adnexa (ADNEX) model that can be used to assess risk of malignancy in an adnexal mass, based on its characteristics and risk factors. The QCancer (Ovary) algorithm is used to predict likelihood of ovarian cancer from risk factors.<a href="#cite_note-DynaMed15-31">[31]</a> <a rel="nofollow" class="external text" href="https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/O-RADS">Ovarian-Adnexal Reporting and Data System (ORADS)</a> is a standardized system developed by the <a href="/wiki/American_College_of_Radiology" title="American College of Radiology">American College of Radiology</a> to improve the management and diagnosis of ovarian and adnexal masses. It provides a consistent framework for interpreting imaging findings, particularly from ultrasound, and assigns risk stratification categories that guide clinical decision-making. By utilizing a clear set of criteria and terminology, ORADS aims to enhance communication among healthcare providers, increase diagnostic accuracy, and ultimately improve patient outcomes in the evaluation of ovarian and adnexal pathologies. Additionally, a specialized ORADS calculator is available to facilitate reporting, helping radiologists and clinicians quickly and accurately classify findings according to the system's guidelines.<a href="#cite_note-65">[65]</a> <div class="mw-heading mw-heading3"><h3 id="Pathology">Pathology</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=16" title="Edit section: Pathology">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Incidence_of_ovarian_cancers_by_histopathology.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Incidence_of_ovarian_cancers_by_histopathology.png/290px-Incidence_of_ovarian_cancers_by_histopathology.png" decoding="async" width="290" height="342" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Incidence_of_ovarian_cancers_by_histopathology.png/435px-Incidence_of_ovarian_cancers_by_histopathology.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Incidence_of_ovarian_cancers_by_histopathology.png/580px-Incidence_of_ovarian_cancers_by_histopathology.png 2x" data-file-width="2674" data-file-height="3155" /></a><figcaption>Primary ovarian cancers in women aged 20+, with area representing relative incidence and color representing five-year relative survival rate<a href="#cite_note-SEER6215ch16-66">[66]</a></figcaption></figure> Ovarian cancers are classified according to the microscopic appearance of their structures (<a href="/wiki/Histology" title="Histology">histology</a> or <a href="/wiki/Histopathology" title="Histopathology">histopathology</a>). Histology dictates many aspects of clinical treatment, management, and <a href="/wiki/Prognosis" title="Prognosis">prognosis</a>. The gross pathology of ovarian cancers is very similar regardless of histologic type: ovarian tumors have solid and cystic masses.<a href="#cite_note-Hoffman35-29">[29]</a> According to <a href="/wiki/Surveillance_Epidemiology_and_End_Results" class="mw-redirect" title="Surveillance Epidemiology and End Results">SEER</a>, the types of ovarian cancers in women age 20 and over are:<a href="#cite_note-SEER6215ch16-66">[66]</a> <table class="wikitable"> <tbody><tr> <th>Percent of ovarian cancers in women age 20+ </th> <th>Percent of ovarian cancers in women age 20+ by subdivision </th> <th><a href="/wiki/Histology" title="Histology">Histology</a> </th> <th>Five-year <a href="/wiki/Relative_survival_rate" class="mw-redirect" title="Relative survival rate">RSR</a> </th></tr> <tr> <td>89.7 </td> <td> </td> <td><a href="/wiki/Surface_epithelial-stromal_tumor" title="Surface epithelial-stromal tumor">Surface epithelial-stromal tumor</a> (<a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">adenocarcinoma</a>) </td> <td>54.4 </td></tr> <tr> <td> </td> <td>26.4 </td> <td><a href="/wiki/Papillary_serous_cystadenocarcinoma" title="Papillary serous cystadenocarcinoma">Papillary serous cystadenocarcinoma</a> </td> <td>21.0 </td></tr> <tr> <td> </td> <td>15.9 </td> <td><a href="/wiki/Borderline_adenocarcinoma" class="mw-redirect" title="Borderline adenocarcinoma">Borderline adenocarcinoma</a> (underestimated - short data collection interval) </td> <td>98.2 </td></tr> <tr> <td> </td> <td>12.6 </td> <td>Adenocarcinoma, not otherwise specified </td> <td>18.3 </td></tr> <tr> <td> </td> <td>9.8 </td> <td><a href="/wiki/Endometrioid_tumor" title="Endometrioid tumor">Endometrioid tumor</a> </td> <td>70.9 </td></tr> <tr> <td> </td> <td>5.8 </td> <td><a href="/wiki/Serous_cystadenocarcinoma" title="Serous cystadenocarcinoma">Serous cystadenocarcinoma</a> </td> <td>44.2 </td></tr> <tr> <td> </td> <td>5.5 </td> <td><a href="/wiki/Papilloma" title="Papilloma">Papillary</a> </td> <td>21.0 </td></tr> <tr> <td> </td> <td>4.2 </td> <td><a href="/wiki/Mucinous_cystadenocarcinoma" title="Mucinous cystadenocarcinoma">Mucinous cystadenocarcinoma</a> </td> <td>77.7 </td></tr> <tr> <td> </td> <td>4.0 </td> <td><a href="/wiki/Ovarian_clear-cell_carcinoma" title="Ovarian clear-cell carcinoma">Ovarian clear-cell carcinoma</a> </td> <td>61.5 </td></tr> <tr> <td> </td> <td>3.4 </td> <td><a href="/wiki/Mucinous_adenocarcinoma" class="mw-redirect" title="Mucinous adenocarcinoma">Mucinous adenocarcinoma</a> </td> <td>49.1 </td></tr> <tr> <td> </td> <td>1.3 </td> <td><a href="/wiki/Cystadenocarcinoma" title="Cystadenocarcinoma">Cystadenocarcinoma</a> </td> <td>50.7 </td></tr> <tr> <td>5.5 </td> <td> </td> <td><a href="/wiki/Carcinoma" title="Carcinoma">Carcinoma</a> </td> <td> </td></tr> <tr> <td> </td> <td>4.1 </td> <td>Carcinoma not otherwise specified </td> <td>26.8 </td></tr> <tr> <td> </td> <td>1.1 </td> <td><a href="/wiki/Sex_cord-stromal_tumor" class="mw-redirect" title="Sex cord-stromal tumor">Sex cord-stromal tumor</a> </td> <td>87.8 </td></tr> <tr> <td> </td> <td>0.3 </td> <td>Other carcinomas, specified </td> <td>37.3 </td></tr> <tr> <td>1.7 </td> <td> </td> <td><a href="/w/index.php?title=M%C3%BCllerian_tumor&action=edit&redlink=1" class="new" title="Müllerian tumor (page does not exist)">Müllerian tumor</a> </td> <td>29.8 </td></tr> <tr> <td>1.5 </td> <td> </td> <td><a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">Germ cell tumor</a> </td> <td>91.0 </td></tr> <tr> <td> </td> <td>0.8 </td> <td><a href="/wiki/Teratoma" title="Teratoma">Teratoma</a> </td> <td>89.1 </td></tr> <tr> <td> </td> <td>0.5 </td> <td><a href="/wiki/Dysgerminoma" title="Dysgerminoma">Dysgerminoma</a> </td> <td>96.8 </td></tr> <tr> <td> </td> <td>0.3 </td> <td>Other, specified </td> <td>85.1 </td></tr> <tr> <td>0.6 </td> <td> </td> <td>Not otherwise specified </td> <td>23.0 </td></tr> <tr> <td>0.5 </td> <td> </td> <td><a href="/wiki/Ovarian_squamous_cell_carcinoma" title="Ovarian squamous cell carcinoma">Ovarian squamous cell carcinoma</a> (Epidermoid) </td> <td>51.3 </td></tr> <tr> <td>0.2 </td> <td> </td> <td><a href="/wiki/Brenner_tumor" class="mw-redirect" title="Brenner tumor">Brenner tumor</a> </td> <td>67.9 </td></tr> <tr> <td>0.2 </td> <td> </td> <td>Other, specified </td> <td>71.7 </td></tr></tbody></table> Ovarian cancers are histologically and genetically divided into type I or type II. Type I cancers are of low histological grade and include endometrioid, mucinous, and clear-cell carcinomas. Type II cancers are of higher histological grade and include serous carcinoma and carcinosarcoma.<a href="#cite_note-Jayson-28">[28]</a> <div class="mw-heading mw-heading4"><h4 id="Epithelial_carcinoma">Epithelial carcinoma</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=17" title="Edit section: Epithelial carcinoma">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Ovarian_carcinoma.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Ovarian_carcinoma.JPG/290px-Ovarian_carcinoma.JPG" decoding="async" width="290" height="172" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Ovarian_carcinoma.JPG/435px-Ovarian_carcinoma.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Ovarian_carcinoma.JPG/580px-Ovarian_carcinoma.JPG 2x" data-file-width="2995" data-file-height="1781" /></a><figcaption>A pathological specimen of ovarian carcinoma</figcaption></figure> Epithelial ovarian cancer typically presents at an advanced stage and is derived from the malignant transformation of the epithelium of the ovarian surface, peritoneum, or fallopian tube.<a href="#cite_note-Desai14-67">[67]</a> It is the most common cause of gynecologic cancer death.<a href="#cite_note-Desai14-67">[67]</a> There are various types of epithelial ovarian cancer, including serous tumor, endometrioid tumor, clear-cell tumor, mucinous tumor, and undifferentiated or unclassified tumors.<a href="#cite_note-68">[68]</a> Annually worldwide, 230,000 women will be diagnosed and 150,000 will die.<a href="#cite_note-Lheureux19-69">[69]</a> It has a 46% 5 year survival rate after diagnosis because of the advanced stage of the disease at the time of diagnosis.<a href="#cite_note-Lheureux19-69">[69]</a> Typically, around 75% of patients are diagnosed as having an advanced stage of the disease because of the asymptomatic nature of its presentation.<a href="#cite_note-Lheureux19-69">[69]</a> There is a genomic predisposition to epithelial ovarian cancer and the BRCA1 and BRCA2 genes have been found to be the causative genes in 65–75% of hereditary epithelial ovarian cancer.<a href="#cite_note-Lheureux19-69">[69]</a> <div class="mw-heading mw-heading5"><h5 id="Serous_carcinoma">Serous carcinoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=18" title="Edit section: Serous carcinoma">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Serous_carcinoma_(3061775966).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3b/Serous_carcinoma_%283061775966%29.jpg/220px-Serous_carcinoma_%283061775966%29.jpg" decoding="async" width="220" height="158" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3b/Serous_carcinoma_%283061775966%29.jpg/330px-Serous_carcinoma_%283061775966%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3b/Serous_carcinoma_%283061775966%29.jpg/440px-Serous_carcinoma_%283061775966%29.jpg 2x" data-file-width="1024" data-file-height="736" /></a><figcaption>Serous carcinoma of ovary</figcaption></figure> Serous ovarian cancer is the most common type of epithelial ovarian cancer and it accounts for about two-thirds of cases of epithelial ovarian cancer.<a href="#cite_note-Jayson-28">[28]</a> Low-grade serous carcinoma is less aggressive than high-grade serous carcinomas, though it does not typically respond well to chemotherapy or hormonal treatments.<a href="#cite_note-Jayson-28">[28]</a> Serous carcinomas are thought to begin in the <a href="/wiki/Fallopian_tube" title="Fallopian tube">Fallopian tube</a>.<a href="#cite_note-:1-70">[70]</a><a href="#cite_note-71">[71]</a> High grade serous carcinoma accounts for 75% of all epithelial ovarian cancer.<a href="#cite_note-Lheureux19-69">[69]</a> About 15–20% of high grade serous carcinoma have germline BRCA1 and BRCA2 mutations.<a href="#cite_note-Lheureux19-69">[69]</a> Histologically, the growth pattern of high grade serous carcinoma is heterogenous and has some papillary or solid growth patterns.<a href="#cite_note-Lheureux19-69">[69]</a> The tumor cells are atypical with large, irregular nuclei.<a href="#cite_note-Lheureux19-69">[69]</a> It has a high proliferation rate.<a href="#cite_note-Lheureux19-69">[69]</a> 50% of the time, serous carcinomas are bilateral, and in 85% of cases, they have spread beyond the ovary at the time of diagnosis.<a href="#cite_note-Gynecologic_pathology_:_a_volume_in-72">[72]</a> Serous Tubal Intraepithelial Carcinoma (STIC) is now recognized to be the precursor lesion of most so-called ovarian high-grade serous carcinomas.<a href="#cite_note-Gynecologic_pathology_:_a_volume_in-72">[72]</a> STIC is characterised by <ol><li>Abnormal p53 staining</li> <li>Ki67 proliferation index in excess of 10%</li> <li>Positive WT1 (to exclude metastases)<a href="#cite_note-Gynecologic_pathology_:_a_volume_in-72">[72]</a></li></ol> <div class="mw-heading mw-heading5"><h5 id="Small-cell_carcinoma">Small-cell carcinoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=19" title="Edit section: Small-cell carcinoma">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/54/Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg/220px-Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/54/Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg/330px-Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/54/Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg/440px-Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a><figcaption>Small cell carcinoma of the ovary, hypercalcemic subtype</figcaption></figure> <a href="/wiki/Small-cell_carcinoma" title="Small-cell carcinoma">Small-cell</a> ovarian carcinoma is rare and aggressive, with two main subtypes: hypercalcemic and pulmonary.<a href="#cite_note-Korivi18-73">[73]</a> This rare malignancy most commonly affects young women under the age of 40 years old with a range between 14 months and 58 years.<a href="#cite_note-Korivi18-73">[73]</a> The mean age of diagnosis of 24 years.<a href="#cite_note-Korivi18-73">[73]</a> Approximately two-thirds of patients will present with paraneoplastic hypercalcemia meaning they have high blood calcium levels for an unknown reason.<a href="#cite_note-Korivi18-73">[73]</a><a href="#cite_note-Lu19-74">[74]</a> The tumor secretes Parathyroid hormone related protein which acts similarly to PTH and binds PTH receptors in the bone and kidney causing hypercalcemia.<a href="#cite_note-Korivi18-73">[73]</a> Recent research has found an inactivating germline and somatic mutation of SMARCA4 gene.<a href="#cite_note-Korivi18-73">[73]</a><a href="#cite_note-Tischkowitz20-75">[75]</a> The hypercalcemic subtype is very aggressive and has an overall survival rate of 16% with a recurrence rate of 65% in patients who receive treatment.<a href="#cite_note-Korivi18-73">[73]</a> Patients who have spread of the disease to other parts of the body tend to die 2 years after the diagnosis.<a href="#cite_note-Korivi18-73">[73]</a> Extra-ovarian spread is involved in 50% of cases and lymph node spread is present in 55% of cases.<a href="#cite_note-Lu19-74">[74]</a> The most common initial presentation is a rapidly growing unilateral pelvic mass with a mean size of 15 cm.<a href="#cite_note-Korivi18-73">[73]</a> Histologically, it is characterized by many sheets of small, round, tightly packed cells with clusters, nests, and cords.<a href="#cite_note-Korivi18-73">[73]</a><a href="#cite_note-Lu19-74">[74]</a> Immunohistochemistry is typically positive for vimentin, cytokeratin, CD10, p53, and WT-1.<a href="#cite_note-Korivi18-73">[73]</a><a href="#cite_note-Tischkowitz20-75">[75]</a> Small cell ovarian carcinoma of the pulmonary subtype presents differently from the hypercalcemic subtype.<a href="#cite_note-Korivi18-73">[73]</a> Typically, pulmonary small cell ovarian cancer usually affects both ovaries of older women and looks like <a href="/wiki/Small-cell_carcinoma" title="Small-cell carcinoma">oat-cell carcinoma of the lung</a>.<a href="#cite_note-Hoffman35-29">[29]</a> The average age of disease onset is 59 years old and approximately 45% of cases are bilateral for the pulmonary subtype.<a href="#cite_note-Korivi18-73">[73]</a> Additionally, several hormones can be elevated in the pulmonary subtype including serotonin, somatostatin, insulin, gastrin, and calcitonin.<a href="#cite_note-Korivi18-73">[73]</a> <div class="mw-heading mw-heading6"><h6 id="Primary_peritoneal_carcinoma">Primary peritoneal carcinoma</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=20" title="Edit section: Primary peritoneal carcinoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Primary_peritoneal_carcinoma" title="Primary peritoneal carcinoma">Primary peritoneal carcinoma</a></div>Primary peritoneal carcinomas develop from the <a href="/wiki/Peritoneum" title="Peritoneum">peritoneum</a>, a membrane that covers the <a href="/wiki/Abdominal_cavity" title="Abdominal cavity">abdominal cavity</a> that has the same embryonic origin as the ovary. They are often discussed and classified with ovarian cancers when they affect the ovary.<a href="#cite_note-:1-70">[70]</a><a href="#cite_note-76">[76]</a> They can develop even after the ovaries have been removed and may appear similar to <a href="/wiki/Mesothelioma" title="Mesothelioma">mesothelioma</a>.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading5"><h5 id="Clear-cell_carcinoma">Clear-cell carcinoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=21" title="Edit section: Clear-cell carcinoma">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b5/Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg/220px-Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b5/Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg/330px-Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b5/Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg/440px-Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a><figcaption><a href="/wiki/Ovarian_clear-cell_carcinoma" title="Ovarian clear-cell carcinoma">Ovarian clear-cell carcinoma</a></figcaption></figure> <a href="/wiki/Ovarian_clear-cell_carcinoma" title="Ovarian clear-cell carcinoma">Ovarian clear-cell carcinoma</a> is a rare subtype of epithelial ovarian cancer. Those diagnosed with ovarian clear-cell carcinoma are typically younger at the age of diagnosis and diagnosed at earlier stages than other subtypes of epithelial ovarian cancer.<a href="#cite_note-Gadducci21-77">[77]</a><a href="#cite_note-Iida21-78">[78]</a> The highest incidence of clear-cell carcinoma of the ovary have been observed among young Asian women, especially those of Korean, Taiwanese, and Japanese background.<a href="#cite_note-Gadducci21-77">[77]</a><a href="#cite_note-Iida21-78">[78]</a> Endometriosis has been linked to being the main risk factor for the development of clear-cell carcinoma of the ovary and has been found to be present in 50% of women diagnosed with clear-cell carcinoma of the ovary.<a href="#cite_note-Gadducci21-77">[77]</a> The development of clots in the legs such as deep vein thromboembolism or in the lungs with pulmonary embolism is reported to be 40% higher in patients with clear-cell carcinoma than other epithelial ovarian cancer subtypes.<a href="#cite_note-Iida21-78">[78]</a> Mutations in molecular pathways such as ARID1A, PIK3, and PIK3CA have been found to be linked to clear-cell carcinoma.<a href="#cite_note-Gadducci21-77">[77]</a><a href="#cite_note-Iida21-78">[78]</a> They typically present as a large, unilateral mass, with a mean size between 13 and 15 cm.<a href="#cite_note-Gadducci21-77">[77]</a> 90% of cases are unilateral.<a href="#cite_note-Gadducci21-77">[77]</a> Ovarian clear-cell carcinoma does not typically respond well to chemotherapy due to intrinsic chemoresistance, therefore treatment is typically with aggressive cytoreductive surgery and platinum-based chemotherapy.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-Gadducci21-77">[77]</a> <div class="mw-heading mw-heading5"><h5 id="Clear-cell_adenocarcinoma">Clear-cell adenocarcinoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=22" title="Edit section: Clear-cell adenocarcinoma">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Clear_cell_carcinoma_hobnail_cells.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Clear_cell_carcinoma_hobnail_cells.png/290px-Clear_cell_carcinoma_hobnail_cells.png" decoding="async" width="290" height="363" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Clear_cell_carcinoma_hobnail_cells.png/435px-Clear_cell_carcinoma_hobnail_cells.png 1.5x, //upload.wikimedia.org/wikipedia/commons/9/99/Clear_cell_carcinoma_hobnail_cells.png 2x" data-file-width="490" data-file-height="613" /></a><figcaption>Hobnail cells seen in a clear-cell carcinoma sample</figcaption></figure> <a href="/wiki/Clear-cell_adenocarcinoma" title="Clear-cell adenocarcinoma">Clear-cell adenocarcinomas</a> are histopathologically similar to other <a href="/wiki/Clear-cell_carcinoma" title="Clear-cell carcinoma">clear-cell carcinomas</a>, with <a href="/wiki/Clear_cell" title="Clear cell">clear cells</a> and <a href="/wiki/Hobnail_cell" class="mw-redirect" title="Hobnail cell">hobnail cells</a>. They represent approximately 5–10% of epithelial ovarian cancers and are associated with endometriosis in the pelvic cavity. They are typically early-stage and therefore curable by surgery, but advanced clear-cell adenocarcinomas (approximately 20%) have a poor prognosis and are often resistant to platinum chemotherapy.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading5"><h5 id="Endometrioid">Endometrioid</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=23" title="Edit section: Endometrioid">edit</a>]</div> Endometrioid adenocarcinomas make up approximately 13–15% of all ovarian cancers.<a href="#cite_note-Fadare19-79">[79]</a> Because they are typically low-grade, endometrioid adenocarcinomas have a good prognosis.<a href="#cite_note-Fadare19-79">[79]</a> The median age of diagnosis is around 53 years of age.<a href="#cite_note-Fadare19-79">[79]</a> These tumors frequently co-occur with <a href="/wiki/Endometriosis" title="Endometriosis">endometriosis</a> or endometrial cancer.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-Fadare19-79">[79]</a> Cancer antigen 125 levels are typically elevated and a family history of a first degree relative with endometrioid ovarian cancer is associated with increased risk of developing endometrioid ovarian cancer.<a href="#cite_note-Fadare19-79">[79]</a> The average tumor size is larger than 10 cm.<a href="#cite_note-Fadare19-79">[79]</a> <div class="mw-heading mw-heading6"><h6 id="Malignant_mixed_müllerian_tumor_(carcinosarcoma)">Malignant mixed müllerian tumor (carcinosarcoma)</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=24" title="Edit section: Malignant mixed müllerian tumor (carcinosarcoma)">edit</a>]</div> Mixed müllerian tumors make up less than 1% of ovarian cancer. They have epithelial and mesenchymal cells visible and tend to have a poor prognosis.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading5"><h5 id="Mucinous">Mucinous</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=25" title="Edit section: Mucinous">edit</a>]</div> Mucinous tumors include mucinous adenocarcinoma and mucinous cystadenocarcinoma.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading6"><h6 id="Mucinous_adenocarcinoma">Mucinous adenocarcinoma</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=26" title="Edit section: Mucinous adenocarcinoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Mucinous_adenocarcinoma" class="mw-redirect" title="Mucinous adenocarcinoma">Mucinous adenocarcinoma</a></div> Mucinous adenocarcinomas make up 5–10% of epithelial ovarian cancers. Histologically, they are similar to intestinal or cervical adenocarcinomas and are often actually metastases of <a href="/wiki/Appendiceal_cancer" class="mw-redirect" title="Appendiceal cancer">appendiceal</a> or <a href="/wiki/Colon_cancer" class="mw-redirect" title="Colon cancer">colon cancers</a>. Advanced mucinous adenocarcinomas have a poor prognosis, generally worse than serous tumors, and are often resistant to platinum chemotherapy, though they are rare.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading6"><h6 id="Pseudomyxoma_peritonei">Pseudomyxoma peritonei</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=27" title="Edit section: Pseudomyxoma peritonei">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Pseudomyxoma_peritonei" title="Pseudomyxoma peritonei">Pseudomyxoma peritonei</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Pseudomyxoma.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/57/Pseudomyxoma.jpg/220px-Pseudomyxoma.jpg" decoding="async" width="220" height="173" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/57/Pseudomyxoma.jpg/330px-Pseudomyxoma.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/57/Pseudomyxoma.jpg/440px-Pseudomyxoma.jpg 2x" data-file-width="1011" data-file-height="794" /></a><figcaption>Pseudomyxoma peritonei</figcaption></figure> Pseudomyxoma peritonei refers to a collection of encapsulated mucus or gelatinous material in the abdominopelvic cavity, which is very rarely caused by a primary mucinous ovarian tumor. More commonly, it is associated with ovarian metastases of intestinal cancer.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading5"><h5 id="Undifferentiated_epithelial">Undifferentiated epithelial</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=28" title="Edit section: Undifferentiated epithelial">edit</a>]</div> Undifferentiated cancers - those where the cell type cannot be determined - make up about 10% of epithelial ovarian cancers and have a comparatively poor prognosis.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-:1-70">[70]</a> When examined under the microscope, these tumors have very abnormal cells that are arranged in clumps or sheets. Usually there are recognizable clumps of serous cells inside the tumor.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading6"><h6 id="Malignant_Brenner_tumor">Malignant Brenner tumor</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=29" title="Edit section: Malignant Brenner tumor">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Brenner_tumor" class="mw-redirect" title="Brenner tumor">Brenner tumor</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Brenner_Tumor_of_Ovary.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c1/Brenner_Tumor_of_Ovary.jpg/220px-Brenner_Tumor_of_Ovary.jpg" decoding="async" width="220" height="158" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c1/Brenner_Tumor_of_Ovary.jpg/330px-Brenner_Tumor_of_Ovary.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c1/Brenner_Tumor_of_Ovary.jpg/440px-Brenner_Tumor_of_Ovary.jpg 2x" data-file-width="1024" data-file-height="735" /></a><figcaption>Brenner Tumor of ovary</figcaption></figure> Malignant Brenner tumors are rare. Histologically, they have dense fibrous stroma with areas of transitional epithelium and some squamous differentiation. To be classified as a malignant Brenner tumor, it must have Brenner tumor foci and transitional cell carcinoma. The transitional cell carcinoma component is typically poorly differentiated and resembles urinary tract cancer.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading6"><h6 id="Transitional_cell_carcinoma">Transitional cell carcinoma</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=30" title="Edit section: Transitional cell carcinoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Transitional_cell_carcinoma" title="Transitional cell carcinoma">Transitional cell carcinoma</a></div> Transitional cell carcinomas represent less than 5% of ovarian cancers. Histologically, they appear similar to <a href="/wiki/Bladder_carcinoma" class="mw-redirect" title="Bladder carcinoma">bladder carcinoma</a>. The prognosis is intermediate - better than most epithelial cancers but worse than malignant Brenner tumors.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading4"><h4 id="Sex_cord-stromal_tumor">Sex cord-stromal tumor</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=31" title="Edit section: Sex cord-stromal tumor">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Sex_cord-stromal_tumor" class="mw-redirect" title="Sex cord-stromal tumor">Sex cord-stromal tumor</a></div> <a href="/wiki/Sex_cord-stromal_tumour" class="mw-redirect" title="Sex cord-stromal tumour">Sex cord-stromal tumor</a>, including <a href="/wiki/Estrogen" title="Estrogen">estrogen</a>-producing <a href="/wiki/Granulosa_cell_tumor" class="mw-redirect" title="Granulosa cell tumor">granulosa cell tumor</a>, the benign <a href="/wiki/Thecoma" title="Thecoma">thecoma</a>, and virilizing <a href="/wiki/Sertoli-Leydig_cell_tumor" class="mw-redirect" title="Sertoli-Leydig cell tumor">Sertoli-Leydig cell tumor</a> or <a href="/wiki/Arrhenoblastoma" class="mw-redirect" title="Arrhenoblastoma">arrhenoblastoma</a>, accounts for 7% of ovarian cancers. They occur most frequently in women between 50 and 69 years of age but can occur in women of any age, including young girls. They are not typically aggressive and are usually unilateral;<a href="#cite_note-Harrisons-26">[26]</a> they are therefore usually treated with surgery alone. Sex cord-stromal tumors are the main hormone-producing ovarian tumors.<a href="#cite_note-Williams12-32">[32]</a> Several different cells from the <a href="/wiki/Mesenchyme" title="Mesenchyme">mesenchyme</a> can give rise to sex-cord or stromal tumors. These include <a href="/wiki/Fibroblast" title="Fibroblast">fibroblasts</a> and endocrine cells. The symptoms of a sex-cord or stromal ovarian tumor can differ from other types of ovarian cancer. Common signs and symptoms include <a href="/wiki/Ovarian_torsion" title="Ovarian torsion">ovarian torsion</a>, <a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">hemorrhage</a> from or rupture of the tumor, an abdominal mass, and hormonal disruption. In children, <a href="/wiki/Precocious_puberty#Isosexual_and_heterosexual" title="Precocious puberty">isosexual precocious pseudopuberty</a> may occur with granulosa cell tumors since they produce estrogen. These tumors cause abnormalities in menstruation (<a href="/wiki/Menometrorrhagia" title="Menometrorrhagia">excessive bleeding</a>, <a href="/wiki/Oligomenorrhea" title="Oligomenorrhea">infrequent menstruation</a>, or <a href="/wiki/Amenorrhea" title="Amenorrhea">no menstruation</a>) or postmenopausal bleeding. Because these tumors produce estrogen, they can cause or occur at the same time as <a href="/wiki/Endometrial_cancer" title="Endometrial cancer">endometrial cancer</a> or <a href="/wiki/Breast_cancer" title="Breast cancer">breast cancer</a>. Other sex-cord/stromal tumors present with distinct symptoms. Sertoli-Leydig cell tumors cause <a href="/wiki/Virilization" title="Virilization">virilization</a> and <a href="/wiki/Hirsutism" title="Hirsutism">excessive hair growth</a> due to the production of <a href="/wiki/Testosterone" title="Testosterone">testosterone</a> and <a href="/wiki/Androstenedione" title="Androstenedione">androstenedione</a>, which can also cause <a href="/wiki/Cushing%27s_syndrome" title="Cushing's syndrome">Cushing's syndrome</a> in rare cases. Also, sex-cord stromal tumors occur that do not cause a hormonal imbalance, including benign fibromas, which cause ascites and <a href="/wiki/Hydrothorax" title="Hydrothorax">hydrothorax</a>.<a href="#cite_note-Harrisons-26">[26]</a> With germ cell tumors, sex cord-stromal tumors are the most common ovarian cancer diagnosed in women under 20.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Granulosa_cell_tumor">Granulosa cell tumor</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=32" title="Edit section: Granulosa cell tumor">edit</a>]</div> Granulosa cell tumors are the most common sex-cord stromal tumors, making up 70% of cases, and are divided into two histologic subtypes: adult granulosa cell tumors, which develop in women over 50, and juvenile granulosa tumors, which develop before puberty or before the age of 30. Both develop in the <a href="/wiki/Ovarian_follicle" title="Ovarian follicle">ovarian follicle</a> from a population of cells that surrounds <a href="/w/index.php?title=Germinal_cell&action=edit&redlink=1" class="new" title="Germinal cell (page does not exist)">germinal cells</a>.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading6"><h6 id="Adult_granulosa_cell_tumor">Adult granulosa cell tumor</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=33" title="Edit section: Adult granulosa cell tumor">edit</a>]</div> Adult granulosa cell tumors are characterized by later onset (30+ years, 50 on average). These tumors produce high levels of estrogen, which causes its characteristic symptoms: <a href="/wiki/Menometrorrhagia" title="Menometrorrhagia">menometrorrhagia</a>; <a href="/wiki/Endometrial_hyperplasia" title="Endometrial hyperplasia">endometrial hyperplasia</a>; <a href="/wiki/Breast_pain" title="Breast pain">tender</a>, <a href="/wiki/Breast_enlargement" title="Breast enlargement">enlarged breasts</a>; <a href="/wiki/Vaginal_bleeding" title="Vaginal bleeding">postmenopausal bleeding</a>; and <a href="/wiki/Amenorrhoea" class="mw-redirect" title="Amenorrhoea">secondary amenorrhea</a>. The mass of the tumor can cause other symptoms, including abdominal pain and distension, or symptoms similar to an <a href="/wiki/Ectopic_pregnancy" title="Ectopic pregnancy">ectopic pregnancy</a> if the tumor bleeds and ruptures.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading6"><h6 id="Juvenile_granulosa_cell_tumor">Juvenile granulosa cell tumor</h6>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=34" title="Edit section: Juvenile granulosa cell tumor">edit</a>]</div> <div class="mw-heading mw-heading5"><h5 id="Sertoli-Leydig_cell_tumor">Sertoli-Leydig cell tumor</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=35" title="Edit section: Sertoli-Leydig cell tumor">edit</a>]</div> Sertoli-Leydig tumors are most common in women before the age of 30, and particularly common before puberty.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Sclerosing_stromal_tumors">Sclerosing stromal tumors</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=36" title="Edit section: Sclerosing stromal tumors">edit</a>]</div> Sclerosing stromal tumors typically occur in girls before puberty or women before the age of 30.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading4"><h4 id="Germ_cell_tumor">Germ cell tumor</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=37" title="Edit section: Germ cell tumor">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Ovarian_germ_cell_tumors" title="Ovarian germ cell tumors">Ovarian germ cell tumors</a></div> Germ cell tumors of the ovary develop from the ovarian <a href="/wiki/Germ_cells" class="mw-redirect" title="Germ cells">germ cells</a>.<a href="#cite_note-:1-70">[70]</a> <a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">Germ cell tumor</a> accounts for about 30% of ovarian tumors, but only 5% of ovarian cancers, because most germ-cell tumors are <a href="/wiki/Teratoma" title="Teratoma">teratomas</a> and most teratomas are benign. Malignant teratomas tend to occur in older women, when one of the germ layers in the tumor develops into a <a href="/wiki/Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">squamous cell carcinoma</a>.<a href="#cite_note-Harrisons-26">[26]</a> Germ-cell tumors tend to occur in young women (20s–30s) and girls, making up 70% of the ovarian cancer seen in that age group.<a href="#cite_note-Current-33">[33]</a> Germ-cell tumors can include dysgerminomas, teratomas, yolk sac tumors/endodermal sinus tumors, and choriocarcinomas, when they arise in the ovary. Some germ-cell tumors have an <a href="/wiki/Isochromosome" title="Isochromosome">isochromosome</a> 12, where one arm of chromosome 12 is deleted and replaced with a duplicate of the other.<a href="#cite_note-Harrisons-26">[26]</a> Most germ-cell cancers have a better prognosis than other subtypes and are more sensitive to chemotherapy. They are more likely to be stage I at diagnosis.<a href="#cite_note-Williams12-32">[32]</a> Overall, they metastasize more frequently than epithelial ovarian cancers. In addition, the cancer markers used vary with tumor type: <a href="/wiki/Choriocarcinomas" class="mw-redirect" title="Choriocarcinomas">choriocarcinomas</a> are monitored with <a href="/wiki/Beta-HCG" class="mw-redirect" title="Beta-HCG">beta-HCG</a> and endodermal sinus tumors with <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">alpha-fetoprotein</a>.<a href="#cite_note-Harrisons-26">[26]</a> Germ-cell tumors are typically discovered when they become large, palpable masses. However, like sex cord tumors, they can cause ovarian torsion or hemorrhage and, in children, isosexual precocious puberty. They frequently metastasize to nearby lymph nodes, especially para-aortic and pelvic lymph nodes.<a href="#cite_note-Harrisons-26">[26]</a> The most common symptom of germ cell tumors is <a href="/wiki/Abdominal_pain" title="Abdominal pain">subacute abdominal pain</a> caused by the tumor bleeding, <a href="/wiki/Necrosis" title="Necrosis">necrotizing</a>, or stretching the <a href="/w/index.php?title=Ovarian_capsule&action=edit&redlink=1" class="new" title="Ovarian capsule (page does not exist)">ovarian capsule</a>. If the tumor ruptures, causes significant bleeding, or torses the ovary, it can cause <a href="/wiki/Acute_abdomen" title="Acute abdomen">acute abdominal pain</a>, which occurs in less than 10% of those with germ-cell tumors. They can also secrete hormones which change the <a href="/wiki/Menstrual_cycle" title="Menstrual cycle">menstrual cycle</a>. In 25% of germ-cell tumors, the cancer is discovered during a <a href="/wiki/Well-woman_examination" title="Well-woman examination">routine examination</a> and does not cause symptoms.<a href="#cite_note-Williams12-32">[32]</a> Diagnosing germ cell tumors may be difficult because the normal menstrual cycle and <a href="/wiki/Puberty" title="Puberty">puberty</a> can cause pain and pelvic symptoms, and a young woman may even believe these symptoms to be those of pregnancy, and not seek treatment due to the stigma of <a href="/wiki/Teenage_pregnancy" title="Teenage pregnancy">teen pregnancy</a>. Blood tests for alpha-fetoprotein, <a href="/wiki/Karyotype" title="Karyotype">karyotype</a>, human chorionic gonadotropin, and liver function are used to diagnose germ cell tumor and potential co-occurring gonadal dysgenesis. A germ cell tumor may be initially mistaken for a benign <a href="/wiki/Ovarian_cyst" title="Ovarian cyst">ovarian cyst</a>.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Dysgerminoma">Dysgerminoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=38" title="Edit section: Dysgerminoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Dysgerminoma" title="Dysgerminoma">Dysgerminoma</a></div> <figure class="mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Dysgerminoma_surgery.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/bc/Dysgerminoma_surgery.jpg/165px-Dysgerminoma_surgery.jpg" decoding="async" width="165" height="173" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/bc/Dysgerminoma_surgery.jpg/249px-Dysgerminoma_surgery.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/bc/Dysgerminoma_surgery.jpg/331px-Dysgerminoma_surgery.jpg 2x" data-file-width="593" data-file-height="620" /></a><figcaption>Dysgerminoma</figcaption></figure> Dysgerminoma accounts for 35% of ovarian cancer in young women and is the most likely germ cell tumor to metastasize to the lymph nodes; nodal metastases occur in 25–30% of cases.<a href="#cite_note-Current-33">[33]</a><a href="#cite_note-Williams12-32">[32]</a> These tumors may have mutations in <a href="/wiki/CD117" class="mw-redirect" title="CD117">the KIT gene</a>, a mutation known for its role in <a href="/wiki/Gastrointestinal_stromal_tumor" title="Gastrointestinal stromal tumor">gastrointestinal stromal tumor</a>. <a href="/wiki/Swyer_syndrome" class="mw-redirect" title="Swyer syndrome">People with an XY karyotype and ovaries</a> (<a href="/wiki/Gonadal_dysgenesis" title="Gonadal dysgenesis">gonadal dysgenesis</a>) or an X,0 karyotype and ovaries (<a href="/wiki/Turner_syndrome" title="Turner syndrome">Turner syndrome</a>) who develop a unilateral dysgerminoma are at risk for a <a href="/wiki/Gonadoblastoma" title="Gonadoblastoma">gonadoblastoma</a> in the other ovary, and in this case, both ovaries are usually removed when a unilateral dysgerminoma is discovered to avoid the risk of another malignant tumor. Gonadoblastomas in people with Swyer or Turner syndrome become malignant in approximately 40% of cases. However, in general, dysgerminomas are bilateral 10–20% of the time.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Williams12-32">[32]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Dysgerminoma,_intermed._mag.1.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Dysgerminoma%2C_intermed._mag.1.jpg/220px-Dysgerminoma%2C_intermed._mag.1.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Dysgerminoma%2C_intermed._mag.1.jpg/330px-Dysgerminoma%2C_intermed._mag.1.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Dysgerminoma%2C_intermed._mag.1.jpg/440px-Dysgerminoma%2C_intermed._mag.1.jpg 2x" data-file-width="4272" data-file-height="2848" /></a><figcaption>Dysgerminoma histology</figcaption></figure> They are composed of cells that cannot <a href="/wiki/Cellular_differentiation" title="Cellular differentiation">differentiate</a> further and develop directly from germ cells or from gonadoblastomas. Dysgerminomas contain <a href="/wiki/Syncytiotrophoblast" title="Syncytiotrophoblast">syncytiotrophoblasts</a> in approximately 5% of cases, and can therefore cause elevated hCG levels. On gross appearance, dysgerminomas are typically pink to tan-colored, have multiple lobes, and are solid. Microscopically, they appear identical to <a href="/wiki/Seminoma" title="Seminoma">seminomas</a> and very close to <a href="/wiki/Embryonic_germ_cell" class="mw-redirect" title="Embryonic germ cell">embryonic primordial germ cells</a>, having large, polyhedral, rounded <a href="/wiki/Clear_cell" title="Clear cell">clear cells</a>. The nuclei are uniform and round or square with prominent <a href="/wiki/Nucleolus" title="Nucleolus">nucleoli</a> and the <a href="/wiki/Cytoplasm" title="Cytoplasm">cytoplasm</a> has high levels of <a href="/wiki/Glycogen" title="Glycogen">glycogen</a>. Inflammation is another prominent histologic feature of dysgerminomas.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Choriocarcinoma">Choriocarcinoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=39" title="Edit section: Choriocarcinoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Choriocarcinoma" title="Choriocarcinoma">Choriocarcinoma</a></div> Choriocarcinoma can occur as a primary ovarian tumor developing from a germ cell, though it is usually a gestational disease that metastasizes to the ovary. Primary ovarian choriocarcinoma has a poor prognosis and can occur without a pregnancy. They produce high levels of hCG and can cause <a href="/wiki/Precocious_puberty" title="Precocious puberty">early puberty</a> in children or <a href="/wiki/Menometrorrhagia" title="Menometrorrhagia">menometrorrhagia</a> (irregular, heavy menstruation) after menarche.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Immature_(solid)_teratoma">Immature (solid) teratoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=40" title="Edit section: Immature (solid) teratoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Immature_teratoma" title="Immature teratoma">Immature teratoma</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Mature_Cystic_Teratoma_of_the_Ovary_(5560431170).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Mature_Cystic_Teratoma_of_the_Ovary_%285560431170%29.jpg/220px-Mature_Cystic_Teratoma_of_the_Ovary_%285560431170%29.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Mature_Cystic_Teratoma_of_the_Ovary_%285560431170%29.jpg/330px-Mature_Cystic_Teratoma_of_the_Ovary_%285560431170%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Mature_Cystic_Teratoma_of_the_Ovary_%285560431170%29.jpg/440px-Mature_Cystic_Teratoma_of_the_Ovary_%285560431170%29.jpg 2x" data-file-width="1738" data-file-height="1160" /></a><figcaption>Mature Cystic Teratoma of Ovary</figcaption></figure> Immature, or solid, teratomas are the most common type of ovarian germ cell tumor, making up 40–50% of cases. Teratomas are characterized by the presence of disorganized tissues arising from all three embryonic <a href="/wiki/Germ_layer" title="Germ layer">germ layers</a>: <a href="/wiki/Ectoderm" title="Ectoderm">ectoderm</a>, <a href="/wiki/Mesoderm" title="Mesoderm">mesoderm</a>, and <a href="/wiki/Endoderm" title="Endoderm">endoderm</a>; immature teratomas also have undifferentiated <a href="/wiki/Stem_cell" title="Stem cell">stem cells</a> that make them more malignant than mature teratomas (dermoid cysts). The different tissues are visible on gross pathology and often include bone, cartilage, hair, <a href="/wiki/Mucus" title="Mucus">mucus</a>, or <a href="/wiki/Sebaceous_gland" title="Sebaceous gland">sebum</a>, but these tissues are not visible from the outside, which appears to be a solid mass with lobes and cysts. Histologically, they have large amounts of <a href="/wiki/Neuroectoderm" title="Neuroectoderm">neuroectoderm</a> organized into sheets and tubules along with <a href="/wiki/Neuroglia" class="mw-redirect" title="Neuroglia">glia</a>; the amount of neural tissue determines the histologic grade. Immature teratomas usually only affect one ovary (10% co-occur with dermoid cysts) and usually metastasize throughout the peritoneum. They can also cause mature teratoma implants to grow throughout the abdomen in a disease called <a href="/wiki/Growing_teratoma_syndrome" title="Growing teratoma syndrome">growing teratoma syndrome</a>; these are usually benign but will continue to grow during chemotherapy, and often necessitate further surgery. Unlike mature teratomas, immature teratomas form many <a href="/wiki/Adhesion_(medicine)" title="Adhesion (medicine)">adhesions</a>, making them less likely to cause ovarian torsion. There is no specific marker for immature teratomas, but <a href="/wiki/Carcinoembryonic_antigen" title="Carcinoembryonic antigen">carcinoembryonic antigen</a> (CEA), CA-125, CA19-9, or AFP can sometimes indicate an immature teratoma.<a href="#cite_note-Williams12-32">[32]</a> Stage I teratomas make up the majority (75%) of cases and have the best prognosis, with 98% of patients surviving five years; if a Stage I tumor is also grade 1, it can be treated with unilateral surgery only. Stage II though IV tumors make up the remaining quarter of cases and have a worse prognosis, with 73–88% of patients surviving five years.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Mature_teratoma_(dermoid_cyst)">Mature teratoma (dermoid cyst)</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=41" title="Edit section: Mature teratoma (dermoid cyst)">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Dermoid_cyst" title="Dermoid cyst">Dermoid cyst</a></div> Mature teratomas, or dermoid cysts, are rare tumors consisting of mostly benign tissue that develop after menopause. The tumors consist of disorganized tissue with nodules of malignant tissue, which can be of various types. The most common malignancy is <a href="/wiki/Squamous-cell_carcinoma" title="Squamous-cell carcinoma">squamous cell carcinoma</a>, but <a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">adenocarcinoma</a>, <a href="/wiki/Basal-cell_carcinoma" title="Basal-cell carcinoma">basal-cell carcinoma</a>, <a href="/wiki/Carcinoid" title="Carcinoid">carcinoid tumor</a>, <a href="/wiki/Neuroectodermal_tumor" class="mw-redirect" title="Neuroectodermal tumor">neuroectodermal tumor</a>, <a href="/wiki/Melanoma" title="Melanoma">malignant melanoma</a>, <a href="/wiki/Sarcoma" title="Sarcoma">sarcoma</a>, <a href="/wiki/Sebaceous_carcinoma" title="Sebaceous carcinoma">sebaceous tumor</a>, and <a href="/wiki/Struma_ovarii" title="Struma ovarii">struma ovarii</a> can also be part of the dermoid cyst. They are treated with surgery and adjuvant platinum chemotherapy or radiation.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Yolk_sac_tumor/endodermal_sinus_tumor">Yolk sac tumor/endodermal sinus tumor</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=42" title="Edit section: Yolk sac tumor/endodermal sinus tumor">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Yolk_sac_tumor" class="mw-redirect" title="Yolk sac tumor">Yolk sac tumor</a></div> <a href="/wiki/Yolk_sac" title="Yolk sac">Yolk sac</a> tumors, formerly called endodermal sinus tumors, make up approximately 10–20% of ovarian germ cell malignancies, and have the worst prognosis of all <a href="/wiki/Ovarian_germ_cell_tumors" title="Ovarian germ cell tumors">ovarian germ cell tumors</a>. They occur both before menarche (in one-third of cases) and after menarche (the remaining two-thirds of cases). Half of the people with yolk sac tumors are diagnosed in stage I. Typically, they are unilateral until metastasis, which occurs within the peritoneal cavity and via the bloodstream to the lungs. Yolk sac tumors grow quickly and recur easily, and are not easily treatable once they have recurred. Stage I yolk sac tumors are highly treatable, with a 5-year disease-free survival rate of 93%, but stage II-IV tumors are less treatable, with survival rates of 64–91%.<a href="#cite_note-Williams12-32">[32]</a> Their gross appearance is solid, friable, and yellow, with necrotic and hemorrhagic areas. They also often contain cysts that can degenerate or rupture. Histologically, yolk sac tumors are characterized by the presence of <a href="/wiki/Schiller%E2%80%93Duval_body" title="Schiller–Duval body">Schiller-Duval bodies</a> (which are pathognomonic for yolk sac tumors) and a reticular pattern. Yolk sac tumors commonly secrete <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">alpha-fetoprotein</a> and can be <a href="/wiki/Immunohistochemistry" title="Immunohistochemistry">immunohistochemically</a> stained for its presence; the level of alpha-fetoprotein in the blood is a useful marker of recurrence.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Embryonal_carcinoma">Embryonal carcinoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=43" title="Edit section: Embryonal carcinoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Embryonal_carcinoma" title="Embryonal carcinoma">Embryonal carcinoma</a></div> Embryonal carcinomas, a rare tumor type usually found in mixed tumors, develop directly from germ cells but are not terminally differentiated; in rare cases, they may develop in dysgenetic gonads. They can develop further into a variety of other neoplasms, including choriocarcinoma, yolk sac tumor, and teratoma. They occur in younger people, with an average age at diagnosis of 14, and secrete both alpha-fetoprotein (in 75% of cases) and hCG.<a href="#cite_note-Williams12-32">[32]</a> Histologically, embryonal carcinoma appears similar to the <a href="/wiki/Embryonic_disc" class="mw-redirect" title="Embryonic disc">embryonic disc</a>, made up of epithelial, <a href="/wiki/Anaplasia" title="Anaplasia">anaplastic</a> cells in disorganized sheets, with gland-like spaces and papillary structures.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading5"><h5 id="Polyembryoma">Polyembryoma</h5>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=44" title="Edit section: Polyembryoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Polyembryoma" title="Polyembryoma">Polyembryoma</a></div> Polyembryomas, the most immature form of teratoma and very rare ovarian tumors, are histologically characterized by having several <a href="/wiki/Embryo" title="Embryo">embryo</a>-like bodies with structures resembling a <a href="/w/index.php?title=Germ_disk&action=edit&redlink=1" class="new" title="Germ disk (page does not exist)">germ disk</a>, <a href="/wiki/Yolk_sac" title="Yolk sac">yolk sac</a>, and <a href="/wiki/Amniotic_sac" title="Amniotic sac">amniotic sac</a>. <a href="/wiki/Syncytiotrophoblast" title="Syncytiotrophoblast">Syncytiotrophoblast giant cells</a> also occur in polyembryomas.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading4"><h4 id="Squamous_cell_carcinoma">Squamous cell carcinoma</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=45" title="Edit section: Squamous cell carcinoma">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Ovarian_squamous_cell_carcinoma" title="Ovarian squamous cell carcinoma">Ovarian squamous cell carcinoma</a></div> Primary <a href="/wiki/Ovarian_squamous_cell_carcinoma" title="Ovarian squamous cell carcinoma">ovarian squamous cell carcinomas</a> are rare and have a poor prognosis when advanced. More typically, ovarian squamous cell carcinomas are cervical metastases, areas of differentiation in an endometrioid tumor, or derived from a mature teratoma.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading4"><h4 id="Mixed_tumors">Mixed tumors</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=46" title="Edit section: Mixed tumors">edit</a>]</div> Mixed tumors contain elements of more than one of the above classes of tumor histology. To be classed as a mixed tumor, the minor type must make up more than 10% of the tumor.<a href="#cite_note-DynaMed15-31">[31]</a> Though mixed carcinomas can have any combination of cell types, mixed ovarian cancers are typically serous/endometrioid or clear-cell/endometrioid.<a href="#cite_note-Hoffman35-29">[29]</a> Mixed germ cell tumors make up approximately 25–30% of all germ cell ovarian cancers, with combinations of dysgerminoma, yolk sac tumor, and/or immature teratoma. The prognosis and treatment vary based on the component cell types.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading4"><h4 id="Secondary_ovarian_cancer">Secondary ovarian cancer</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=47" title="Edit section: Secondary ovarian cancer">edit</a>]</div> Ovarian cancer can also be a secondary cancer, the result of <a href="/wiki/Metastasis" title="Metastasis">metastasis</a> from a primary cancer elsewhere in the body.<a href="#cite_note-Harrisons-26">[26]</a> About 5–30% of ovarian cancers are due to metastases, while the rest are primary cancers.<a href="#cite_note-pmid19270823-80">[80]</a> Common primary cancers are <a href="/wiki/Breast_cancer" title="Breast cancer">breast cancer</a>, <a href="/wiki/Colon_cancer" class="mw-redirect" title="Colon cancer">colon cancer</a>, <a href="/wiki/Appendiceal_cancer" class="mw-redirect" title="Appendiceal cancer">appendiceal cancer</a>, and <a href="/wiki/Stomach_cancer" title="Stomach cancer">stomach cancer</a> (primary gastric cancers that metastasize to the ovary are called <a href="/wiki/Krukenberg_tumor" title="Krukenberg tumor">Krukenberg tumors</a>).<a href="#cite_note-Harrisons-26">[26]</a> Krukenberg tumors have signet ring cells and mucinous cells.<a href="#cite_note-Hoffman35-29">[29]</a> Endometrial cancer and lymphomas can also metastasize to the ovary.<a href="#cite_note-Levy-81">[81]</a> <div class="mw-heading mw-heading4"><h4 id="Borderline_tumors">Borderline tumors</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=48" title="Edit section: Borderline tumors">edit</a>]</div> Ovarian <a href="/wiki/Borderline_tumor" title="Borderline tumor">borderline tumors</a>, sometimes called low malignant potential (LMP) ovarian tumors, have some benign and some malignant features.<a href="#cite_note-Hoffman35-29">[29]</a> LMP tumors make up approximately 10–15% of all ovarian tumors.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-:1-70">[70]</a> They develop earlier than epithelial ovarian cancer, around the age of 40–49. They typically do not have extensive invasion; 10% of LMP tumors have areas of stromal microinvasion (<3mm, <5% of tumor). LMP tumors have other abnormal features, including increased mitosis, <a href="/wiki/Pleomorphism_(cytology)" title="Pleomorphism (cytology)">changes in cell size or nucleus size</a>, <a href="/wiki/Nuclear_atypia" title="Nuclear atypia">abnormal nuclei</a>, cell stratification, and <a href="/w/index.php?title=Papillary_projections&action=edit&redlink=1" class="new" title="Papillary projections (page does not exist)">small projections on cells</a> (papillary projections). Serous and/or mucinous characteristics can be seen on histological examination, and serous histology makes up the overwhelming majority of advanced LMP tumors. More than 80% of LMP tumors are Stage I; 15% are stage II and III and less than 5% are stage IV.<a href="#cite_note-Hoffman35-29">[29]</a> Implants of LMP tumors are often non-invasive.<a href="#cite_note-:1-70">[70]</a> <div class="mw-heading mw-heading3"><h3 id="Staging">Staging</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=49" title="Edit section: Staging">edit</a>]</div> Ovarian cancer is staged using the <a href="/wiki/International_Federation_of_Gynecology_and_Obstetrics" class="mw-redirect" title="International Federation of Gynecology and Obstetrics">FIGO</a> staging system and uses information obtained after surgery, which can include a total <a href="/wiki/Hysterectomy" title="Hysterectomy">abdominal hysterectomy</a> via <a href="/wiki/Laparotomy" title="Laparotomy">midline laparotomy</a>, <a href="/wiki/Salpingoophorectomy" class="mw-redirect" title="Salpingoophorectomy">removal of (usually) both ovaries and Fallopian tubes</a>, <a href="/wiki/Omentectomy" class="mw-redirect" title="Omentectomy">(usually) the omentum</a>, <a href="/wiki/Pelvic_washing" class="mw-redirect" title="Pelvic washing">pelvic (peritoneal) washings</a>, assessment of <a href="/wiki/Retroperitoneal_lymph_node_dissection" title="Retroperitoneal lymph node dissection">retroperitoneal lymph nodes</a> (including the <a href="/w/index.php?title=Pelvic_lymph_nodes&action=edit&redlink=1" class="new" title="Pelvic lymph nodes (page does not exist)">pelvic</a> and <a href="/wiki/Paraaortic_lymph_node" class="mw-redirect" title="Paraaortic lymph node">para-aortic lymph nodes</a>), <a href="/wiki/Appendectomy" title="Appendectomy">appendectomy</a> in suspected mucinous tumors, and pelvic/peritoneal biopsies for <a href="/wiki/Cytopathology" title="Cytopathology">cytopathology</a>.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-SGO-82">[82]</a> Around 30% of ovarian cancers that appear confined to the ovary have metastasized microscopically, which is why even stage-I cancers must be staged completely.<a href="#cite_note-Harrisons-26">[26]</a> 22% of cancers presumed to be stage I are observed to have lymphatic metastases.<a href="#cite_note-DynaMed15-31">[31]</a> The AJCC stage is the same as the FIGO stage. The AJCC staging system describes the extent of the primary tumor (T), the absence or presence of <a href="/wiki/Metastasis" title="Metastasis">metastasis</a> to nearby <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a> (N), and the absence or presence of distant metastasis (M).<a href="#cite_note-A-83">[83]</a> The most common stage at diagnosis is stage IIIc, with over 70% of diagnoses.<a href="#cite_note-Harrisons-26">[26]</a> <div class="mw-heading mw-heading4"><h4 id="FIGO">FIGO</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=50" title="Edit section: FIGO">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Tumor_deposet.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/21/Tumor_deposet.JPG/290px-Tumor_deposet.JPG" decoding="async" width="290" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/21/Tumor_deposet.JPG/435px-Tumor_deposet.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/21/Tumor_deposet.JPG/580px-Tumor_deposet.JPG 2x" data-file-width="2592" data-file-height="1936" /></a><figcaption>Ovarian adenocarcinoma deposit in the <a href="/wiki/Mesentery" title="Mesentery">mesentery</a> of the small bowel</figcaption></figure> <table class="wikitable"> <caption>FIGO stages of ovarian cancer<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-SGO-82">[82]</a> </caption> <tbody><tr> <th>Stage </th> <th> </th> <th> </th> <th> </th> <th>Description </th></tr> <tr> <td>I </td> <td> </td> <td> </td> <td> </td> <td>Cancer is completely limited to the ovary </td></tr> <tr> <td> </td> <td>IA </td> <td> </td> <td> </td> <td>involves one ovary, capsule intact, no tumor on ovarian surface, negative washings </td></tr> <tr> <td> </td> <td>IB </td> <td> </td> <td> </td> <td>involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings </td></tr> <tr> <td> </td> <td>IC </td> <td> </td> <td> </td> <td>tumor involves one or both ovaries </td></tr> <tr> <td> </td> <td>IC1 </td> <td> </td> <td> </td> <td>surgical spill </td></tr> <tr> <td> </td> <td>IC2 </td> <td> </td> <td> </td> <td>capsule has ruptured or tumor on ovarian surface </td></tr> <tr> <td> </td> <td>IC3 </td> <td> </td> <td> </td> <td>positive ascites or washings </td></tr> <tr> <td>II </td> <td> </td> <td> </td> <td> </td> <td>pelvic extension of the tumor (must be confined to the pelvis) or primary peritoneal tumor, involves one or both ovaries </td></tr> <tr> <td> </td> <td>IIA </td> <td> </td> <td> </td> <td>tumor found on uterus or fallopian tubes </td></tr> <tr> <td> </td> <td>IIB </td> <td> </td> <td> </td> <td>tumor elsewhere in the pelvis </td></tr> <tr> <td>III </td> <td> </td> <td> </td> <td> </td> <td>cancer found outside the pelvis or in the retroperitoneal lymph nodes, involves one or both ovaries </td></tr> <tr> <td> </td> <td>IIIA </td> <td> </td> <td> </td> <td>metastasis in retroperitoneal lymph nodes or microscopic extrapelvic metastasis </td></tr> <tr> <td> </td> <td> </td> <td>IIIA1 </td> <td> </td> <td>metastasis in retroperitoneal lymph nodes </td></tr> <tr> <td> </td> <td> </td> <td> </td> <td>IIIA1(i) </td> <td>the metastasis is less than 10 mm in diameter </td></tr> <tr> <td> </td> <td> </td> <td> </td> <td>IIIA1(ii) </td> <td>the metastasis is greater than 10 mm in diameter </td></tr> <tr> <td> </td> <td> </td> <td>IIIA2 </td> <td> </td> <td>microscopic metastasis in the peritoneum, regardless of retroperitoneal lymph node status </td></tr> <tr> <td> </td> <td>IIIB </td> <td> </td> <td> </td> <td>metastasis in the peritoneum less than or equal to 2 cm in diameter, regardless of retroperitoneal lymph node status; or metastasis to liver or spleen capsule </td></tr> <tr> <td> </td> <td>IIIC </td> <td> </td> <td> </td> <td>metastasis in the peritoneum greater than 2 cm in diameter, regardless of retroperitoneal lymph node status; or metastasis to liver or spleen capsule </td></tr> <tr> <td>IV </td> <td> </td> <td> </td> <td> </td> <td>distant metastasis (i.e. outside of the peritoneum) </td></tr> <tr> <td> </td> <td>IVA </td> <td> </td> <td> </td> <td>pleural effusion containing cancer cells </td></tr> <tr> <td> </td> <td>IVB </td> <td> </td> <td> </td> <td>metastasis to distant organs (including the parenchyma of the spleen or liver), or metastasis to the inguinal and extra-abdominal lymph nodes </td></tr></tbody></table> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg" class="mw-file-description" title="Stage 1 ovarian cancer"><img alt="Stage 1 ovarian cancer" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/56/Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg/120px-Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg.png" decoding="async" width="120" height="99" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/56/Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg/180px-Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/56/Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg/240px-Diagram_showing_stage_1_ovarian_cancer_CRUK_193.svg.png 2x" data-file-width="375" data-file-height="310" /></a></div> <div class="gallerytext">Stage 1 ovarian cancer</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg" class="mw-file-description" title="Stage 2 ovarian cancer"><img alt="Stage 2 ovarian cancer" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/19/Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg/120px-Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg.png" decoding="async" width="120" height="94" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/19/Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg/180px-Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/19/Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg/240px-Diagram_showing_stage_2A_to_2C_ovarian_cancer_CRUK_214.svg.png 2x" data-file-width="375" data-file-height="295" /></a></div> <div class="gallerytext">Stage 2 ovarian cancer</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg" class="mw-file-description" title="Stage 3 ovarian cancer"><img alt="Stage 3 ovarian cancer" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg/119px-Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg.png" decoding="async" width="119" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg/178px-Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg/237px-Diagram_showing_stage_3A_to_3C_ovarian_cancer_CRUK_225.svg.png 2x" data-file-width="375" data-file-height="379" /></a></div> <div class="gallerytext">Stage 3 ovarian cancer</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg" class="mw-file-description" title="Stage 4 ovarian cancer"><img alt="Stage 4 ovarian cancer" src="//upload.wikimedia.org/wikipedia/commons/thumb/6/68/Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg/111px-Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg.png" decoding="async" width="111" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/68/Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg/167px-Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/68/Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg/222px-Diagram_showing_stage_4_ovarian_cancer_CRUK_233.svg.png 2x" data-file-width="375" data-file-height="405" /></a></div> <div class="gallerytext">Stage 4 ovarian cancer</div> </li> </ul> <div class="mw-heading mw-heading4"><h4 id="AJCC/TNM">AJCC/TNM</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=51" title="Edit section: AJCC/TNM">edit</a>]</div> The AJCC/TNM staging system indicates where the tumor has developed, spread to lymph nodes, and metastasis.<a href="#cite_note-DynaMed15-31">[31]</a> <table class="wikitable"> <caption>AJCC/TNM stages of ovarian cancer<a href="#cite_note-DynaMed15-31">[31]</a> </caption> <tbody><tr> <th>Stage </th> <th> </th> <th> </th> <th>Description </th></tr> <tr> <td>T </td> <td> </td> <td> </td> <td>Primary tumor </td></tr> <tr> <td> </td> <td>Tx </td> <td> </td> <td>Cannot be assessed </td></tr> <tr> <td> </td> <td>T0 </td> <td> </td> <td>No evidence </td></tr> <tr> <td> </td> <td>T1 </td> <td> </td> <td>Tumor limited to ovary/ovaries </td></tr> <tr> <td> </td> <td> </td> <td>T1a </td> <td>One ovary with intact capsule, no surface tumor, and negative ascites/peritoneal washings </td></tr> <tr> <td> </td> <td> </td> <td>T1b </td> <td>Both ovaries with intact capsules, no surface tumor, and negative ascites/peritoneal washings </td></tr> <tr> <td> </td> <td> </td> <td>T1c </td> <td>One or both ovaries with ruptured capsule or capsules, surface tumor, positive ascites/peritoneal washings </td></tr> <tr> <td> </td> <td>T2 </td> <td> </td> <td>Tumor is in ovaries and pelvis (extension or implantation) </td></tr> <tr> <td> </td> <td> </td> <td>T2a </td> <td>Expansion to uterus or Fallopian tubes, negative ascites/peritoneal washings </td></tr> <tr> <td> </td> <td> </td> <td>T2b </td> <td>Expansion in other pelvic tissues, negative ascites/peritoneal washings </td></tr> <tr> <td> </td> <td> </td> <td>T2c </td> <td>Expansion to any pelvic tissue, positive ascites/peritoneal washings </td></tr> <tr> <td> </td> <td>T3 </td> <td> </td> <td>Tumor is in ovaries and has metastasized outside the pelvis to the peritoneum (including the liver capsule) </td></tr> <tr> <td> </td> <td> </td> <td>T3a </td> <td>Microscopic metastasis </td></tr> <tr> <td> </td> <td> </td> <td>T3b </td> <td>Macroscopic metastasis less than 2 cm diameter </td></tr> <tr> <td> </td> <td> </td> <td>T3c </td> <td>Macroscopic metastasis greater than 2 cm diameter </td></tr> <tr> <td>N </td> <td> </td> <td> </td> <td>Regional lymph node metastasis </td></tr> <tr> <td> </td> <td>Nx </td> <td> </td> <td>Cannot be assessed </td></tr> <tr> <td> </td> <td>N0 </td> <td> </td> <td>No metastasis </td></tr> <tr> <td> </td> <td>N1 </td> <td> </td> <td>Metastasis present </td></tr> <tr> <td>M </td> <td> </td> <td> </td> <td>Distant metastasis </td></tr> <tr> <td> </td> <td>M0 </td> <td> </td> <td>No metastasis </td></tr> <tr> <td> </td> <td>M1 </td> <td> </td> <td>Metastasis present (excluding liver capsule, including liver parenchyma and cytologically confirmed pleural effusion) </td></tr></tbody></table> The AJCC/TNM stages can be correlated with the FIGO stages:<a href="#cite_note-DynaMed15-31">[31]</a> <table class="wikitable"> <tbody><tr> <th>FIGO </th> <th>T </th> <th>N </th> <th>M </th></tr> <tr> <td>I </td> <td>T1 </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IA </td> <td>T1a </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IB </td> <td>T1b </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IC </td> <td>T1c </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>II </td> <td>T2 </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IIA </td> <td>T2a </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IIB </td> <td>T2b </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IIC </td> <td>T2c </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>III </td> <td>T3 </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IIIA </td> <td>T3a </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IIIB </td> <td>T3b </td> <td>N0 </td> <td>M0 </td></tr> <tr> <td>IIIC </td> <td>T3c </td> <td>N0/N1 </td> <td>M0 </td></tr> <tr> <td>IV </td> <td>Any </td> <td>Any </td> <td>M1 </td></tr></tbody></table> <div class="mw-heading mw-heading4"><h4 id="Grading">Grading</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=52" title="Edit section: Grading">edit</a>]</div> Grade 1 tumors have well differentiated cells (look very similar to the normal tissue) and are the ones with the best prognosis. Grade 2 tumors are also called moderately well-differentiated and they are made up of cells that resemble the normal tissue. Grade 3 tumors have the worst prognosis and their cells are abnormal, referred to as poorly differentiated.<a href="#cite_note-84">[84]</a> Metastasis in ovarian cancer is very common in the abdomen and occurs via exfoliation, where cancer cells burst through the ovarian capsule and are able to move freely throughout the peritoneal cavity. Ovarian cancer metastases usually grow on the surface of organs rather than the inside; they are also common on the omentum and the peritoneal lining. Cancer cells can also travel through the <a href="/wiki/Lymphatic_system" title="Lymphatic system">lymphatic system</a> and metastasize to lymph nodes connected to the ovaries via blood vessels; i.e. the lymph nodes along the <a href="/wiki/Suspensory_ligament_of_ovary" title="Suspensory ligament of ovary">infundibulopelvic ligament</a>, the <a href="/wiki/Broad_ligament_of_the_uterus" title="Broad ligament of the uterus">broad ligament</a>, and the <a href="/wiki/Round_ligament_of_uterus" title="Round ligament of uterus">round ligament</a>. The most commonly affected groups include the <a href="/wiki/Paraaortic_lymph_node" class="mw-redirect" title="Paraaortic lymph node">paraaortic</a>, <a href="/w/index.php?title=Hypogastric_lymph_node&action=edit&redlink=1" class="new" title="Hypogastric lymph node (page does not exist)">hypogastric</a>, <a href="/wiki/External_iliac_lymph_nodes" title="External iliac lymph nodes">external iliac</a>, <a href="/w/index.php?title=Obturator_lymph_nodes&action=edit&redlink=1" class="new" title="Obturator lymph nodes (page does not exist)">obturator</a>, and <a href="/wiki/Inguinal_lymph_node" class="mw-redirect" title="Inguinal lymph node">inguinal lymph nodes</a>. Usually, ovarian cancer does not metastasize to the liver, lung, brain, or kidneys unless it is a recurrent disease; this differentiates ovarian cancer from many other forms of cancer.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=53" title="Edit section: Prevention">edit</a>]</div> Women with strong genetic risk for ovarian cancer may consider the surgical removal of their ovaries as a preventive measure. This is often done after completion of childbearing years. This reduces the chances of developing both breast cancer (by around 50%) and ovarian cancer (by about 96%) in women at high risk. Women with BRCA gene mutations usually also have their Fallopian tubes removed at the same time (salpingo-oophorectomy), since they also have an increased risk of <a href="/wiki/Fallopian_tube_cancer" title="Fallopian tube cancer">Fallopian tube cancer</a>. However, these statistics may overestimate the risk reduction because of how they have been studied.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Harrisons82-85">[85]</a> Because a large fraction of ovarian cancers originate in the fallopian tubes,<a href="#cite_note-86">[86]</a> the <a href="/wiki/Ovarian_Cancer_Research_Alliance" title="Ovarian Cancer Research Alliance">Ovarian Cancer Research Alliance</a> and the <a href="/wiki/Society_of_Gynecologic_Oncology" title="Society of Gynecologic Oncology">Society of Gynecologic Oncology</a> now recommend that women who are not planning on having additional children and who are undergoing surgical procedures such as <a href="/wiki/Tubal_ligation" title="Tubal ligation">tubal ligation</a> (having one's "tubes tied") undergo opportunistic salpingo-oophorectomy — i.e. simultaneously having their fallopian tubes removed.<a href="#cite_note-Salamon2023-87">[87]</a> OVCARE — <a href="/wiki/BC_Cancer" class="mw-redirect" title="BC Cancer">BC Cancer</a>'s multi-institutional and multidisciplinary ovarian research group — began recommending salpingectomy at the time of hysterectomy and in place of tubal ligation in 2010.<a href="#cite_note-Hanley2023-88">[88]</a> Women with a significant family history for ovarian cancer are often referred to a <a href="/wiki/Genetic_counselor" class="mw-redirect" title="Genetic counselor">genetic counselor</a> to see if testing for BRCA mutations would be beneficial.<a href="#cite_note-Hoffman35-29">[29]</a> The use of oral contraceptives, the absence of 'periods' during the menstrual cycle, and tubal ligation reduce the risk.<a href="#cite_note-CibulaWidschwendter2010-89">[89]</a> There may an association of developing ovarian cancer and ovarian stimulation during infertility treatments. Endometriosis has been linked to ovarian cancers. <a href="/wiki/Human_papillomavirus_infection" title="Human papillomavirus infection">Human papillomavirus infection</a>, smoking, and <a href="/wiki/Talc" title="Talc">talc</a> have not been identified as increasing the risk for developing ovarian cancer.<a href="#cite_note-Jayson-28">[28]</a> <div class="mw-heading mw-heading2"><h2 id="Screening">Screening</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=54" title="Edit section: Screening">edit</a>]</div> There is no simple and reliable way to test for ovarian cancer in women who do not have any signs or symptoms. Screening is not recommended in women who are at average risk, as evidence does not support a reduction in death and the high rate of false positive tests may lead to unneeded surgery, which is accompanied by its own risks.<a href="#cite_note-Gros2018-19">[19]</a> Women with high risk of ovarian cancer that are currently identified based on family history and <a href="/wiki/Genetic_testing" title="Genetic testing">genetic testing</a> may benefit from screening.<a href="#cite_note-Nash20-90">[90]</a> The <a href="/wiki/Pap_test" title="Pap test">Pap test</a> does not screen for ovarian cancer.<a href="#cite_note-CDCsep2016-27">[27]</a> Ovarian cancer is usually only palpable in advanced stages.<a href="#cite_note-Hoffman35-29">[29]</a> This high risk group has benefited with earlier detection.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Harrisons82-85">[85]</a> Screening is not recommended using <a href="/wiki/CA-125" class="mw-redirect" title="CA-125">CA-125</a> measurements, <a href="/wiki/HE4" class="mw-redirect" title="HE4">HE4</a> levels, ultrasound, or adnexal palpation in women who are at average risk. Currently there is no national screening programme in the UK for ovarian cancer. CA125 and transvaginal ultrasound can be utilised but there is minimal evidence to suggest this decreases mortality . More recently, the Risk of Ovarian Cancer Algorithm (ROMA) has been shown to detect earlier cancers using CA125 and age but again does not provide a robust measure to decrease mortality at present.<a href="#cite_note-91">[91]</a> Ovarian cancer has low prevalence, even in the high-risk group of women from the ages of 50 to 60 (about one in 2000), and screening of women with average risk is more likely to give ambiguous results than detect a problem that requires treatment. Because ambiguous results are more likely than detection of a treatable problem, and because the usual response to ambiguous results is invasive interventions, in women of average risk, the potential harms of having screening without an indication outweigh the potential benefits. The purpose of screening is to diagnose ovarian cancer at an early stage when it is more likely to be treated successfully.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Harrisons82-85">[85]</a> Screening with <a href="/wiki/Transvaginal_ultrasound" class="mw-redirect" title="Transvaginal ultrasound">transvaginal ultrasound</a>, pelvic examination, and CA-125 levels can be used instead of preventive surgery in women who have BRCA1 or BRCA2 mutations. This strategy has shown some success.<a href="#cite_note-Hoffman35-29">[29]</a> Screening for CA125, a chemical released by ovarian tumours, with follow-up using ultrasound, was shown to be ineffective in reducing mortality in a large-scale UK study.<a href="#cite_note-92">[92]</a> There have been some screening trials that have used age, family history of ovarian cancer, and mutation status to identify target populations for screening.<a href="#cite_note-Nash20-90">[90]</a> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=55" title="Edit section: Management">edit</a>]</div> Once it is determined that ovarian, fallopian tube or primary peritoneal cancer is present, treatment is scheduled by a gynecologic oncologist (a physician trained to treat cancers of a woman's reproductive system). Gynecologic oncologists can perform surgery on and give chemotherapy to women with ovarian cancer. A treatment plan is developed.<a href="#cite_note-CDCfeb2017-93">[93]</a> Treatment usually involves <a href="/wiki/Surgery" title="Surgery">surgery</a> and <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a>, and sometimes <a href="/wiki/Radiotherapy" class="mw-redirect" title="Radiotherapy">radiotherapy</a>, regardless of the subtype of ovarian cancer.<a href="#cite_note-:1-70">[70]</a><a href="#cite_note-94">[94]</a> Surgical treatment may be sufficient for well-differentiated malignant tumors and confined to the ovary. Addition of chemotherapy may be required for more aggressive tumors confined to the ovary. For patients with advanced disease, a combination of surgical reduction with a combination chemotherapy regimen is standard. Since 1980, platinum-based drugs have had an important role in treating ovarian cancer.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <a href="/wiki/Borderline_tumor" title="Borderline tumor">Borderline tumors</a>, even following spread outside of the ovary, are managed well with surgery, and chemotherapy is not seen as useful.<a href="#cite_note-:2-95">[95]</a> <a href="/w/index.php?title=Second-look_surgery&action=edit&redlink=1" class="new" title="Second-look surgery (page does not exist)">Second-look surgery</a> and <a href="/wiki/Maintenance_chemotherapy" class="mw-redirect" title="Maintenance chemotherapy">maintenance chemotherapy</a> have not been shown to provide benefit.<a href="#cite_note-Hoffman35-29">[29]</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information on the investigational new drug: <a href="/wiki/Senaparib" title="Senaparib">Senaparib</a></div> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=56" title="Edit section: Surgery">edit</a>]</div> <a href="/wiki/Surgery" title="Surgery">Surgery</a> has been the standard of care for decades and may be necessary for obtaining a specimen for <a href="/wiki/Medical_diagnosis" title="Medical diagnosis">diagnosis</a>. The surgery depends upon the extent of nearby invasion of other tissues by the cancer when it is diagnosed. This extent of the cancer is described by assigning it a stage, the presumed type, and the grade of cancer. The gynecological surgeon may remove one (unilateral oophorectomy) or both ovaries (bilateral oophorectomy). The Fallopian tubes (salpingectomy), uterus (hysterectomy), and the <a href="/wiki/Greater_omentum" title="Greater omentum">omentum</a> (omentectomy) may also be removed. Typically, all of these organs are removed.<a href="#cite_note-CanadianCS2017-96">[96]</a> For those who test positive for faulty BRCA1 or BRCA2 genes having a <a href="/wiki/Prophylactic_surgery" title="Prophylactic surgery">risk-reducing surgery</a> is an option. An increasing number of women choose this. At the same time the average waiting time for undergoing the procedure is two-years which is much longer than recommended.<a href="#cite_note-97">[97]</a><a href="#cite_note-98">[98]</a> For low-grade, unilateral stage-IA cancers, only the involved ovary (which must be unruptured) and Fallopian tube will be removed. This can be done especially in young people who wish to preserve their fertility. However, a risk of microscopic metastases exists and staging must be completed.<a href="#cite_note-Jayson-28">[28]</a> If any metastases are found, a second surgery to remove the remaining ovary and uterus is needed.<a href="#cite_note-:2-95">[95]</a> <a href="/wiki/Tranexamic_acid" title="Tranexamic acid">Tranexamic acid</a> can be administered prior to surgery to reduce the need for blood transfusions due to blood loss during the surgery.<a href="#cite_note-DynaMed15-31">[31]</a> If a tumor in a premenopausal woman is determined to be a low malignant potential tumor during surgery, and it is clearly stage I cancer, only the affected ovary is removed. For postmenopausal women with low malignant potential tumors, hysterectomy with bilateral salpingo-oophorectomy is still the preferred option. During staging, the appendix can be examined or removed. This is particularly important with mucinous tumors.<a href="#cite_note-Hoffman35-29">[29]</a> In children or adolescents with ovarian cancer, surgeons typically attempt to preserve one ovary to allow for the completion of <a href="/wiki/Puberty" title="Puberty">puberty</a>, but if the cancer has spread, this is not always possible. Dysgerminomas, in particular, tend to affect both ovaries: 8–15% of dysgerminomas are present in both ovaries.<a href="#cite_note-Current-33">[33]</a> People with low-grade (well-differentiated) tumors are typically treated only with surgery,<a href="#cite_note-Harrisons-26">[26]</a> which is often curative.<a href="#cite_note-:1-70">[70]</a> In general, germ cell tumors can be treated with unilateral surgery unless the cancer is widespread or fertility is not a factor.<a href="#cite_note-Williams12-32">[32]</a> In women with surgically staged advanced epithelial ovarian cancer (stages III and IV), studies suggest all attempts should be made to reach complete cytoreduction (surgical efforts to remove the bulk of the tumor).<a href="#cite_note-99">[99]</a> In advanced cancers, where complete removal is not an option, as much tumor as possible is removed in a procedure called <a href="/wiki/Debulking" title="Debulking">debulking</a> surgery. This surgery is not always successful, and is less likely to be successful in women with extensive metastases in the peritoneum, stage- IV disease, cancer in the <a href="/wiki/Porta_hepatis" title="Porta hepatis">transverse fissure of the liver</a>, <a href="/wiki/Mesentery" title="Mesentery">mesentery</a>, or diaphragm, and large areas of ascites. Debulking surgery has usually only been done once<a href="#cite_note-Jayson-28">[28]</a> but a recent study has shown a longer overall survival in recurrent ovarian cancer when surgery combined with chemotherapy was performed compared to treatment with chemotherapy alone.<a href="#cite_note-100">[100]</a> Computed tomography (abdominal CT) is often used to assess if primary debulking surgery is possible, but low certainty evidence also suggests fluorodeoxyglucose‐18 (FDG) PET/CT and MRI may be useful as an addition for assessing macroscopic incomplete debulking.<a href="#cite_note-101">[101]</a> More complete debulking is associated with better outcomes: women with no macroscopic evidence of disease after debulking have a median survival of 39 months, as opposed to 17 months with less complete surgery.<a href="#cite_note-Harrisons-26">[26]</a> By removing metastases, many cells that are resistant to chemotherapy are removed, and any clumps of cells that have died are also removed. This allows chemotherapy to better reach the remaining cancer cells, which are more likely to be fast-growing and therefore chemosensitive.<a href="#cite_note-Hoffman35-29">[29]</a> Interval debulking surgery is another protocol used, where neoadjuvant chemotherapy is given, debulking surgery is performed, and chemotherapy is finished after debulking.<a href="#cite_note-:2-95">[95]</a> Though no definitive studies have been completed, it is shown to be approximately equivalent to primary debulking surgery in terms of survival and shows slightly lower morbidity.<a href="#cite_note-Hoffman35-29">[29]</a> Previous studies have shown different results from primary debulking versus interval debulking. The ongoing TRUST study may clarify selection criteria for each surgical approach.<a href="#cite_note-102">[102]</a> There are several different surgical procedures that can be employed to treat ovarian cancer. For stage I and II cancer, laparoscopic (keyhole) surgery can be used, but metastases may not be found. For advanced cancer, laparoscopy is not used, since debulking metastases requires access to the entire peritoneal cavity. Depending on the extent of the cancer, procedures may include a bilateral salpingo-oophorectomy, biopsies throughout the peritoneum and abdominal lymphatic system, <a href="/wiki/Omentectomy" class="mw-redirect" title="Omentectomy">omentectomy</a>, <a href="/wiki/Splenectomy" title="Splenectomy">splenectomy</a>, <a href="/wiki/Bowel_resection" title="Bowel resection">bowel resection</a>, <a href="/w/index.php?title=Diaphragm_resection&action=edit&redlink=1" class="new" title="Diaphragm resection (page does not exist)">diaphragm stripping or resection</a>, <a href="/wiki/Appendectomy" title="Appendectomy">appendectomy</a>, or even a posterior <a href="/wiki/Pelvic_exenteration" title="Pelvic exenteration">pelvic exenteration</a>.<a href="#cite_note-Hoffman35-29">[29]</a> To fully stage ovarian cancer, <a href="/wiki/Lymphadenectomy" title="Lymphadenectomy">lymphadenectomy</a> can be included in the surgery, However, it has not offered benefits in terms of survival in either <a href="/wiki/High-grade_serous_carcinoma" title="High-grade serous carcinoma">HGSOC</a><a href="#cite_note-103">[103]</a> or <a href="/w/index.php?title=Low-grade_Serous_Ovarian_Carcinoma&action=edit&redlink=1" class="new" title="Low-grade Serous Ovarian Carcinoma (page does not exist)">LGSOC</a>.<a href="#cite_note-104">[104]</a> This is particularly important in germ cell tumors because they frequently metastasize to nearby lymph nodes.<a href="#cite_note-Harrisons-26">[26]</a> If ovarian cancer recurs, secondary surgery is sometimes a treatment option. This depends on how easily the tumor can be removed, how much fluid has accumulated in the abdomen, and overall health.<a href="#cite_note-Jayson-28">[28]</a> Effectivenes of this surgery depends on surgical technique, completeness of cytoreduction, and extent of disease.<a href="#cite_note-105">[105]</a> It also can be helpful in people who had their first surgery done by a generalist and in epithelial ovarian cancer.<a href="#cite_note-DynaMed15-31">[31]</a> Secondary surgery can be effective in dysgerminomas and immature teratomas.<a href="#cite_note-Williams12-32">[32]</a> Evidence suggests surgery in recurrent epithelial ovarian cancer may be associated with prolonging life in some women with platinum-sensitive disease.<a href="#cite_note-106">[106]</a> The major side effect of oophorectomy in younger women is early <a href="/wiki/Menopause" title="Menopause">menopause</a>, which can cause <a href="/wiki/Osteoporosis" title="Osteoporosis">osteoporosis</a>. After surgery, hormone replacement therapy can be considered, especially in younger women. This therapy can consist of a combination of estrogen and progesterone, or estrogen alone. Estrogen alone is safe after hysterectomy; when the uterus is still present, unopposed estrogen dramatically raises the risk of <a href="/wiki/Endometrial_cancer" title="Endometrial cancer">endometrial cancer</a>.<a href="#cite_note-Jayson-28">[28]</a> Estrogen therapy after surgery does not change survival rates.<a href="#cite_note-DynaMed15-31">[31]</a> People having ovarian cancer surgery are typically hospitalized afterwards for 3–4 days and spend around a month recovering at home.<a href="#cite_note-107">[107]</a> Surgery outcomes are best at hospitals that do a large number of ovarian cancer surgeries.<a href="#cite_note-Hoffman35-29">[29]</a> It is unclear if <a href="/wiki/Laparoscopy" title="Laparoscopy">laparoscopy</a> or <a href="/wiki/Laparotomy" title="Laparotomy">laparotomy</a> is better or worse for FIGO stage I ovarian cancer.<a href="#cite_note-108">[108]</a> There is also no apparent difference between total abdominal hysterectomy and supracervical hysterectomy for advanced cancers. Approximately 2.8% of people having a first surgery for advanced ovarian cancer die within two weeks of the surgery (2.8% <a href="/wiki/Perioperative_mortality" title="Perioperative mortality">perioperative mortality</a> rate).<a href="#cite_note-DynaMed15-31">[31]</a> More aggressive surgeries are associated with better outcomes in advanced (stage III or IV) ovarian cancer.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading3"><h3 id="Chemotherapy">Chemotherapy</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=57" title="Edit section: Chemotherapy">edit</a>]</div> <a href="/wiki/Chemotherapy" title="Chemotherapy">Chemotherapy</a> has been a general <a href="/wiki/Standard_of_care" title="Standard of care">standard of care</a> for ovarian cancer for decades, although with variable protocols. Chemotherapy is used after surgery to treat any residual disease, if appropriate. In some cases, there may be reason to perform chemotherapy first, followed by surgery. This is called "neoadjuvant chemotherapy", and is common when a tumor cannot be completely removed or optimally debulked via surgery. Though it has not been shown to increase survival, it can reduce the risk of complications after surgery. If a unilateral salpingo-oophorectomy or other surgery is performed, additional chemotherapy, called "adjuvant chemotherapy", can be given.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-DynaMed15-31">[31]</a> Adjuvant chemotherapy is used in stage 1 cancer typically if the tumor is of a high histologic grade (grade 3) or the highest substage (stage 1c), provided the cancer has been optimally staged during surgery.<a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-:2-95">[95]</a> <a href="/wiki/Bevacizumab" title="Bevacizumab">Bevacizumab</a> may be used as an adjuvant chemotherapy if the tumor is not completely removed during surgery or if the cancer is stage IV; it can extend progression-free survival but has not been shown to extend overall survival.<a href="#cite_note-DynaMed15-31">[31]</a> Chemotherapy is curative in approximately 20% of advanced ovarian cancers;<a href="#cite_note-Hoffman35-29">[29]</a> it is more often curative with malignant germ cell tumors than epithelial tumors.<a href="#cite_note-Williams12-32">[32]</a> Adjuvant chemotherapy has been found to improve survival and reduce the risk of ovarian cancer recurring compared to no adjuvant therapy in women with early stage epithelial ovarian cancer.<a href="#cite_note-109">[109]</a> Chemotherapy in ovarian cancer typically consists of <a href="/wiki/Platins" class="mw-redirect" title="Platins">platins</a>, a group of <a href="/wiki/Platinum" title="Platinum">platinum</a>-based drugs, combined with non-platins.<a href="#cite_note-110">[110]</a> Platinum-based drugs have been used since 1980. Common therapies can include <a href="/wiki/Paclitaxel" title="Paclitaxel">paclitaxel</a>, <a href="/wiki/Cisplatin" title="Cisplatin">cisplatin</a>, <a href="/wiki/Topotecan" title="Topotecan">topotecan</a>, doxorubicin, <a href="/wiki/Epirubicin" title="Epirubicin">epirubicin</a>, and <a href="/wiki/Gemcitabine" title="Gemcitabine">gemcitabine</a>. <a href="/wiki/Carboplatin" title="Carboplatin">Carboplatin</a> is typically given in combination with either <a href="/wiki/Paclitaxel" title="Paclitaxel">paclitaxel</a> or <a href="/wiki/Docetaxel" title="Docetaxel">docetaxel</a>; the typical combination is carboplatin with paclitaxel.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-DynaMed15-31">[31]</a> Carboplatin is superior to cisplatin in that it is less toxic and has fewer side effects, generally allowing for an improved quality of life in comparison, though both are similarly effective.<a href="#cite_note-DynaMed15-31">[31]</a> Three-drug regimens have not been found to be more effective,<a href="#cite_note-Jayson-28">[28]</a> and platins alone or nonplatins alone are less effective than platins and nonplatins in combination.<a href="#cite_note-DynaMed15-31">[31]</a> There is a small benefit in platinum‐based chemotherapy compared with non‐platinum therapy.<a href="#cite_note-111">[111]</a> Platinum combinations can offer improved survival over single platinum. In people with relapsed ovarian cancer, evidence suggests topotecan has a similar effect on overall survival as paclitaxel and topotecan plus thalidomide, whilst it is superior to treosulfan and not as effective as pegylated liposomal doxorubicin in platinum-sensitive people.<a href="#cite_note-112">[112]</a> Chemotherapy can be given <a href="/wiki/Chemotherapy#Delivery" title="Chemotherapy">intravenously</a> or <a href="/wiki/Hyperthermic_intraperitoneal_chemotherapy" title="Hyperthermic intraperitoneal chemotherapy">in the peritoneal cavity</a>.<a href="#cite_note-Harrisons-26">[26]</a> Though intraperitoneal chemotherapy is associated with longer progression-free survival and overall survival, it also causes more adverse side effects than intravenous chemotherapy.<a href="#cite_note-DynaMed15-31">[31]</a> It is mainly used when the cancer has been optimally debulked. Intraperitoneal chemotherapy can be highly effective because ovarian cancer mainly spreads inside the peritoneal cavity, and higher doses of the drugs can reach the tumors this way.<a href="#cite_note-Hoffman35-29">[29]</a> Chemotherapy can cause <a href="/wiki/Anemia" title="Anemia">anemia</a>; intravenous iron has been found to be more effective than oral <a href="/wiki/Iron_supplement" title="Iron supplement">iron supplements</a> in reducing the need for <a href="/wiki/Blood_transfusion" title="Blood transfusion">blood transfusions</a>.<a href="#cite_note-DynaMed15-31">[31]</a> Typical cycles of treatment involve one treatment every 3 weeks, repeated for 6 weeks or more.<a href="#cite_note-:3-113">[113]</a> Fewer than 6 weeks (cycles) of treatment is less effective than 6 weeks or more.<a href="#cite_note-DynaMed15-31">[31]</a> Germ-cell malignancies are treated differently than other ovarian cancers — a regimen of <a href="/wiki/Bleomycin" title="Bleomycin">bleomycin</a>, <a href="/wiki/Etoposide" title="Etoposide">etoposide</a>, and cisplatin (BEP) is used with 5 days of chemotherapy administered every 3 weeks for 3 to 4 cycles.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Williams12-32">[32]</a> Chemotherapy for germ cell tumors has not been shown to cause <a href="/wiki/Amenorrhoea" class="mw-redirect" title="Amenorrhoea">amenorrhea</a>, infertility, <a href="/wiki/Congenital_disorder" class="mw-redirect" title="Congenital disorder">birth defects</a>, or <a href="/wiki/Miscarriage" title="Miscarriage">miscarriage</a>.<a href="#cite_note-Williams12-32">[32]</a> <a href="/wiki/Maintenance_chemotherapy" class="mw-redirect" title="Maintenance chemotherapy">Maintenance chemotherapy</a> has not been shown to be effective.<a href="#cite_note-DynaMed15-31">[31]</a> In people with BRCA mutations, platinum chemotherapy is more effective.<a href="#cite_note-Jayson-28">[28]</a> Germ-cell tumors and malignant sex-cord/stromal tumors are treated with chemotherapy, though dysgerminomas and sex-cord tumors are not typically very responsive.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-Current-33">[33]</a> <div class="mw-heading mw-heading4"><h4 id="Platinum-sensitive_or_platinum-resistant">Platinum-sensitive or platinum-resistant</h4>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=58" title="Edit section: Platinum-sensitive or platinum-resistant">edit</a>]</div> If ovarian cancer recurs, it is considered partially platinum-sensitive or platinum-resistant, based on the time since the last recurrence treated with platins: partially platinum-sensitive cancers recurred 6–12 months after last treatment, and platinum-resistant cancers have an interval of less than 6 months. Second-line chemotherapy can be given after the cancer becomes symptomatic because no difference in survival is seen between treating asymptomatic (elevated CA-125) and symptomatic recurrences.[<a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)">medical citation needed</a>] For platinum-sensitive tumors, platins are the drugs of choice for second-line chemotherapy, in combination with other cytotoxic agents. Regimens include carboplatin combined with <a href="/wiki/Doxorubicin#Liposomal_formulations" title="Doxorubicin">pegylated liposomal doxorubicin</a>, <a href="/wiki/Gemcitabine" title="Gemcitabine">gemcitabine</a>, or <a href="/wiki/Paclitaxel" title="Paclitaxel">paclitaxel</a>.<a href="#cite_note-Harrisons-26">[26]</a> Carboplatin-doublet therapy can be combined with paclitaxel for increased efficacy in some cases. Another potential adjuvant therapy for platinum-sensitive recurrences is <a href="/wiki/Olaparib" title="Olaparib">olaparib</a>, which may improve <a href="/wiki/Progression-free_survival" title="Progression-free survival">progression-free survival</a> but has not been shown to improve <a href="/wiki/Overall_survival" class="mw-redirect" title="Overall survival">overall survival</a>.<a href="#cite_note-DynaMed15-31">[31]</a> (<a href="/wiki/Olaparib" title="Olaparib">Olaparib</a>, a <a href="/wiki/PARP_inhibitor" title="PARP inhibitor">PARP inhibitor</a>, was approved by the <a href="/wiki/US_FDA" class="mw-redirect" title="US FDA">US FDA</a> for use in BRCA-associated ovarian cancer that had previously been treated with chemotherapy.<a href="#cite_note-114">[114]</a><a href="#cite_note-:60-115">[115]</a>) For recurrent germ cell tumors, an additional 4 cycles of BEP chemotherapy is the first-line treatment for those who have been treated with surgery or platins. If the tumor is determined to be platinum-resistant, <a href="/wiki/Vincristine" title="Vincristine">vincristine</a>, <a href="/wiki/Dactinomycin" title="Dactinomycin">dactinomycin</a>, and <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a> (VAC) or some combination of paclitaxel, gemcitabine, and <a href="/wiki/Oxaliplatin" title="Oxaliplatin">oxaliplatin</a> may be used as a second-line therapy.<a href="#cite_note-Williams12-32">[32]</a> For platinum-resistant tumors, there are no high-efficacy chemotherapy options. Single-drug regimens (doxorubicin or <a href="/wiki/Topotecan" title="Topotecan">topotecan</a>) do not have high response rates,<a href="#cite_note-Jayson-28">[28]</a> but single-drug regimens of topotecan, pegylated liposomal doxorubicin, or gemcitabine are used in some cases.<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-DynaMed15-31">[31]</a> Topotecan cannot be used in people with an intestinal blockage. Paclitaxel used alone is another possible regimen, or it may be combined with liposomal doxorubicin, gemcitabine, cisplatin, topotecan, <a href="/wiki/Etoposide" title="Etoposide">etoposide</a>, or <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>.<a href="#cite_note-:3-113">[113]</a> ( See also Palliative care below.) Novel agents are being developed to inhibit the development of new blood vessels (angiogenesis) for women with ovarian cancer who develop resistance to chemotherapy drugs. As of 2023 there would appear to be a role for these treatments but due to the additional treatment burden and cost of maintenance treatments the risk versus benefits require careful consideration.<a href="#cite_note-116">[116]</a> Novocure sponsored a phase-2 trial proving efficacy of <a href="/wiki/Alternating_electric_field_therapy" title="Alternating electric field therapy">tumor treating fields</a> in recurrent platinum-resistant ovarian carcinoma, in conjunction with weekly paclitaxel chemotherapy.<a href="#cite_note-Liao20-45">[45]</a> <div class="mw-heading mw-heading3"><h3 id="Radiation_therapy">Radiation therapy</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=59" title="Edit section: Radiation therapy">edit</a>]</div> <a href="/wiki/Dysgerminomas" class="mw-redirect" title="Dysgerminomas">Dysgerminomas</a> are most effectively treated with radiation,<a href="#cite_note-Current-33">[33]</a> though this can cause infertility and is being phased out in favor of chemotherapy.<a href="#cite_note-Harrisons-26">[26]</a> Radiation therapy does not improve survival in people with well-differentiated tumors.<a href="#cite_note-Harrisons-26">[26]</a> In stage 1c and 2 cancers, radiation therapy is used after surgery if there is the possibility of residual disease in the pelvis but the abdomen is cancer-free. Radiotherapy can also be used in palliative care of advanced cancers. A typical course of radiotherapy for ovarian cancer is 5 days a week for 3–4 weeks. Common side effects of radiotherapy include diarrhea, constipation, and frequent urination.<a href="#cite_note-:4-117">[117]</a> Radiotherapy late effects (and occurrence rates) include <a href="/wiki/Osteonecrosis" class="mw-redirect" title="Osteonecrosis">osteonecrosis</a> (8-20%), <a href="/wiki/Interstitial_cystitis" title="Interstitial cystitis">bladder ulceration</a> (<3%), <a href="/wiki/Vaginal_stenosis" title="Vaginal stenosis">vaginal stenosis</a> (>2.5%) and <a href="/wiki/Radiation-induced_lumbar_plexopathy" title="Radiation-induced lumbar plexopathy">irreversible lumbosacral plexopathy</a>.<a href="#cite_note-LateEffects2023-118">[118]</a> <div class="mw-heading mw-heading3"><h3 id="Hormonal_therapy">Hormonal therapy</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=60" title="Edit section: Hormonal therapy">edit</a>]</div> Despite the fact that 60% of ovarian tumors have <a href="/wiki/Estrogen_receptor" title="Estrogen receptor">estrogen receptors</a>, ovarian cancer is only rarely responsive to hormonal treatments. A Cochrane review found a lack of evidence about the effects of tamoxifen in people with relapsed ovarian cancer.<a href="#cite_note-119">[119]</a> Estrogen alone does not have an effect on the cancer, and <a href="/wiki/Tamoxifen" title="Tamoxifen">tamoxifen</a> and <a href="/wiki/Letrozole" title="Letrozole">letrozole</a> are rarely effective.<a href="#cite_note-Jayson-28">[28]</a> "Some women with borderline malignancy ovarian cancer and stromal ovarian cancer may receive hormonal therapy."<a href="#cite_note-CanadianCS2017-96">[96]</a> <div class="mw-heading mw-heading3"><h3 id="Immunotherapy">Immunotherapy</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=61" title="Edit section: Immunotherapy">edit</a>]</div> Immunotherapy is a topic of current research in ovarian cancer. In some cases, the antibody drug <a href="/wiki/Bevacizumab" title="Bevacizumab">bevacizumab</a>, though still a topic of active research, is used to treat advanced cancer along with chemotherapy.<a href="#cite_note-:2-95">[95]</a> It has been approved for this use in the European Union.<a href="#cite_note-:6-120">[120]</a> <div class="mw-heading mw-heading3"><h3 id="Follow-up">Follow-up</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=62" title="Edit section: Follow-up">edit</a>]</div> Specific follow-up depends on, for example, the type and stage of ovarian cancer, the treatment, and the presence of any symptoms. Usually, a check-up appointment is made about every 2 to 3 months initially, followed by twice per year for up to 5 years.<a href="#cite_note-121">[121]</a> For epithelial ovarian cancers, the most common test upon follow-up is CA-125 level. However, treatment based only on elevated CA-125 levels and not any symptoms can increase side effects without any prolongation of life, so the implication of the outcome of a CA-125 test can be discussed before taking it.<a href="#cite_note-ACSfollowup-122">[122]</a> The recommendation as of 2014 is recurrent cancer may be present if the CA-125 level is twice normal.<a href="#cite_note-Jayson-28">[28]</a> Treating a recurrence detected by CA-125 does not improve survival.<a href="#cite_note-DynaMed15-31">[31]</a> For women with <a href="/w/index.php?title=Germ-cell_tumor&action=edit&redlink=1" class="new" title="Germ-cell tumor (page does not exist)">germ-cell tumors</a>, follow-up tests generally include <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">alpha-fetoprotein</a> (AFP) and/or <a href="/wiki/Human_chorionic_gonadotropin" title="Human chorionic gonadotropin">human chorionic gonadotropin</a>. For women with <a href="/wiki/Stromal_cancer" class="mw-redirect" title="Stromal cancer">stromal cancers</a>, tests for hormones like estrogen, testosterone, and <a href="/wiki/Inhibin" class="mw-redirect" title="Inhibin">inhibin</a> are sometimes helpful.<a href="#cite_note-ACSfollowup-122">[122]</a> Inhibin can also be useful for monitoring the progress of sex-cord tumors, along with <a href="/wiki/M%C3%BCllerian_inhibiting_substance" class="mw-redirect" title="Müllerian inhibiting substance">Müllerian inhibiting substance</a>. AFP can also be used to monitor Sertoli-Leydig tumors.<a href="#cite_note-Harrisons-26">[26]</a> In dysgerminomas, <a href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">lactate dehydrogenase</a> and its two <a href="/wiki/Isozyme" title="Isozyme">isozymes</a> (<a href="/w/index.php?title=LDH-1&action=edit&redlink=1" class="new" title="LDH-1 (page does not exist)">LDH-1</a> and <a href="/w/index.php?title=LDH-2&action=edit&redlink=1" class="new" title="LDH-2 (page does not exist)">LDH-2</a>) are used to test for recurrence.<a href="#cite_note-Williams12-32">[32]</a> Women with ovarian cancer may not need routine surveillance imaging to monitor the cancer unless new symptoms appear or <a href="/wiki/Tumor_markers" class="mw-redirect" title="Tumor markers">tumor markers</a> begin rising.<a href="#cite_note-SGOfive-123">[123]</a> Imaging without these indications is discouraged because it is unlikely to detect a recurrence, improve survival, and because it has its own costs and side effects.<a href="#cite_note-SGOfive-123">[123]</a> However, CT imaging can be used if desired, though this is not common.<a href="#cite_note-Jayson-28">[28]</a> If a tumor is easily imaged, imaging may be used to monitor the progress of treatment.<a href="#cite_note-124">[124]</a> <div class="mw-heading mw-heading3"><h3 id="Palliative_care">Palliative care</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=63" title="Edit section: Palliative care">edit</a>]</div> <a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a> focuses on relieving symptoms and increasing or maintaining quality of life. This type of treatment's purpose is not to cure the cancer but to make the woman more comfortable while living with cancer that can not be cured. It has been recommended as part of the treatment plan for any person with advanced ovarian cancer or patients with significant symptoms.<a href="#cite_note-125">[125]</a> In platinum-refractory and platinum-resistant cases, other palliative chemotherapy is the main treatment.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-CanadianCS2017-96">[96]</a> Palliative care can entail treatment of symptoms and complications of the cancer, including pain, nausea, constipation, ascites, <a href="/wiki/Bowel_obstruction" title="Bowel obstruction">bowel obstruction</a>, <a href="/wiki/Edema" title="Edema">edema</a>, <a href="/wiki/Pleural_effusion" title="Pleural effusion">pleural effusion</a>, and <a href="/wiki/Mucositis" title="Mucositis">mucositis</a>. Especially if the cancer advances and becomes incurable, treatment of symptoms becomes one of the main goals of therapy. Palliative care can also entail helping with decision-making such as if or when <a href="/wiki/Hospice_care" class="mw-redirect" title="Hospice care">hospice care</a> is appropriate, and the preferred place for the patient at end of life care.<a href="#cite_note-DynaMed15-31">[31]</a> Bowel obstruction can be treated with <a href="/wiki/Palliative_surgery" title="Palliative surgery">palliative surgery</a> (<a href="/wiki/Colostomy" title="Colostomy">colostomy</a>, <a href="/wiki/Ileostomy" title="Ileostomy">ileostomy</a>, or internal bypass) or medicine, but surgery has been shown to increase survival time.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-DynaMed15-31">[31]</a> Palliative surgery may result in <a href="/wiki/Short_bowel_syndrome" title="Short bowel syndrome">short bowel syndrome</a>, <a href="/wiki/Enterocutaneous_fistula" title="Enterocutaneous fistula">enterocutaneous fistula</a>, or re-obstruction; or may not be possible due to the extent of obstruction.<a href="#cite_note-Hoffman35-29">[29]</a> Other treatments of complications can include <a href="/wiki/Total_parenteral_nutrition" class="mw-redirect" title="Total parenteral nutrition">total parenteral nutrition</a>, a <a href="/wiki/Low-residue_diet" class="mw-redirect" title="Low-residue diet">low-residue diet</a>, palliative <a href="/wiki/Gastrostomy" title="Gastrostomy">gastrostomy</a>, and adequate pain control.<a href="#cite_note-Jayson-28">[28]</a> Bowel obstruction can also be treated with <a href="/wiki/Octreotide" title="Octreotide">octreotide</a> when palliative surgery is not an option. Cancer can also block the <a href="/wiki/Ureters" class="mw-redirect" title="Ureters">ureters</a>, which can be relieved by a <a href="/wiki/Nephrostomy" title="Nephrostomy">nephrostomy</a> or a <a href="/wiki/Ureteric_stent" class="mw-redirect" title="Ureteric stent">ureteric stent</a>. Ascites can be relieved by repeated <a href="/wiki/Paracentesis" title="Paracentesis">paracentesis</a> or placement of a <a href="/wiki/Drain_(surgery)" title="Drain (surgery)">drain</a> to increase comfort.<a href="#cite_note-:5-126">[126]</a> Pleural effusions can be treated in a similar manner, with repeated <a href="/wiki/Thoracentesis" title="Thoracentesis">thoracentesis</a>, <a href="/wiki/Pleurodesis" title="Pleurodesis">pleurodesis</a>, or placement of a drain.<a href="#cite_note-Hoffman35-29">[29]</a> Radiation therapy can be used as part of the palliative care of advanced ovarian cancer, since it can help to shrink tumors that are causing symptoms.<a href="#cite_note-CanadianCS2017-96">[96]</a> Palliative radiotherapy typically lasts for only a few treatments, a much shorter course of therapy than non-palliative radiotherapy.<a href="#cite_note-:4-117">[117]</a> It is also used for palliation of chemotherapy-resistant germ cell tumors.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading3"><h3 id="Psychosocial_care">Psychosocial care</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=64" title="Edit section: Psychosocial care">edit</a>]</div> Ovarian cancer has a significant effect on <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a>, psychological health and well-being. Interventions are available to help with the needs and social support. Many ovarian cancer survivors report a good quality of life and <a href="/wiki/Optimism" title="Optimism">optimism</a>. Others reported a "spiritual change" that helped them find <a href="/wiki/Meaning_of_life" title="Meaning of life">meaning</a> during their experience. Others have described their loss of faith after their diagnosis with ovarian cancer. Those who have gone through treatment sometimes experience <a href="/wiki/Social_isolation" title="Social isolation">social isolation</a> but benefit from having relationships with other survivors. <a href="/wiki/Frustration" title="Frustration">Frustration</a> and <a href="/wiki/Guilt_(emotion)" title="Guilt (emotion)">guilt</a> have been described by some who have expressed their inability to care for their family.<a href="#cite_note-Roland13-127">[127]</a> <a href="/wiki/Self-esteem" title="Self-esteem">Self-esteem</a> and <a href="/wiki/Body_image" title="Body image">body image</a> changes can occur due to <a href="/wiki/Hair_loss" title="Hair loss">hair loss</a>, removal of ovaries and other reproductive structures, and <a href="/wiki/Scar" title="Scar">scars</a>. There is some improvement after hair grows in. Sexual issues can develop. The removal of ovaries results in surgically induced <a href="/wiki/Menopause" title="Menopause">menopause</a> that can result in <a href="/wiki/Dyspareunia" title="Dyspareunia">painful intercourse</a>, vaginal dryness, loss of <a href="/wiki/Hypoactive_sexual_desire_disorder" title="Hypoactive sexual desire disorder">sexual desire</a> and being tired. Though prognosis is better for younger survivors, the impact on sexuality can still be substantial.<a href="#cite_note-Roland13-127">[127]</a> <a href="/wiki/Anxiety" title="Anxiety">Anxiety</a>, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a> and <a href="/wiki/Distress_in_cancer_caregiving" title="Distress in cancer caregiving">distress</a> is present in those surviving ovarian cancer at higher rates than in the general population.<a href="#cite_note-Roland13-127">[127]</a><a href="#cite_note-128">[128]</a> The same psychosocial problems can develop in family members. Emotional effects can include a <a href="/wiki/Death_anxiety" title="Death anxiety">fear of death</a>, <a href="/wiki/Sadness" title="Sadness">sadness</a>, memory problems and difficulty in concentrating. When optimism was adopted by those at the beginning of their treatment, they were less likely to develop distress. Those who have fear of the cancer recurring may have difficulty in expressing <a href="/wiki/Joy" title="Joy">joy</a> even when disease-free. The more treatments that a woman undergoes, the more likely the loss of <a href="/wiki/Hope" title="Hope">hope</a> is expressed. Women often can cope and reduce negative psychosocial effects by a number of strategies. Activities such as traveling, spending additional time with family and friends, ignoring <a href="/wiki/Statistics" title="Statistics">statistics</a>, journaling and increasing involvement in <a href="/wiki/Spirituality" title="Spirituality">spiritually-based</a> events are adaptive.<a href="#cite_note-Roland13-127">[127]</a> Women with ovarian cancer may also experience difficulties with their diet and are at risk of malnutrition.<a href="#cite_note-129">[129]</a> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=65" title="Edit section: Prognosis">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Relative_survival_of_ovarian_cancer_by_stage.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Relative_survival_of_ovarian_cancer_by_stage.png/290px-Relative_survival_of_ovarian_cancer_by_stage.png" decoding="async" width="290" height="208" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Relative_survival_of_ovarian_cancer_by_stage.png/435px-Relative_survival_of_ovarian_cancer_by_stage.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Relative_survival_of_ovarian_cancer_by_stage.png/580px-Relative_survival_of_ovarian_cancer_by_stage.png 2x" data-file-width="657" data-file-height="471" /></a><figcaption>Relative <a href="/wiki/Five-year_survival" class="mw-redirect" title="Five-year survival">five-year survival</a> of invasive epithelial ovarian cancer by stage<a href="#cite_note-ACS-130">[130]</a></figcaption></figure> Ovarian cancer usually has a relatively poor <a href="/wiki/Prognosis" title="Prognosis">prognosis</a>. It is disproportionately deadly because it lacks any clear early detection or screening test, meaning most cases are not diagnosed until they have reached advanced stages.<a href="#cite_note-SGOfive-123">[123]</a><a href="#cite_note-Jayson-28">[28]</a> Ovarian cancer metastasizes early in its development, often before it has been diagnosed. High-grade tumors metastasize more readily than low-grade tumors. Typically, tumor cells begin to metastasize by growing in the peritoneal cavity.<a href="#cite_note-Harrisons-26">[26]</a> More than 60% of women presenting with ovarian cancer have stage-III or stage-IV cancer, when it has already spread beyond the ovaries. Ovarian cancers shed cells into the naturally occurring fluid within the abdominal cavity. These cells can then implant on other abdominal (peritoneal) structures, including the uterus, <a href="/wiki/Urinary_bladder" class="mw-redirect" title="Urinary bladder">urinary bladder</a>, <a href="/wiki/Bowel" class="mw-redirect" title="Bowel">bowel</a>, <a href="/wiki/Mesentery" title="Mesentery">lining of the bowel wall</a>, and <a href="/wiki/Greater_omentum" title="Greater omentum">omentum</a>, forming new tumor growths before cancer is even suspected. The five-year survival rate for all stages of ovarian cancer is 46%; the one-year survival rate is 72% and the ten-year survival rate is 35%.<a href="#cite_note-131">[131]</a> For cases where a diagnosis is made early in the disease, when the cancer is still confined to the primary site, the five-year survival rate is 92.7%.<a href="#cite_note-SEER-132">[132]</a> About 70% of women with advanced disease respond to initial treatment, most of whom attain complete remission, but half of these women experience a recurrence 1–4 years after treatment.<a href="#cite_note-Harrisons-26">[26]</a> <a href="/wiki/Brain_metastasis" title="Brain metastasis">Brain metastasis</a> is more common in stage III/IV cancer but can still occur in cancers staged at I/II. People with brain metastases survive a median of 8.2 months, though surgery, chemotherapy, and <a href="/wiki/Whole_brain_radiotherapy" title="Whole brain radiotherapy">whole brain radiation therapy</a> can improve survival.<a href="#cite_note-DynaMed15-31">[31]</a> Ovarian cancer survival varies significantly with subtype. Dysgerminomas have a very favorable prognosis. In early stages, they have a five-year survival rate of 96.9%.<a href="#cite_note-Current-33">[33]</a> Around two-thirds of dysgerminomas are diagnosed at stage I.<a href="#cite_note-Williams12-32">[32]</a> Stage-III dysgerminomas have a five-year survival of 61%; when treated with BEP chemotherapy after incomplete surgical removal, dysgerminomas have a 95% two-year survival rate. Sex-cord-stromal malignancies also have a favorable prognosis; because they are slow-growing, even those with metastatic disease can survive a decade or more.<a href="#cite_note-Harrisons-26">[26]</a> Low malignant potential tumors usually only have a bad prognosis when there are invasive tumor implants found in the peritoneal cavity.<a href="#cite_note-Hoffman35-29">[29]</a> Complications of ovarian cancer can include spread of the cancer to other organs, progressive function loss of various organs, ascites, and intestinal obstructions, which can be fatal. Intestinal obstructions in multiple sites are the most common proximate cause of death.<a href="#cite_note-Jayson-28">[28]</a> Intestinal obstruction in ovarian cancer can either be a true obstruction, where tumor blocks the <a href="/wiki/Intestinal_lumen" class="mw-redirect" title="Intestinal lumen">intestinal lumen</a>, or a pseudo-obstruction, when tumor prevents normal <a href="/wiki/Peristalsis" title="Peristalsis">peristalsis</a>.<a href="#cite_note-133">[133]</a> Continuous accumulation of ascites can be treated by placing a drain that can be self-drained.<a href="#cite_note-Jayson-28">[28]</a> <div class="mw-heading mw-heading3"><h3 id="Prognostic_factors">Prognostic factors</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=66" title="Edit section: Prognostic factors">edit</a>]</div> There are a number of <a href="/w/index.php?title=Prognostic_factor&action=edit&redlink=1" class="new" title="Prognostic factor (page does not exist)">prognostic factors</a> in ovarian cancer. Positive prognostic factors – those indicating better chances of survival – include no residual disease after surgery (stage III/IV), complete macroscopic resection (stage IV), BRCA2 mutations, young age (under 45 years), nonserous type, low histologic grade, early stage, co-occurrence with endometrial cancer, and low CA-125 levels. There is conflicting evidence for BRCA1 as a prognostic factor. Conversely, negative prognostic factors – those that indicate a worse chance of survival – include rupture of the ovarian capsule during surgery, older age (over 45 years), mucinous type, stage IV, high histologic grade, clear-cell type, upper abdominal involvement, high CA-125 levels, the presence of tumor cells in the blood, and elevated <a href="/wiki/Cyclooxygenase_2" class="mw-redirect" title="Cyclooxygenase 2">cyclooxygenase-2</a>.<a href="#cite_note-DynaMed15-31">[31]</a> Expression of various mRNAs can also be prognostic for ovarian cancer. High levels of <a href="/wiki/Drosha" title="Drosha">Drosha</a> and <a href="/wiki/Dicer" title="Dicer">Dicer</a> are associated with improved survival, whereas high levels of <a href="/w/index.php?title=Let-7b&action=edit&redlink=1" class="new" title="Let-7b (page does not exist)">let-7b</a>, <a href="/wiki/HIF1A" title="HIF1A">HIF1A</a>, <a href="/wiki/EPH_receptor_A1" title="EPH receptor A1">EphA1</a>, and <a href="/wiki/Poly_ADP_ribose_polymerase" class="mw-redirect" title="Poly ADP ribose polymerase">poly(ADP-ribose) polymerase</a> are associated with worse survival. Cancers that are positive for <a href="/wiki/WT1" class="mw-redirect" title="WT1">WT1</a> carry a worse prognosis; estrogen-receptor positive cancers have a better prognosis.<a href="#cite_note-DynaMed15-31">[31]</a> <div class="mw-heading mw-heading3"><h3 id="Survival_rates">Survival rates</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=67" title="Edit section: Survival rates">edit</a>]</div> Overall five-year survival rates for all types of ovarian cancer are presented below by stage and histologic grade:<a href="#cite_note-Harrisons-26">[26]</a> <table class="wikitable" align="left" style="text-align: center; margin-right: 10px;"> <tbody><tr> <th>Stage </th> <th>Survival </th></tr> <tr> <td>I </td> <td>90–95% </td></tr> <tr> <td>II </td> <td>70–80% </td></tr> <tr> <td>III </td> <td>20–50% </td></tr> <tr> <td>IV </td> <td>1–5% </td></tr></tbody></table> <table class="wikitable" align="left" style="text-align: center;"> <tbody><tr> <th>Histologic grade </th> <th>Survival </th></tr> <tr> <td>Low grade </td> <td>88% </td></tr> <tr> <td>Intermediate grade </td> <td>58% </td></tr> <tr> <td>High grade </td> <td>27% </td></tr></tbody></table> <div style="clear:both;" class=""></div> The survival rates given below are for the different types of ovarian cancer, according to <a href="/wiki/American_Cancer_Society" title="American Cancer Society">American Cancer Society</a>.<a href="#cite_note-ACS-130">[130]</a> They come from the <a href="/wiki/National_Cancer_Institute" title="National Cancer Institute">National Cancer Institute</a>, <a href="/wiki/Surveillance_Epidemiology_and_End_Results" class="mw-redirect" title="Surveillance Epidemiology and End Results">SEER</a>, and are based on patients diagnosed from 2004 to 2010. <table class="wikitable" align="left" style="text-align: center; margin-right: 10px;"> <tbody><tr> <th colspan="2">Invasive epithelial ovarian cancer </th></tr> <tr> <th>Stage </th> <th>Relative five-year survival rate </th></tr> <tr> <td>I </td> <td>90% </td></tr> <tr> <td>IA </td> <td>94% </td></tr> <tr> <td>IB </td> <td>92% </td></tr> <tr> <td>IC </td> <td>85% </td></tr> <tr> <td>II </td> <td>70% </td></tr> <tr> <td>IIA </td> <td>78% </td></tr> <tr> <td>IIB </td> <td>73% </td></tr> <tr> <td>III </td> <td>39% </td></tr> <tr> <td>IIIA </td> <td>59% </td></tr> <tr> <td>IIIB </td> <td>52% </td></tr> <tr> <td>IIIC </td> <td>39% </td></tr> <tr> <td>IV </td> <td>17% </td></tr></tbody></table> <table class="wikitable" align="left" style="text-align: center; margin-right: 10px;"> <tbody><tr> <th colspan="2">Ovarian stromal tumors </th></tr> <tr> <th>Stage </th> <th>Relative five-year survival rate </th></tr> <tr> <td>I </td> <td>95% </td></tr> <tr> <td>II </td> <td>78% </td></tr> <tr> <td>III </td> <td>65% </td></tr> <tr> <td>IV </td> <td>35% </td></tr></tbody></table> <table class="wikitable" align="left" style="text-align: center; margin-right: 10px;"> <tbody><tr> <th colspan="2">Germ cell tumors of the ovary </th></tr> <tr> <th>Stage </th> <th>Relative five-year Survival Rate </th></tr> <tr> <td>I </td> <td>98% </td></tr> <tr> <td>II </td> <td>94% </td></tr> <tr> <td>III </td> <td>87% </td></tr> <tr> <td>IV </td> <td>69% </td></tr></tbody></table> <table class="wikitable" align="left" style="text-align: center; margin-right: 10px;"> <tbody><tr> <th colspan="2">Fallopian tube carcinoma </th></tr> <tr> <th>Stage </th> <th>Relative five-year survival rate </th></tr> <tr> <td>I </td> <td>87% </td></tr> <tr> <td>II </td> <td>86% </td></tr> <tr> <td>III </td> <td>52% </td></tr> <tr> <td>IV </td> <td>40% </td></tr></tbody></table> <table class="wikitable" align="left" style="text-align: center; margin-right: 10px;"> <tbody><tr> <th colspan="2">Low malignant potential tumors<a href="#cite_note-Hoffman35-29">[29]</a> </th></tr> <tr> <th>Stage </th> <th>Relative five-year survival rate </th></tr> <tr> <td>I </td> <td>99% </td></tr> <tr> <td>II </td> <td>98% </td></tr> <tr> <td>III </td> <td>96% </td></tr> <tr> <td>IV </td> <td>77% </td></tr></tbody></table> <div style="clear:both;" class=""></div> <div class="mw-heading mw-heading3"><h3 id="Recurrence_rates">Recurrence rates</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=68" title="Edit section: Recurrence rates">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Cancer_recurrence#Ovarian_cancer" class="mw-redirect" title="Cancer recurrence">Cancer recurrence § Ovarian cancer</a></div> Ovarian cancer frequently recurs after treatment. Overall, in a 5-year period, 20% of stage I and II cancers recur. Most recurrences are in the abdomen.<a href="#cite_note-Hoffman35-29">[29]</a> If a recurrence occurs in advanced disease, it typically occurs within 18 months of initial treatment (18 months <a href="/wiki/Progression-free_survival" title="Progression-free survival">progression-free survival</a>). Recurrences can be treated, but the disease-free interval tends to shorten and chemoresistance increases with each recurrence.<a href="#cite_note-Jayson-28">[28]</a> When a dysgerminoma recurs, it is most likely to recur within a year of diagnosis, and other malignant germ cell tumors recur within 2 years 90% of the time. Germ cell tumors other than dysgerminomas have a poor prognosis when they relapse, with a 10% long-term survival rate.<a href="#cite_note-Williams12-32">[32]</a> Low malignant potential tumors rarely relapse, even when fertility-sparing surgery is the treatment of choice. 15% of LMP tumors relapse after unilateral surgery in the previously unaffected ovary, and they are typically easily treated with surgery. More advanced tumors may take up to 20 years to relapse, if they relapse at all, and are only treated with surgery unless the tumor has changed its histological characteristics or grown very quickly. In these cases, and when there is significant ascites, chemotherapy may also be used. Relapse is usually indicated by rising CA-125 levels and then progresses to symptomatic relapse within 2–6 months.<a href="#cite_note-Hoffman35-29">[29]</a> Recurrent sex cord-stromal tumors are typically unresponsive to treatment but not aggressive.<a href="#cite_note-Williams12-32">[32]</a> It is the most deadly gynecologic cancer.<a href="#cite_note-Hoffman35-29">[29]</a> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=69" title="Edit section: Epidemiology">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Ovary_cancer_world_map_-_Death_-_WHO2004.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/03/Ovary_cancer_world_map_-_Death_-_WHO2004.svg/290px-Ovary_cancer_world_map_-_Death_-_WHO2004.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/03/Ovary_cancer_world_map_-_Death_-_WHO2004.svg/435px-Ovary_cancer_world_map_-_Death_-_WHO2004.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/03/Ovary_cancer_world_map_-_Death_-_WHO2004.svg/580px-Ovary_cancer_world_map_-_Death_-_WHO2004.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption><a href="/wiki/Age_adjustment" title="Age adjustment">Age-standardized</a> death from ovarian cancer per 100,000 inhabitants in 2004<a href="#cite_note-134">[134]</a><style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col div-col-small" style="column-width: 10em;"> <style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend">  no data</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  less than 0.6</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  0.6–1.2</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  1.2–1.8</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  1.8–2.4</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  2.4–3</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  3–3.6</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  3.6–4.2</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  4.2–4.8</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  4.8–5.4</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  5.4–6</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  6–7</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  more than 7</div> </div></figcaption></figure> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Ovarian_tumors_by_incidence_and_cancer_risk.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Ovarian_tumors_by_incidence_and_cancer_risk.png/320px-Ovarian_tumors_by_incidence_and_cancer_risk.png" decoding="async" width="320" height="162" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Ovarian_tumors_by_incidence_and_cancer_risk.png/480px-Ovarian_tumors_by_incidence_and_cancer_risk.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Ovarian_tumors_by_incidence_and_cancer_risk.png/640px-Ovarian_tumors_by_incidence_and_cancer_risk.png 2x" data-file-width="2153" data-file-height="1093" /></a><figcaption><a href="/wiki/Ovarian_tumor" title="Ovarian tumor">Ovarian tumors</a> (including non-cancerous tumors) by <a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">incidence</a> and risk of ovarian cancer.<a href="#cite_note-135">[135]</a></figcaption></figure> Globally, in 2018, the incidence of ovarian cancer was 6.6 per 100,000 and mortality was 3.9.<a href="#cite_note-Gaona20-136">[136]</a> Globally, about 160,000 people died from ovarian cancer in 2010. This was an increase from 113,000 in 1990.<a href="#cite_note-Loz_2012-137">[137]</a> The number of new cases per year in Europe is approximately 5–15 per 100,000 women.<a href="#cite_note-DynaMed15-31">[31]</a> In Europe, <a href="/wiki/Lithuania" title="Lithuania">Lithuania</a>, <a href="/wiki/Latvia" title="Latvia">Latvia</a>, <a href="/wiki/Ireland" title="Ireland">Ireland</a>, <a href="/wiki/Slovakia" title="Slovakia">Slovakia</a>, and the <a href="/wiki/Czech_Republic" title="Czech Republic">Czech Republic</a> have the highest incidences of ovarian cancer, whereas <a href="/wiki/Portugal" title="Portugal">Portugal</a> and <a href="/wiki/Cyprus" title="Cyprus">Cyprus</a> have the lowest incidences.<a href="#cite_note-DynaMed15-31">[31]</a> In 2008, the five-year survival rate was 44%. This has increased since 1977 when the survival rate was 36%.<a href="#cite_note-Roland13-127">[127]</a> <div class="mw-heading mw-heading3"><h3 id="United_States">United States</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=70" title="Edit section: United States">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Ovarian_cancer_by_age_group.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e0/Ovarian_cancer_by_age_group.png/290px-Ovarian_cancer_by_age_group.png" decoding="async" width="290" height="274" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/e/e0/Ovarian_cancer_by_age_group.png 1.5x" data-file-width="373" data-file-height="353" /></a><figcaption>Ovarian cancer cases diagnosed by age group in the US<a href="#cite_note-SEER-132">[132]</a></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Ovarian_cancer_incidence_by_age_and_type.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/bf/Ovarian_cancer_incidence_by_age_and_type.png/220px-Ovarian_cancer_incidence_by_age_and_type.png" decoding="async" width="220" height="177" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/bf/Ovarian_cancer_incidence_by_age_and_type.png/330px-Ovarian_cancer_incidence_by_age_and_type.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/bf/Ovarian_cancer_incidence_by_age_and_type.png/440px-Ovarian_cancer_incidence_by_age_and_type.png 2x" data-file-width="468" data-file-height="377" /></a><figcaption>Ovarian cancer by age and type.<a href="#cite_note-138">[138]</a></figcaption></figure> In 2022, in the United States, an estimated 19,880 new cases were diagnosed and 12,810 women died of ovarian cancer.<a href="#cite_note-139">[139]</a> The 5-year relative survival rate is 49.7%.<a href="#cite_note-:17-140">[140]</a> Around 57% cases have metastasized at the time of diagnosis.<a href="#cite_note-:17-140">[140]</a> In 2014, over 220,000 diagnoses of epithelial ovarian cancer were made yearly.<a href="#cite_note-Jayson-28">[28]</a> The overall lifetime risk in the US is around 1.6%<a href="#cite_note-Harrisons-26">[26]</a><a href="#cite_note-DynaMed15-31">[31]</a> In the US, ovarian cancer affects 1.3–1.4% and is the cause of death of about 1% of women.<a href="#cite_note-Hoffman35-29">[29]</a><a href="#cite_note-merck-141">[141]</a> In the United States, it is also the fifth-most common cancer in women but the fourth-most common cause of cancer death.<a href="#cite_note-DynaMed15-31">[31]</a> This decrease made it the ninth-most common cancer in women.<a href="#cite_note-Hoffman35-29">[29]</a> The risks from developing specific types of ovarian cancer varies. Germ cell tumors and sex cord-stromal tumors are less common than epithelial tumors. The number of new cases a year in the US is 0.4 per 100,000 women and 0.2 per 100,000 women, respectively. In young people, sex-cord stromal tumors and germ cell tumors total 1% of overall ovarian cancer.<a href="#cite_note-Williams12-32">[32]</a> Ovarian cancer represents approximately 4% of cancers diagnosed in women.<a href="#cite_note-DynaMed15-31">[31]</a> <div class="mw-heading mw-heading3"><h3 id="United_Kingdom">United Kingdom</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=71" title="Edit section: United Kingdom">edit</a>]</div> It is the 5th-most common cancer in UK women (around 7,100 were diagnosed in 2011) and the 5th-most common cause of cancer death in women (around 4,300 died in 2012).<a href="#cite_note-142">[142]</a><a href="#cite_note-DynaMed15-31">[31]</a><a href="#cite_note-CRUKRisks-34">[34]</a> The incidence rate over the whole UK population is 21.6 per 100,000. As of 2014, the UK saw approximately 7,000–7,100 yearly diagnoses with 4,200 deaths.<a href="#cite_note-Jayson-28">[28]</a><a href="#cite_note-CRUKRisks-34">[34]</a> A 2022 article from The Times put the estimate at 7,500 new cases yearly in Britain.<a href="#cite_note-thetimes2022-143">[143]</a> Early symptoms are often mistaken for common conditions such as cystitis or irritable bowel syndrome, and about 40 per cent of UK women wrongly believe that cervical screening detects ovarian cancer, an increase from 30 per cent in 2016.<a href="#cite_note-thetimes2022-143">[143]</a> <div class="mw-heading mw-heading3"><h3 id="Ethnicity">Ethnicity</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=72" title="Edit section: Ethnicity">edit</a>]</div> Black women have twice the risk for sex cord-stromal tumors compared to non-Black women.<a href="#cite_note-Williams12-32">[32]</a> The highest prevalence is in Caucasian and Hispanic women, followed by African-American and Asian women.<a href="#cite_note-Gaona20-136">[136]</a> The highest mortality from ovarian cancer is in African-American women.<a href="#cite_note-Gaona20-136">[136]</a> <a href="/wiki/Ashkenazi_Jew" class="mw-redirect" title="Ashkenazi Jew">Ashkenazi Jewish</a> women carry mutated BRCA alleles five times more often than the rest of the population, giving them a higher risk developing ovarian cancer.<a href="#cite_note-Jayson-28">[28]</a> <div class="mw-heading mw-heading3"><h3 id="Older_women">Older women</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=73" title="Edit section: Older women">edit</a>]</div> In the US, the incidence rate in women over 50 is approximately 33 per 100,000.<a href="#cite_note-144">[144]</a> The rate of ovarian cancer between 1993 and 2008 decreased in women of the 40–49 age cohort and in the 50–64 age cohort.<a href="#cite_note-Jayson-28">[28]</a> Ovarian cancer is most commonly diagnosed after menopause,<a href="#cite_note-CRUKRisks-34">[34]</a> between the ages of 60 and 64. Ninety percent of ovarian cancer occurs in women over the age of 45 and 80% in women over 50.<a href="#cite_note-DynaMed15-31">[31]</a> Older women are more likely to present with advanced ovarian cancer.<a href="#cite_note-Gib2016-20">[20]</a> <div class="mw-heading mw-heading2"><h2 id="In_pregnancy">In pregnancy</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=74" title="Edit section: In pregnancy">edit</a>]</div> Malignant germ cell tumors are the type of ovarian cancer most likely to occur during <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>. They are typically diagnosed when an adnexal mass is found on examination (in 1–2% of all pregnancies), a tumor is seen on ultrasound, or the parent's level of alpha-fetoprotein is elevated. Dermoid cysts and dysgerminomas are the most common germ cell tumors during pregnancy. Germ cell tumors diagnosed during pregnancy are unlikely to have metastasized and can be treated by surgery and, in some cases, chemotherapy, which carries the risk of birth defects. Yolk sac tumors and immature teratomas grow particularly quickly and are usually treated with chemotherapy even during pregnancy; however, dysgerminomas that have been optimally debulked may be treated after childbirth.<a href="#cite_note-Williams12-32">[32]</a> <div class="mw-heading mw-heading2"><h2 id="Other_animals">Other animals</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=75" title="Edit section: Other animals">edit</a>]</div> Ovarian tumors have been reported in <a href="/wiki/Equine" class="mw-redirect" title="Equine">equine</a> <a href="/wiki/Mare" title="Mare">mares</a>. Reported tumor types include teratoma,<a href="#cite_note-pmid15065985-145">[145]</a><a href="#cite_note-pmid16363331-146">[146]</a> <a href="/wiki/Cystadenocarcinoma" title="Cystadenocarcinoma">cystadenocarcinoma</a>,<a href="#cite_note-pmid15957389-147">[147]</a> and particularly <a href="/wiki/Granulosa_cell_tumor" class="mw-redirect" title="Granulosa cell tumor">granulosa cell tumor</a>.<a href="#cite_note-pmid17542368-148">[148]</a><a href="#cite_note-pmid12867740-149">[149]</a><a href="#cite_note-pmid9364230-150">[150]</a><a href="#cite_note-pmid3507181-151">[151]</a><a href="#cite_note-pmid2835223-152">[152]</a>[<a href="/wiki/Wikipedia:Citing_sources#Bundling_citations" title="Wikipedia:Citing sources">excessive citations</a>] <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=76" title="Edit section: Research">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Screening_2">Screening</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=77" title="Edit section: Screening">edit</a>]</div> Screening by hysteroscopy to obtain cell samples obtained for histological examination is being developed. This is similar to the current pap smear that is used to detect cervical cancer.<a href="#cite_note-GizzoNoventa2016-153">[153]</a> The UK Collaborative Trial of Ovarian Cancer Screening is testing a screening technique that combines CA-125 blood tests with transvaginal ultrasound.<a href="#cite_note-Jayson-28">[28]</a> Other studies suggest that this screening procedure may be effective.<a href="#cite_note-:6-120">[120]</a> Although results published in 2015 were not conclusive, there was some evidence that screening may save lives in the long-term.<a href="#cite_note-154">[154]</a> As a result, the trial has been extended and will publish definitive results at the end of 2019. One major problem with screening is no clear progression of the disease from stage I (noninvasive) to stage III (invasive) is seen, and it may not be possible to find cancers before they reach stage III. Another problem is that screening methods tend to find too many suspicious lesions, most of which are not cancer, but malignancy can only be assessed with surgery.<a href="#cite_note-Jayson-28">[28]</a> The ROCA method combined with transvaginal ultrasonography is being researched in high-risk women to determine if it is a viable screening method. It is also being investigated in normal-risk women as it has shown promise in the wider population.<a href="#cite_note-Hoffman35-29">[29]</a> Studies are also in progress to determine if screening helps detect cancer earlier in people with BRCA mutations.<a href="#cite_note-:6-120">[120]</a> Researchers from BGI Genomics and Fudan University have uncovered significant findings on ovarian cancer (OV) in Chinese patients, revealing a unique RAD51D variant that may serve as a therapeutic target.<a href="#cite_note-:7-12">[12]</a> Published in <a href="//doi.org/10.1200/GO.23.00454" class="extiw" title="doi:10.1200/GO.23.00454">JCO Global Oncology</a>, the study identified an enriched RAD51D variant associated with tumor growth promotion. Notably, the RAD51D K91fs variant was found to increase sensitivity to PARP inhibitors, such as olaparib and niraparib, offering new treatment avenues. <div class="mw-heading mw-heading3"><h3 id="Prognosis_research">Prognosis research</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=78" title="Edit section: Prognosis research">edit</a>]</div> Research into various <a href="/w/index.php?title=Prognostic_factor&action=edit&redlink=1" class="new" title="Prognostic factor (page does not exist)">prognostic factors</a> for ovarian cancer is also going on. Recent research shows that <a href="/wiki/Thrombocytosis" class="mw-redirect" title="Thrombocytosis">thrombocytosis</a> predicts lower survival and higher stage cancer.<a href="#cite_note-Jayson-28">[28]</a> Ongoing research is also investigating the benefits of surgery for recurrent ovarian cancer.<a href="#cite_note-:6-120">[120]</a> <div class="mw-heading mw-heading3"><h3 id="Immunotherapy_2">Immunotherapy</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=79" title="Edit section: Immunotherapy">edit</a>]</div> While an active area of research, as of 2018 there is no good evidence that <a href="/wiki/Immunotherapy" title="Immunotherapy">immunotherapy</a> is effective for ovarian cancer.<a href="#cite_note-pmid30199097-155">[155]</a> However, trials of the antibody and <a href="/wiki/VEGF" class="mw-redirect" title="VEGF">VEGF</a> inhibitor <a href="/wiki/Bevacizumab" title="Bevacizumab">bevacizumab</a>, which can slow the <a href="/wiki/Angiogenesis" title="Angiogenesis">growth of new blood vessels</a> in the cancer, have shown promising results, especially in combination with <a href="/wiki/Pazopanib" title="Pazopanib">pazopanib</a>, which also slows the process of blood vessel growth. Bevacizumab has been particularly effective in preliminary studies on stage-III and -IV cancer<a href="#cite_note-Jayson-28">[28]</a> and has been cited as having at least a 15% response rate.<a href="#cite_note-Harrisons-26">[26]</a> It is being investigated particularly in mucinous ovarian cancers.<a href="#cite_note-:6-120">[120]</a> <div class="mw-heading mw-heading3"><h3 id="Pharmacology">Pharmacology</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=80" title="Edit section: Pharmacology">edit</a>]</div> <a href="/wiki/MTOR_inhibitor" class="mw-redirect" title="MTOR inhibitor">mTOR inhibitors</a> were a highly investigated potential treatment in the 2000s and 2010s, but the side effects of these drugs (particularly <a href="/wiki/Hyperglycemia" title="Hyperglycemia">hyperglycemia</a> and <a href="/wiki/Hyperlipidemia" title="Hyperlipidemia">hyperlipidemia</a>) were not well tolerated and the survival benefit not confirmed. PI3 kinase inhibitors have been of interest, but they tend to be highly toxic and cause <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a>. Another investigated drug is <a href="/wiki/Selumetinib" title="Selumetinib">selumetinib</a>, a <a href="/wiki/MAPK" class="mw-redirect" title="MAPK">MAPK</a> inhibitor. It improved survival, but did not correlate with any mutations found in tumors.<a href="#cite_note-Jayson-28">[28]</a> Bevacizumab can also be combined with platinum chemotherapy, a combination that has had positive preliminary results in PFS, but equivocal results regarding overall survival. One disadvantage to these treatments is the side effect profile, which includes <a href="/wiki/Hypertension" title="Hypertension">high blood pressure</a> and <a href="/wiki/Proteinuria" title="Proteinuria">proteinuria</a>. The drug can also exacerbate bowel disease, leading to <a href="/wiki/Fistula" title="Fistula">fistulae</a> or <a href="/wiki/Bowel_perforation" class="mw-redirect" title="Bowel perforation">bowel perforation</a>. <a href="/wiki/Vintafolide" title="Vintafolide">Vintafolide</a>, which consists of an <a href="/wiki/Antifolate" title="Antifolate">antifolate</a> conjugated with <a href="/wiki/Vinblastine" title="Vinblastine">vinblastine</a>, is also in clinical trials; it may prove beneficial because <a href="/wiki/Folate_receptor" title="Folate receptor">folate receptors</a> are overexpressed in many ovarian cancers.<a href="#cite_note-Jayson-28">[28]</a> Another potential immunotherapy is <a href="/wiki/Trastuzumab" title="Trastuzumab">trastuzumab</a>, which is active against tumors positive for Her2/neu mutations.<a href="#cite_note-Harrisons-26">[26]</a> Other angiogenesis inhibitors are also being investigated as potential ovarian cancer treatments. <a href="/wiki/Combretastatin" title="Combretastatin">Combretastatin</a> and <a href="/wiki/Pazopanib" title="Pazopanib">pazopanib</a> are being researched in combination for recurrent ovarian cancer. <a href="/w/index.php?title=Trebananib&action=edit&redlink=1" class="new" title="Trebananib (page does not exist)">Trebananib</a> and <a href="/wiki/Tasquinimod" title="Tasquinimod">tasquinimod</a> are other angiogenesis inhibitors being investigated. The <a href="/wiki/Monoclonal_antibody" title="Monoclonal antibody">monoclonal antibody</a> <a href="/wiki/Farletuzumab" title="Farletuzumab">farletuzumab</a> is being researched as an adjuvant to traditional chemotherapy. Another type of immunotherapy involves <a href="/wiki/Vaccines" class="mw-redirect" title="Vaccines">vaccines</a>, including <a href="/wiki/TroVax" title="TroVax">TroVax</a>.<a href="#cite_note-:6-120">[120]</a> An alternative to BEP chemotherapy, a regimen of 3 cycles of <a href="/wiki/Carboplatin" title="Carboplatin">carboplatin</a> and <a href="/wiki/Etoposide" title="Etoposide">etoposide</a>, is a current topic of research for germ cell malignancies.<a href="#cite_note-Williams12-32">[32]</a> <a href="/wiki/Intraperitoneal_chemotherapy" class="mw-redirect" title="Intraperitoneal chemotherapy">Intraperitoneal chemotherapy</a> has also been under investigation during the 2000s and 2010s for its potential to deliver higher doses of cytotoxic agent to tumors. Preliminary trials with cisplatin and paclitaxel have shown it is not well tolerated, but does improve survival, and more tolerable regimens are being researched.<a href="#cite_note-Jayson-28">[28]</a> Cisplatin and paclitaxel are both being researched as intraperitoneal chemotherapy agents. A specific chemotherapy regimen for rare clear-cell cancers is also under investigation: <a href="/wiki/Irinotecan" title="Irinotecan">irinotecan</a> combined with cisplatin.<a href="#cite_note-:6-120">[120]</a> <a href="/wiki/PARP_inhibitor" title="PARP inhibitor">PARP inhibitors</a> have also shown promise in early trials, particularly in people with BRCA gene mutations, since the BRCA protein interacts with the PARP pathway. It is also being studied in recurrent ovarian cancer in general, where preliminary studies have shown longer PFS. Specifically, <a href="/wiki/Olaparib" title="Olaparib">olaparib</a> has shown greater survival compared to doxorubicin, though this treatment is still being investigated. It is not clear yet which <a href="/wiki/Biomarker" title="Biomarker">biomarkers</a> are predictive of responsiveness to PARP inhibitors.<a href="#cite_note-Jayson-28">[28]</a> <a href="/wiki/Rucaparib" title="Rucaparib">Rucaparib</a> is another PARP inhibitor being researched in BRCA-positive and BRCA-negative recurrent advanced ovarian cancer. <a href="/wiki/Niraparib" title="Niraparib">Niraparib</a> is a PARP inhibitor being tested in BRCA-positive recurrent ovarian cancer.<a href="#cite_note-:6-120">[120]</a> <a href="/wiki/Tyrosine_kinase_inhibitors" class="mw-redirect" title="Tyrosine kinase inhibitors">Tyrosine kinase inhibitors</a> are another investigational drug class that may have applications in ovarian cancer. Angiogenesis inhibitors in the <a href="/wiki/Receptor_tyrosine_kinase" title="Receptor tyrosine kinase">receptor tyrosine kinase</a> inhibitor group, including <a href="/wiki/Pazopanib" title="Pazopanib">pazopanib</a>, <a href="/wiki/Cediranib" title="Cediranib">cediranib</a>, and <a href="/wiki/Nintedanib" title="Nintedanib">nintedanib</a>, have also been shown to increase progression free survival (PFS), but their benefit for overall survival has not been investigated as of 2015.<a href="#cite_note-Jayson-28">[28]</a> Preliminary research showed that cediranib combined with platins in recurrent ovarian cancer increased the time to second recurrence by 3–4 months and increased survival by 3 months.<a href="#cite_note-:6-120">[120]</a> <a href="/wiki/MK-1775" class="mw-redirect" title="MK-1775">MK-1775</a> is a tyrosine kinase inhibitor that is being used in combination with paclitaxel and carboplatin in platinum-sensitive cancers with p53 mutations. <a href="/wiki/Nintedanib" title="Nintedanib">Nintedanib</a> is being researched as a potential therapy in combination with cyclophosphamide for people with recurrences.<a href="#cite_note-:6-120">[120]</a> <a href="/wiki/Histone_deacetylase_inhibitor" title="Histone deacetylase inhibitor">Histone deacetylase inhibitors</a> (HDACi) are another area of research. <div class="mw-heading mw-heading3"><h3 id="Hormones_and_radiation">Hormones and radiation</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=81" title="Edit section: Hormones and radiation">edit</a>]</div> Hormone therapies are a topic of current research in ovarian cancer, particularly, the value of certain medications used to treat breast cancer. These include <a href="/wiki/Tamoxifen" title="Tamoxifen">tamoxifen</a>, <a href="/wiki/Letrozole" title="Letrozole">letrozole</a>, and <a href="/wiki/Anastrozole" title="Anastrozole">anastrozole</a>. Preliminary studies have showed a benefit for tamoxifen in a small number of people with advanced ovarian cancer. Letrozole may help to slow or stop growth of <a href="/wiki/Estrogen_receptor" title="Estrogen receptor">estrogen receptor</a> positive ovarian cancer. Anastrozole is being investigated in postmenopausal people with estrogen receptor-positive cancer.<a href="#cite_note-:6-120">[120]</a> Research into mitigating side effects of ovarian cancer treatment is also ongoing. <a href="/w/index.php?title=Radiation_fibrosis&action=edit&redlink=1" class="new" title="Radiation fibrosis (page does not exist)">Radiation fibrosis</a>, the formation of scar tissue in an area treated with radiation, may be relieved with <a href="/wiki/Hyperbaric_medicine" title="Hyperbaric medicine">hyperbaric oxygen therapy</a>, but research has not been completed in this area. Treatment of ovarian cancer may also cause people to experience psychiatric difficulties, including <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>. Research is ongoing to determine how counseling and psychotherapy can help people who have ovarian cancer during treatment.<a href="#cite_note-:6-120">[120]</a> <div class="mw-heading mw-heading3"><h3 id="Inflammation">Inflammation</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=82" title="Edit section: Inflammation">edit</a>]</div> There are some indications that pelvic inflammatory disease may be associated with ovarian cancer, especially in non-western countries. It may be due to the inflammatory process present with pelvic inflammatory disease.<a href="#cite_note-IngerslevHogdall2017-156">[156]</a> <div class="mw-heading mw-heading3"><h3 id="Clinical_trials">Clinical trials</h3>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=83" title="Edit section: Clinical trials">edit</a>]</div> <a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a> are monitored and funded by US governmental organizations to test treatment options to see if they are safe and effective. These include NIH Clinical Research Trials and You (<a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a>),<a href="#cite_note-157">[157]</a> Learn About Clinical Trials (<a href="/wiki/National_Cancer_Institute" title="National Cancer Institute">National Cancer Institute</a>),<a href="#cite_note-158">[158]</a> Search for Clinical Trials (National Cancer Institute),<a href="#cite_note-159">[159]</a> ClinicalTrials.gov (National Institutes of Health).<a href="#cite_note-160">[160]</a><a href="#cite_note-CDCfeb2017-93">[93]</a> Clinical trials are also conducted in Canada.<a href="#cite_note-161">[161]</a> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=84" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-NCI2014TxPt-1">^ <a href="#cite_ref-NCI2014TxPt_1-0">a</a> <a href="#cite_ref-NCI2014TxPt_1-1">b</a> <a href="#cite_ref-NCI2014TxPt_1-2">c</a> <a href="#cite_ref-NCI2014TxPt_1-3">d</a> <a href="#cite_ref-NCI2014TxPt_1-4">e</a> <a href="#cite_ref-NCI2014TxPt_1-5">f</a> <a href="#cite_ref-NCI2014TxPt_1-6">g</a> <a href="#cite_ref-NCI2014TxPt_1-7">h</a> <a href="#cite_ref-NCI2014TxPt_1-8">i</a> <a href="#cite_ref-NCI2014TxPt_1-9">j</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/Patient/page1/AllPages">"Ovarian Epithelial Cancer Treatment"</a>. 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Infectious Agents and Cancer. 12 (1): 25. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1186%2Fs13027-017-0134-9">10.1186/s13027-017-0134-9</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437405">5437405</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28529540">28529540</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Infectious+Agents+and+Cancer&rft.atitle=The+potential+role+of+infectious+agents+and+pelvic+inflammatory+disease+in+ovarian+carcinogenesis&rft.volume=12&rft.issue=1&rft.pages=25&rft.date=2017&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5437405%23id-name%3DPMC&rft_id=info%3Apmid%2F28529540&rft_id=info%3Adoi%2F10.1186%2Fs13027-017-0134-9&rft.aulast=Ingerslev&rft.aufirst=K&rft.au=Hogdall%2C+E&rft.au=Schnack%2C+TH&rft.au=Skovrider-Ruminski%2C+W&rft.au=Hogdall%2C+C&rft.au=Blaakaer%2C+J&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5437405&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"> </li> <li id="cite_note-157"><a href="#cite_ref-157">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.nih.gov/health-information/nih-clinical-research-trials-you">"NIH Clinical Research Trials and You"</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20170608133010/https://www.nih.gov/health-information/nih-clinical-research-trials-you">Archived</a> from the original on 8 June 2017. 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Retrieved 17 June 2017.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=National+Cancer+Institute&rft.atitle=Clinical+Trials+Information+for+Patients+and+Caregivers&rft.date=2015-05&rft_id=https%3A%2F%2Fwww.cancer.gov%2Fabout-cancer%2Ftreatment%2Fclinical-trials&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"> </li> <li id="cite_note-159"><a href="#cite_ref-159">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/">"Find NCI-Supported Clinical Trials"</a>. National Cancer Institute. 23 June 2016. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20170701064612/https://www.cancer.gov/about-cancer/treatment/clinical-trials/search">Archived</a> from the original on 1 July 2017. Retrieved 17 June 2017.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=National+Cancer+Institute&rft.atitle=Find+NCI-Supported+Clinical+Trials&rft.date=2016-06-23&rft_id=https%3A%2F%2Fwww.cancer.gov%2Fabout-cancer%2Ftreatment%2Fclinical-trials%2Fsearch%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"> </li> <li id="cite_note-160"><a href="#cite_ref-160">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.clinicaltrials.gov/">"Home — ClinicalTrials.gov"</a>. www.clinicaltrials.gov. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20170616200907/https://www.clinicaltrials.gov/">Archived</a> from the original on 16 June 2017. Retrieved 17 June 2017.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.clinicaltrials.gov&rft.atitle=Home+%E2%80%94+ClinicalTrials.gov&rft_id=https%3A%2F%2Fwww.clinicaltrials.gov%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"> </li> <li id="cite_note-161"><a href="#cite_ref-161">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.canadiancancertrials.ca/">"Home - Canadian Cancer Trials"</a>. www.canadiancancertrials.ca. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20170626081519/http://canadiancancertrials.ca/">Archived</a> from the original on 26 June 2017. Retrieved 17 June 2017.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.canadiancancertrials.ca&rft.atitle=Home+-+Canadian+Cancer+Trials&rft_id=http%3A%2F%2Fwww.canadiancancertrials.ca%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=85" title="Edit section: Further reading">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCannistra2004" class="citation journal cs1">Cannistra SA (December 2004). "Cancer of the ovary". The New England Journal of Medicine. 351 (24): 2519–29. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJMra041842">10.1056/NEJMra041842</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15590954">15590954</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+England+Journal+of+Medicine&rft.atitle=Cancer+of+the+ovary&rft.volume=351&rft.issue=24&rft.pages=2519-29&rft.date=2004-12&rft_id=info%3Adoi%2F10.1056%2FNEJMra041842&rft_id=info%3Apmid%2F15590954&rft.aulast=Cannistra&rft.aufirst=SA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKhodavandiAlizadehRazis2021" class="citation journal cs1">Khodavandi A, Alizadeh F, Razis AF (June 2021). "Association between dietary intake and risk of ovarian cancer: a systematic review and meta-analysis". Eur J Nutr. 60 (4): 1707–36. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs00394-020-02332-y">10.1007/s00394-020-02332-y</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/32661683">32661683</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:220505663">220505663</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur+J+Nutr&rft.atitle=Association+between+dietary+intake+and+risk+of+ovarian+cancer%3A+a+systematic+review+and+meta-analysis&rft.volume=60&rft.issue=4&rft.pages=1707-36&rft.date=2021-06&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A220505663%23id-name%3DS2CID&rft_id=info%3Apmid%2F32661683&rft_id=info%3Adoi%2F10.1007%2Fs00394-020-02332-y&rft.aulast=Khodavandi&rft.aufirst=A&rft.au=Alizadeh%2C+F&rft.au=Razis%2C+AF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPetrucelliDalyFeldman2013" class="citation book cs1">Petrucelli N, Daly MB, Feldman GL (2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK1247/">"BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer"</a>. GeneReviews. University of Washington, Seattle. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20301425">20301425</a>. NBK1247.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=BRCA1-+and+BRCA2-Associated+Hereditary+Breast+and+Ovarian+Cancer&rft.btitle=GeneReviews&rft.pub=University+of+Washington%2C+Seattle&rft.date=2013&rft_id=info%3Apmid%2F20301425&rft.aulast=Petrucelli&rft.aufirst=N&rft.au=Daly%2C+MB&rft.au=Feldman%2C+GL&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK1247%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Ovarian_cancer&action=edit&section=86" title="Edit section: External links">edit</a>]</div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cancer.gov/types/ovarian/hp">"Ovarian, Fallopian Tube, and Primary Peritoneal Cancer - Patient Version"</a>. National Cancer Institute. Retrieved 30 March 2017.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ovarian%2C+Fallopian+Tube%2C+and+Primary+Peritoneal+Cancer+-+Patient+Version&rft.pub=National+Cancer+Institute&rft_id=https%3A%2F%2Fwww.cancer.gov%2Ftypes%2Fovarian%2Fhp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOvarian+cancer" class="Z3988"></li> <li><a rel="nofollow" class="external text" href="http://www.mountsinai.org/patient-care/service-areas/obgyn-and-reproductive-services/areas-of-care/gynecologic-oncology/ovarian-cancer/infographic/ovariancancerinfo">What is Ovarian Cancer Infographic, information on ovarian cancer</a> - <a href="/wiki/Mount_Sinai_Hospital,_New_York" class="mw-redirect" title="Mount Sinai Hospital, New York">Mount Sinai Hospital, New York</a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid 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dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q172341" class="extiw" title="d:Q172341">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/C56">C56</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=183">183</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=220">220</a></li><li><a href="/wiki/International_Classification_of_Diseases_for_Oncology" title="International Classification of Diseases for Oncology">ICD-O</a>: varied</li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D010051">D010051</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb9418.htm">9418</a></li><li><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a>: <a rel="nofollow" class="external text" href="http://snomed.info/id/363443007">363443007</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000889.htm">000889</a></li><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/1698-overview">med/1698</a></li><li><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/ovarian-cancer-pro">Ovarian cancer</a></li><li><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=213500">213500</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Tumors_of_the_female_urogenital_system" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Female_genital_neoplasia" title="Template:Female genital neoplasia"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Female_genital_neoplasia" title="Template talk:Female genital neoplasia"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Female_genital_neoplasia" title="Special:EditPage/Template:Female genital neoplasia"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Tumors_of_the_female_urogenital_system" style="font-size:114%;margin:0 4em"><a href="/wiki/Tumor" class="mw-redirect" title="Tumor">Tumors</a> of the female <a href="/wiki/Urogenital_system" class="mw-redirect" title="Urogenital system">urogenital system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adnexa_of_uterus" class="mw-redirect" title="Adnexa of uterus">Adnexa</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Ovaries</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/w/index.php?title=Glandular_and_epithelial_neoplasm&action=edit&redlink=1" class="new" title="Glandular and epithelial neoplasm (page does not exist)">Glandular and epithelial</a>/ <a href="/wiki/Surface_epithelial-stromal_tumor" title="Surface epithelial-stromal tumor">surface epithelial- stromal tumor</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="CMS:" scope="row" class="navbox-group" style="width:1%">CMS:</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ovarian_serous_cystadenoma" title="Ovarian serous cystadenoma">Ovarian serous cystadenoma</a></li> <li><a href="/wiki/Mucinous_cystadenoma" title="Mucinous cystadenoma">Mucinous cystadenoma</a></li> <li><a href="/wiki/Cystadenocarcinoma" title="Cystadenocarcinoma">Cystadenocarcinoma</a> <ul><li><a href="/wiki/Papillary_serous_cystadenocarcinoma" title="Papillary serous cystadenocarcinoma">Papillary serous cystadenocarcinoma</a></li></ul></li> <li><a href="/wiki/Krukenberg_tumor" title="Krukenberg tumor">Krukenberg tumor</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Endometrioid_tumor" title="Endometrioid tumor">Endometrioid tumor</a></li> <li><a href="/wiki/Ovarian_clear-cell_carcinoma" title="Ovarian clear-cell carcinoma">Ovarian clear-cell carcinoma</a></li> <li><a href="/wiki/Brenner_tumour" title="Brenner tumour">Brenner tumour</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sex_cord%E2%80%93gonadal_stromal_tumour" title="Sex cord–gonadal stromal tumour">Sex cord–gonadal stromal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Leydig_cell_tumour" title="Leydig cell tumour">Leydig cell tumour</a></li> <li><a href="/wiki/Sertoli_cell_tumour" title="Sertoli cell tumour">Sertoli cell tumour</a></li> <li><a href="/wiki/Sertoli%E2%80%93Leydig_cell_tumour" title="Sertoli–Leydig cell tumour">Sertoli–Leydig cell tumour</a></li> <li><a href="/wiki/Thecoma" title="Thecoma">Thecoma</a></li> <li><a href="/wiki/Granulosa_cell_tumour" title="Granulosa cell tumour">Granulosa cell tumour</a></li> <li><a href="/wiki/Luteoma" title="Luteoma">Luteoma</a></li> <li><a href="/wiki/Sex_cord_tumour_with_annular_tubules" title="Sex cord tumour with annular tubules">Sex cord tumour with annular tubules</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">Germ cell</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dysgerminoma" title="Dysgerminoma">Dysgerminoma</a></li> <li><a href="/wiki/Germ_cell_tumor#Nongerminomatous" title="Germ cell tumor">Nongerminomatous</a> <ul><li><a href="/wiki/Embryonal_carcinoma" title="Embryonal carcinoma">Embryonal carcinoma</a></li> <li><a href="/wiki/Endodermal_sinus_tumor" title="Endodermal sinus tumor">Endodermal sinus tumor</a></li> <li><a href="/wiki/Gonadoblastoma" title="Gonadoblastoma">Gonadoblastoma</a></li> <li><a href="/wiki/Teratoma" title="Teratoma">Teratoma</a>/<a href="/wiki/Struma_ovarii" title="Struma ovarii">Struma ovarii</a></li> <li><a href="/wiki/Choriocarcinoma" title="Choriocarcinoma">Choriocarcinoma</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ovarian_fibroma" title="Ovarian fibroma">Fibroma</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Meigs%27_syndrome" class="mw-redirect" title="Meigs' syndrome">Meigs' syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Fallopian_tube_cancer" title="Fallopian tube cancer">Fallopian tube</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adenomatoid_tumor" title="Adenomatoid tumor">Adenomatoid tumor</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Uterine_cancer" title="Uterine cancer">Uterus</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Myometrium" title="Myometrium">Myometrium</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Uterine_fibroid" title="Uterine fibroid">Uterine fibroids/leiomyoma</a></li> <li><a href="/wiki/Leiomyosarcoma" title="Leiomyosarcoma">Leiomyosarcoma</a></li> <li><a href="/wiki/Adenomyoma" title="Adenomyoma">Adenomyoma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endometrial_cancer" title="Endometrial cancer">Endometrium</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Endometrioid_tumor" title="Endometrioid tumor">Endometrioid tumor</a></li> <li><a href="/wiki/Uterine_serous_carcinoma" title="Uterine serous carcinoma">Uterine papillary serous carcinoma</a></li> <li><a href="/wiki/Endometrial_intraepithelial_neoplasia" title="Endometrial intraepithelial neoplasia">Endometrial intraepithelial neoplasia</a></li> <li><a href="/wiki/Uterine_clear-cell_carcinoma" title="Uterine clear-cell carcinoma">Uterine clear-cell carcinoma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cervical_cancer" title="Cervical cancer">Cervix</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cervical_intraepithelial_neoplasia" title="Cervical intraepithelial neoplasia">Cervical intraepithelial neoplasia</a></li> <li><a href="/wiki/Clear-cell_adenocarcinoma_of_the_vagina" title="Clear-cell adenocarcinoma of the vagina">Clear-cell carcinoma</a></li> <li><a href="/wiki/Squamous-cell_carcinoma#Vagina_and_cervix" title="Squamous-cell carcinoma">SCC</a></li> <li><a href="/wiki/Glassy_cell_carcinoma_of_the_cervix" title="Glassy cell carcinoma of the cervix">Glassy-cell carcinoma</a></li> <li><a href="/wiki/Villoglandular_adenocarcinoma_of_the_cervix" title="Villoglandular adenocarcinoma of the cervix">Villoglandular adenocarcinoma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Placenta" title="Placenta">Placenta</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Choriocarcinoma" title="Choriocarcinoma">Choriocarcinoma</a></li> <li><a href="/wiki/Gestational_trophoblastic_disease" title="Gestational trophoblastic disease">Gestational trophoblastic disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Uterine_sarcoma" title="Uterine sarcoma">Uterine sarcoma</a></li> <li><a href="/wiki/Mixed_M%C3%BCllerian_tumor" title="Mixed Müllerian tumor">Mixed Müllerian tumor</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vaginal_cancer" title="Vaginal cancer">Vagina</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Squamous-cell_carcinoma_of_the_vagina" class="mw-redirect" title="Squamous-cell carcinoma of the vagina">Squamous-cell carcinoma of the vagina</a></li> <li><a href="/wiki/Sarcoma_botryoides" title="Sarcoma botryoides">Botryoid rhabdomyosarcoma</a></li> <li><a href="/wiki/Clear-cell_adenocarcinoma_of_the_vagina" title="Clear-cell adenocarcinoma of the vagina">Clear-cell adenocarcinoma of the vagina</a></li> <li><a href="/wiki/Vaginal_intraepithelial_neoplasia" title="Vaginal intraepithelial neoplasia">Vaginal intraepithelial neoplasia</a></li> <li><a href="/wiki/Vaginal_cysts" title="Vaginal cysts">Vaginal cysts</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vulvar_cancer" title="Vulvar cancer">Vulva</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">SCC</a></li> <li><a href="/wiki/Melanoma" title="Melanoma">Melanoma</a></li> <li><a href="/wiki/Papillary_hidradenoma" title="Papillary hidradenoma">Papillary hidradenoma</a></li> <li><a href="/wiki/Extramammary_Paget%27s_disease" title="Extramammary Paget's disease">Extramammary Paget's disease</a></li> <li><a href="/wiki/Vulvar_intraepithelial_neoplasia" title="Vulvar intraepithelial neoplasia">Vulvar intraepithelial neoplasia</a></li> <li><a href="/wiki/Bartholin_gland_carcinoma" title="Bartholin gland carcinoma">Bartholin gland carcinoma</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"></div><div role="navigation" 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