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Abstract
There is general agreement that ovarian malignancies pose an important health problem.
The combination of late presentation, non specific symptomatology and poor prognosis account for the increasing number of deaths from ovarian malignancy every year. Despite of the improved surgical techniques and effective chemotherapeutic regimens available for management of ovarian cancer, there is no improvement in its early detection. Thus ovarian cancer remains a leading cause of death from gynecological malignancies with an overall poor prognosis.
Epidemiologic studies had identified certain factors associated with the development of ovarian cancer. The strongest patient-related risk factor for ovarian cancer is increasing age; with mean age of diagnosis of epithelial ovarian cancer is 53 years. A woman with a single-first degree relative with ovarian cancer has a relative risk of approximately 3.5 for developing ovarian cancer compared with general population. Approximately 5-10% of ovarian cancers are linked to identifiable inherited mutations in the BRCA1 and BRCA2 genes. Nulligravidae or those of low parity and women with past history of breast, colonic and endometrial cancers are more susceptible to develop ovarian carcinoma.
Early-stage disease is usually quiet and rarely gives rise to symptoms until ovarian masses are quite large. The earliest symptoms of ovarian cancer are non specific and mostly related to gastrointestinal tract, so cases of ovarian cancer are often first seen by physicians rather than by gynecologists. In advanced cases, the patients may present with abdominal distension, abdominal pain, bleeding, pelvic pressure symptoms and ascites-related increased abdominal girth.
The signs which are suggestive of ovarian malignancy including cachexia, ascites, irregular fixed masses and presence of nodules in douglas pouch.
Owing to the development and improvement of growing number of conservative surgeries including laparoscopic surgery and radical surgeries, the definitive diagnosis of an ovarian mass is considered to be an important task in gynecologic practice.
Suspicious ovarian masses should be evaluated preoperatively to know their nature and behavior which in turn inflict the choice of type of surgery. Evaluation of suspicious ovarian mass should include clinical evaluation, two dimensional ultrasound, and measurement of tumor marker CA-125 and the site of research, Haptoglobin blood levels.