- Ovarian cancer is the 5th most common cancer in women and the most common cause of gynecologic mortality, with an estimated 21,650 new cases and 15,520 deaths in the US in 2008. - Risk factors include advancing age, infertility, endometriosis, talcum powder use, and genetic susceptibility. Protective factors include oral contraceptive use, parity, and tubal sterilization. - Screening with transvaginal ultrasound and CA125 is recommended for high-risk women like those with BRCA mutations, but routine screening is not recommended for the general population due to low sensitivity of tests for early detection.

1. Ovarian Cancer Pedro T. Ramirez, M.D. Associate Professor Director of Minimally Invasive Research & Education Department of Gynecologic Oncology

14. FIGO Staging Stage Description I Growth limited to the ovaries IA Growth limited to one ovary; no ascites containing malignant cells present; no tumor on external surface; capsule intact IB Growth limited to both ovaries; no ascites containing malignant cells present; no tumor on the external surface; capsule intact IC Tumor either stage IA or IB, but with tumor on the surface of one or both ovaries, or with capsule ruptured, or with ascites containing malignant cells present, or with positive peritoneal washings II Growth involving one or both ovaries with pelvic extension IIA Extension or metastases or both to the uterus or fallopian tubes or both IIB Extension to other pelvic tissues IIC Tumor either stage IIA or IIB, but with tumor on the surface of one or both ovaries, or with capsule ruptured, or with ascites containing malignant cells present, or with positive peritoneal washings III Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis or positive retroperitoneal or inguinal nodes or both; superficial liver metastasis equals stage III; tumor is limited to the true pelvis but with histologically confirmed IIIA Tumor grossly limited to the true pelvis with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologically proven extension to small bowel or omentum IIIB Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2cm in diameter; nodes are negative IIIC Peritoneal metastasis beyond the pelvis larger than 2cm in diameter or positive retroperitoneal or inguinal nodes or all IV Growth involving one or both ovaries with distant metastases; if pleural effusion is present, there must be positive cytologic findings to allot a case to stage IV; parenchymal liver metastasis equals stage IV

17. Therapy for Epithelial Ovarian Cancer Category of Ovarian Cancer Based on Surgical Staging Recommended (standard) Therapy Early ovarian cancer Low risk (stages IA and IB, grade 1) TAH, BSO High risk (stages IA and IB, grade 2 and 3; stages IC, IIA, IIB, and IIC, no residual) TAH, BSO Adjuvant therapy with combination carboplatin and paclitaxel chemotherapy Advanced ovarian cancer Stage III with optimal residual disease Maximal surgical cytoreduction Combination chemotherapy with systemic carboplatin and paclitaxel or systemic paclitaxel plus intraperitoneal cisplatinand paclitaxel Stage IV, or suboptimal disease, or both Maximal surgical cytoreduction Combination chemotherapy with carboplatin and paclitaxel

25. SPLEEN

26. SPLEEN HILUS

41. MD Anderson Cancer Center