Skip to main content Accessibility help
  • Print publication year: 2008
  • Online publication date: December 2009

22 - Ovary



Ovarian cancer is the most common cause of death from gynaecological malignancy in the Western world. It has been named a ‘silent killer’ because of its lack of symptoms during early stages. Around 90% of ovarian cancers arise from the epithelium. Two-thirds of patients present late, with stage III or IV disease, with increasing abdominal symptoms including ascites. Typically, treatment depends on a combination of surgery and chemotherapy. Improvements in surgical techniques and chemotherapy agents have resulted in a modest increase in the 5-year survival over the past 30 years although, even now, two-thirds of women die from their disease.

Types of tumour affecting the ovary

The WHO classification of tumours of the ovary defines broad categories of ovarian tumours (WHO classification, 2003):

  • Surface epithelial-stromal tumours.

  • Sex cord-stromal tumours.

  • Germ cell tumours.

  • Tumours of the rete ovarii.

  • Miscellaneous tumours.

  • Lymphomas and haematopoietic tumours.

  • Secondary tumours.

Surface epithelial-stromal tumours are classified as benign, borderline or malignant. The subtypes are serous; mucinous; endometrioid, including malignant mixed müllerian tumour (carcinosarcoma); clear cell; transitional cell; squamous cell; mixed; and undifferentiated or unclassified.

Sex cord-stromal tumours are classified as granulosa-stromal cell tumours (including granulosa cell tumours and theca-fibroma tumours), sertoli-stromal cell tumours, sex-cord stromal tumours of mixed or unclassified cell types, and steroid cell tumours.

Germ cell tumours are classified as primitive germ cell tumours (including dysgerminoma, yolk sac tumour, and embryonal carcinoma), biphasic or triphasic teratomas (including immature teratoma and mature teratoma), and monodermal teratoma (composed of a single type of tissue and includes struma ovarii, which is composed of thyroid cells).

Anonymous. (1991). Chemotherapy in advanced ovarian cancer: an overview of randomised clinical trials. B.M.J., 303, 884–93.
Anonymous. (1998). International Collaborative Ovarian Neoplasm study2: randomised trial of single-agent carboplatin against three-drug combination of cyclophosphamide, doxorubicin, cisplatin (cyclophosphamide, doxorubicin and cisplatin) in women with ovarian cancer. Lancet, 352, 1571–6.
Antoniou, A., Pharoah, P. D., Narod, al. (2003). Average risks of breast and ovarian cancer associated with breast cancer gene1 or breast cancer gene2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am. J. Hum. Genet., 72, 1117–30.
Benedet, J. L., Bender, H., Jones, H. 3rdet al. (2000). Federation Internationale de Gynecologie et d'Obstetrique staging classifications and clinical practice guidelines of gynaecologic cancers. Int. J. Gynecol. Obstet., 70, 209–62.
Bower, M., Fife, K., Holden, al. (1996). Chemotherapy for ovarian germ cell tumours. Eur. J. Cancer., 32A, 593–7.
Bristow, R. E., Tomacruz, R. S., Armstrong, D. al. (2002). Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J. Clin. Oncol., 20, 1248–59.
Gordon, A. N., Tonda, M., Sun, al. (2004). Long term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol. Oncol., 95, 1–8.
Hanna, L. and Adams, M. (2006). Prevention of ovarian cancer. Best Pract. Res. Clin. Obstet. Gynaecol., 20, 339–62.
Herzog, T. J. (2002). Update on the role of topotecan in the treatment of recurrent ovarian cancer. Oncologist, 7 (Suppl. 5), 3–10.
International Collaborative Ovarian Neoplasm study Group. (2002). Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the International Collaborative Ovarian Neoplasm study 3 randomised trial. Lancet, 360, 505–15.
Longacre, T. A., McKenney, J. K., Tazelaar, H. al. (2005). Ovarian serous tumors of low malignant potential (borderline tumors): outcome-based study of 276 patients with long-term (> or = 5-year) follow-up. Am. J. Surg. Pathol., 29, 707–23.
Lu, K. H., Dinh, M., Kohlmann, al. (2005). Gynecologic cancer as a “sentinal cancer” for women with hereditary nonpolyposis colorectal cancer syndrome. Obstet. Gynecol., 105, 569–74.
McGuire, W. P., Hoskins, W. J., Brady, M. al. (1996). Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N. Engl. J. Med., 334, 1–6.
Meeuwissen, P. A., Seynaeve, C., Brekelmans, C. al. (2005). Outcome of surveillance and prophylactic salpingo-oophorectomy in asymptomatic women at high risk for ovarian cancer. Gynecol. Oncol., 97, 476–82.
Modugno, F. (2003). Ovarian cancer and high-risk women: implications for prevention, screening, and early detection. Gynecol. Oncol., 91, 15–31.
Moran, B. J. and Cecil, T. D. (2003). The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg. Oncol. Clin. N. Am., 12, 585–603.
Muggia, F. and Hamilton, A. (2001). Phase II data on Caelyx® in ovarian cancer. Eur. J. Cancer., 37 (Suppl. 9), S15–18.
Muggia, F. M., Braly, P. S., Brady, M. al. (2000). Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a Gynecologic Oncology Group study. J. Clin. Oncol., 18, 106–15.
National Statistics. (2005). In Cancer Statistics Registrations, ed. Gautrey, M., Sheldreke, M. and Cooper, N.. Series MB1 no. 33. London: Office for National Statistics, p. 17.
National Institute for Health and Clinical Excellence. (2003). Technology Appraisal Guidance – No. 55. Guidance of the Use of Paclitaxel in the Treatment of Ovarian Cancer. London: National Institute for Clinical Excellence.
National Institute for Health and Clinical Excellence. (2005). Technology Appraisal Guidance – No. 91. Paclitaxel, Pegylated Liposomal Doxorubicin Hydrochloride and Topotecan for Second-line or Subsequent Treatment of Advanced Ovarian Cancer. Review of Technology Appraisal Guidance 28, 45 and 55. London: National Institute for Clinical Excellence.
Parmar, M. K., Ledermann, J. A., Colombo, al. (2003). Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the International Collaborative Ovarian Neoplasm study4/AGO-OVAR-2.2 trial. Lancet, 361, 2099–106.
Piccart, M. J., Bertelsen, K., James, al. (2000). Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. J. Natl. Cancer Inst., 92, 699–708.
Risch, H. A., McLaughlin, J. R., Cole, D. al. (2001). Prevalence and penetrance of germline breast cancer gene1 and breast cancer gene2 mutations in a population series of 649 women with ovarian cancer. Am. J. Hum. Genet., 68, 700–10.
Runowicz, C. (2006). Should patients with ovarian cancer receive intraperitoneal chemotherapy following initial cytoreductive surgery?Nat. Clin. Pract. Oncol., 3, 416–7.
Scottish Intercollegiate Guidelines Network. (2003). Guideline 75. Epithelial Ovarian Cancer. Edinburgh: Scottish Intercollegiate Guidelines Network.
Struewing, J. P., Hartge, P., Wacholder, al. (1997). The risk of cancer associated with specific mutations of breast cancer gene1 and breast cancer gene2 among Ashkenazi Jews. N. Engl. J. Med., 336, 1401–8.
Trimbos, J. B., Parmar, M., Vergote, al. (2003). International Collaborative Ovarian Neoplasm trial 1 and Adjuvant ChemoTherapy In Ovarian Neoplasm trial: two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. J. Natl. Cancer. Inst., 95, 105–12.
World Health Organisation Classification. (2003). In World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Breast and Female Genital Organs, ed. Tavassoli, A. and Devilee, P.. Lyon: IARC Press, Chap. 4.