HOW SERIOUS IS OVARIAN CANCER?

HOW SERIOUS IS OVARIAN CANCER?
Ovarian cancer ranks behind lung, breast, and colorectal cancer as the fourth most common cause of female cancer death in this country. About 13,900 American women are expected to die from ovarian cancer in 2002. In, general, however, survival rates increased from 37% in 1974 to greater than 50% currently. (As a comparison, however, the average five-year survival rate for all breast cancer cases is now over 85%, primarily because of early detection.) This rate varies according to when the cancer is detected:
Five-year survival rates are over 90% if the cancer is caught when it is still confined to the ovary.

If it has spread to nearby regions in the pelvis, the survival rate drops to between 60% and 80%.
If it has spread to sites outside the pelvis, the five-year survival rates are only 0% to 30%. Unfortunately, most patients with ovarian cancer will present with advanced disease, which typically has spread to the upper abdomen. In order to establish a prognosis and determine treatment, the physician needs to know the cell type, stage, and grade of the disease.

Prognosis by Cell Type

About 90% of ovarian epithelial cancers fall into one of four major subtypes based on their origin and shape as viewed under a microscope:
Serous. (This is the most common type.)
Endometrioid. (This is sometimes associated with endometriosis and tends to have a more favorable outlook.)

Mucinous. (The presence of malignant mucinous cells indicates a poorer outlook if the disease is advanced.)
Clear cell. (Clear cell carcinomas are the most difficult to treat even when the malignancy is still confined to the ovary.) The remaining 10% of common epithelial cancers are referred to as undifferentiated, because their exact cell of origin cannot be determined microscopically. These epithelial ovarian carcinomas tend to grow and spread quickly.

Prognosis by Stage

Cancers are staged according to whether they are still localized (remain in the ovary) or have spread beyond the original site.

In Stage I, the cancer is thought to be confined to one or both ovaries (Stage IA or IB, respectively). The five-year survival rate for this stage is 90%, but the presence of other factors may reduce this rate. For example,
Stage IA or IB with non-clear-cell well-differentiated cancer cells or borderline tumors has a favorable prognosis. Clear cells or those that are more poorly differentiated have a worse outlook. If the tumor has involved the capsule of the ovary, or if fluid in the abdomen (ascites) contains malignant cells (Stage IC), the outlook is poorer than average for this stage.

In Stage II, cancer is found outside of the ovary but is still contained within the pelvis. It may have advanced to the uterus or fallopian tubes, or other areas within the pelvis (Stage IIA or IIB, respectively). The five-year survival rate for stage II is approximately 60% to 80%.

In Stage III, one or both of the following are present: (1) The cancer has spread beyond the pelvis to the omentum and other areas within the abdomen, such as the surface of the liver or intestine. (2) The cancer has spread to the lymph nodes. The average five-year survival rate for this stage is 20%.

Stage IV is the most advanced. The cancer may have spread to the inside of the liver or spleen. There may be distant metastases, such as ovarian cancer cells in the fluid around the lungs. The average five-year survival rate for this stage is less than 10%.

Prognosis by Grade

Tumors are also graded according to how well or poorly organized they are (their differentiation). Ovarian tumors are graded on a scale of 1, 2, or 3. Grade 1 tends to closely resemble normal tissue and has a better prognosis than Grade 3, which indicates very abnormal, poorly defined tissue.Other Prognostic Factors
Age. It is commonly thought that younger women have a better prognosis than older women, although a 1996 study indicated that the stage and grade of the tumor were the main factors in prognosis, while age itself played no role. BRCA Carriers. Some studies have reported that women who carry mutated BRCA genes may have better survival rates than non-carriers. The survival advantages may be due to having a slower course or being more responsive to therapies than sporadic ovarian cancers, although this is controversial.

Angiogenesis. Experimentally, the level of biochemicals stimulating the formation of new blood vessels that support tumor growth (angiogenesis) appears to correlate with prognosis. The more angiogenic factors present in a tumor population, the more new blood vessels will form, encouraging both tumor growth and metastasis. Hormone Receptor. In one 2000 study, women with ovarian cancer cells with progesterone receptors had higher survival rates than those with estrogen, both progesterone and estrogen, or no hormone receptors. Nevertheless, assessment of hormone receptor status is not usually necessary in ovarian cancer management.Consequences for Survivors

Women who survive ovarian cancer have a high risk for psychological stress. Support groups can be very helpful and are recommended for appropriate patients.