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  • Extraovarian primary peritoneal carcinoma (EOPPC)
  • Germ cell tumor (in egg cells)

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  • 183 Malignant neoplasm of ovary and other uterine adnexa1
  • 183.0 Malignant neoplasm of ovary1
  • 198.6 Secondary malignant neoplasm of ovary2

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  • C56.9 Malignant neoplasm of unspecified ovary
  • C79.60 Secondary malignant neoplasm of unspecified ovary

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Description

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  • Either EOPPC or germ cell tumor (in egg cells)
  • Second-most common female urogenital cancer
  • EOPCC is the most lethal of ovarian cancers
  • Epithelial tumors make up 90% of cases

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Essentials of Diagnosis

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  • Diagnosis is difficult and most women present with metastasis at time of diagnosis
  • Most primary malignant ovarian neoplasms are either carcinomas (serous, mucinous, or endometrioid adenocarcinomas) or malignant germ cell tumors1
  • Metastatic malignant neoplasms to the ovary include carcinomas, lymphomas, and melanomas1
  • This may be from a primary ovarian cancer involving the opposite ovary, or from a cancer at a distant site2

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General Considerations

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  • Most symptoms are common with non-cancer diagnoses, and therefore are overlooked (e.g., abdominal/pelvic pain)

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Demographics

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  • Occurs in women
  • Incidence peaks in women during their 5th and 6th decade of life
  • White and Hawaiian women have the highest incidence of ovarian cancer in the United States

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Signs and Symptoms

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  • Typically asymptomatic or vague symptoms
    • Abdominal bloating
    • Flatulence
    • Fatigue and malaise
    • Gastritis
    • General abdominal discomfort
    • Antalgic gait
    • Postural abnormality
    • Abdominal/back pain
  • Less common symptoms
    • Abnormal vaginal bleeding
    • Leg pain
    • Pelvic mass
    • Low back pain
    • Local pelvic pain (occurs late in the disease)
  • Symptoms associated with metastasis
    • Unexplained weight loss
    • Weakness
    • Pleurisy
    • Ascites
    • Cachexia
  • Paraneoplastic cerebellar degeneration (PCD): primarily affects women with gynecologic cancers
    • Ataxic gait
    • Truncal and appendicular ataxia
    • Nystagmus
    • Speech impairment (dysarthria)
  • Radiation side effects
    • Fatigue
    • Secondary neoplasm
    • Integumentary compromise (burns)
    • Radiation fibrosis
  • Chemotherapy side effects
    • Nausea
    • Vomiting
    • Diarrhea
    • Alopecia
    • Mouth sores
    • Conjunctivitis
    • Ulcers
    • Leukopenia
    • Anemia
    • Thrombocytopenia
    • Headaches
    • Dizziness
    • Menstrual irregularities
    • Infertility
    • Peripheral neuropathies

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Functional Implications

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  • Decreased endurance
  • Postural muscle imbalance
  • Pain with mobility (guarded pelvic/hip movements)
  • Self care/ADL deficits
  • Antalgic gait
  • Postural abnormality

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Possible Contributing Causes

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  • Etiology unknown
  • Risk factors include
    • Hormonal factors
    • Environmental factors
    • Genetic factors
      • Family history of ovarian or breast cancer
      • First-degree relative with ovarian cancer or who has the BRCA1 mutation has a 45% lifetime chance of developing ovarian cancer
    • Nulliparous women

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Differential Diagnoses

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  • Malignant gastric tumors
  • Adnexal tumors
  • Appendicitis (acute); appendiceal tumors
  • Ascites
  • Bladder distention/urinary retention
  • Borderline ovarian cancer
  • Bowel adhesions
  • Cervicitis
  • Colon cancer (adenocarcinoma)
  • Colonic obstruction
  • Ectopic pregnancy
  • Embryologic remnants
  • Endometriosis
  • Fecal impaction
  • Gastric cancer (gastric adenocarcinoma)
  • Hydrosalpinx/pyosalpinx
  • Irritable bowel syndrome (IBS)
  • Low-lying cecum
  • Metastatic gastrointestinal carcinoma
  • Ovarian cysts; torsion
  • Pancreatic cancer
  • Pelvic inflammatory disease (PID); pelvic abscess
  • ...

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