Ovarian

# Ovarian Cancer: The Whispering Disease

## Introduction: Silent Progression
Epithelial ovarian cancer (EOC) causes more deaths than all other gynecologic malignancies combined, largely due to asymptomatic progression until advanced stages. The dualistic model classifies EOC into:
- **Type I**: Low-grade, indolent (endometrioid, mucinous)
- **Type II**: High-grade, aggressive (serous, carcinosarcoma)

Only 15% of cases are diagnosed at stage I, where survival exceeds 90%.

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## Causes and Risk Factors: Reproductive and Genetic

### Hormonal Factors
- **Ovulation Frequency**: Nulliparity increases risk
- **Endometriosis**: 1.5× risk for clear cell carcinoma
- **Androgen Exposure**: PCOS association

### Genetic Predisposition
- **BRCA1/2**: 40-60% lifetime risk
- **Lynch Syndrome**: 12% lifetime risk
- **RAD51C/D**: Emerging moderate-risk genes

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## Prevention Strategies: From Contraception to Surgery

### Risk-Reduction Approaches
- **Oral Contraceptives**: 5 years use reduces risk 50%
- **Tubal Ligation**: 30% risk reduction
- **Breastfeeding**: 2% reduction per month of lactation

### Surgical Prevention
| Procedure | Risk Reduction | Recommended For |
|-----------|----------------|-----------------|
| Bilateral salpingectomy | 40-50% | Women undergoing pelvic surgery |
| Risk-reducing salpingo-oophorectomy | 80-90% | BRCA carriers >40 |
| Hysterectomy | 30% | BRCA1 carriers |

### Screening Limitations
- No effective screening for average-risk women
- CA125 + TVUS for high-risk women (limited sensitivity)