Ovarian cancer, although ranking lower in overall incidence among cancers in the United States, is the most lethal gynecologic malignancy, with a 5-year survival rate of 50.9% despite advances in therapies. Two of the largest challenges in management are the lack of effective screening and the vague symptoms of the disease. Most ovarian cancers are diagnosed after metastasis has occurred. Genetic variants, such as BRCA1 and BRCA2, are strong risk factors, accounting for 10% to 15% of all ovarian cancers. Physicians should consider ovarian cancer in patients with pelvic pain or rapidly increasing abdominal girth. Initial workup includes a bimanual examination palpating for pelvic mass, an abdominal examination for ascites, transvaginal ultrasonography, and a cancer antigen 125 level. Referral to gynecologic oncology is appropriate for patients with findings concerning for malignancy on ultrasonography or with ascites or findings of metastasis. For patients with elevated cancer antigen 125 levels, referral is also warranted. Although there have not been significant advances in early detection, survival rates have improved because of better management and treatment. Family physicians play an important role by providing long-term continuous relationships with patients that may improve recognition of the disease and by providing support during treatment.
Case 3. JN is a 59-year-old cisgender woman who presents with several months of abdominal bloating, early satiety, fatigue, and vague pelvic pain. She has lost approximately 6.8 kg (15 lb) but has been trying to eat healthier and exercise. You palpate a fullness in her right adnexa on bimanual examination and order transvaginal ultrasonography.
Background, Epidemiology, and Risk Factors
Despite its relative rarity, ovarian cancer remains the most lethal gynecologic malignancy. It ranks 17th in prevalence among all cancers in the United States but is the fifth leading cause of cancer-related deaths. Advances in detection and treatment have been made; however, the 5-year survival rate stands at 50.9%.1 Overall, approximately 1.1% of women receive an ovarian cancer diagnosis during their lifetime, with an estimated 19,680 new cases diagnosed in the United States during 2024. As for many cancers, the 5-year relative survival rate is higher when the cancer is detected early and still localized rather than after metastasis. The challenge with ovarian cancer is that only 19% of cases are localized at diagnosis. Ovarian cancer more commonly occurs in postmenopausal patients, with a median age at diagnosis of 63 years.1,2
There are marked disparities in ovarian cancer outcomes including stage at diagnosis, treatment received, and survival based on race, insurance type, socioeconomic status, and geographic location. Black patients and those with low socioeconomic status or nonprivate insurance generally have worse outcomes compared with their counterparts. For example, Black patients have a 17% to 18% lower survival rate than White patients, which might be explained by more advanced disease on presentation and younger age at the time of diagnosis.2 This disparity persists after adjusting for health care availability and socioeconomic status. Meta-analyses of ovarian cancer clinical trials are limited by the relatively small number of Black patients included, highlighting the need for enrollment of underrepresented populations and for genetic testing to advance diagnosis and improve survival among all patients with this disease.
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