There are three main types of ovarian cancer, with different incidence rates and ages of onset. Surgery is the preferred treatment!

Author: Pan Lingya, chief physician of Peking Union Medical College Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Overall, ovarian cancer ranks third in incidence in China and ranks first in mortality among female reproductive system tumors. There are three main different histological types.

1. What are the three main types of ovarian cancer?

Ovarian cancer is mainly divided into three categories: ovarian epithelial tumors, ovarian germ cell tumors and ovarian sex cord stromal tumors. Among them, ovarian epithelial tumors originate from the epithelial cells on the surface of the ovary and are usually called ovarian cancer; ovarian germ cell tumors originate from egg cells or related tissues; and ovarian sex cord stromal tumors originate from the sex cords and stromal tissues in the ovary, including granulosa cells.

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The incidence of these three types of tumors varies. Ovarian epithelial tumors are the most common, accounting for about 70%-80% of all ovarian tumor cases; ovarian germ cell tumors account for about 15%; in contrast, ovarian sex cord stromal tumors are relatively rare, accounting for only 2%-5%.

According to foreign statistics, the average age of onset of ovarian epithelial tumors is 60-65 years old, while domestic statistics show that the average age of onset is about 56 years old. Ovarian germ cell tumors are more common in adolescents, with an average age of onset of 21 years old, but infants and young children can also be affected. The age distribution of ovarian sex cord stromal tumors is relatively wide and can occur at any age. Because of their endocrine function, they may cause precocious puberty in children and postmenopausal bleeding in elderly patients.

2. Is surgery the preferred treatment for ovarian cancer?

Surgery is the core treatment for ovarian cancer, supplemented by chemotherapy, while radiotherapy is rarely used due to the low sensitivity of ovarian cancer.

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The thoroughness of ovarian cancer surgery is directly related to the patient's prognosis. In the early stages of ovarian cancer, although the lesions appear to be confined to the ovaries, they may have occultly metastasized to the pelvic or abdominal cavity, so comprehensive staging surgery is required to ensure extensive removal of the lesions.

According to the standards of the International Federation of Gynecology and Obstetrics, ovarian cancer staging surgery is not limited to the removal of the primary lesion, but also requires the removal of areas where the tumor is prone to metastasis, such as the omentum, appendix, uterus, and contralateral ovary, and multiple biopsies are performed at potential metastatic sites to accurately assess the condition.

For ovarian cancer patients who have metastasized to the pelvic and abdominal viscera, cytoreductive surgery becomes a key treatment step, aiming to remove tumor tissue as much as possible, combined with chemotherapy after surgery to optimize prognosis. Given that ovarian cancer is prone to implantation metastasis and the range of lesions is extensive, advanced patients sometimes need to receive chemotherapy first to reduce the tumor volume and control ascites before undergoing cytoreductive surgery. Chemotherapy is particularly important in such cases.

3. Can patients with ovarian cancer still have children?

Ovarian germ cell tumors are common in children or young women. Treatment tends to preserve fertility. The principle is to first remove the tumor, followed by a specific chemotherapy regimen for germ cell tumors.

For ovarian epithelial tumors, an extremely cautious attitude is required in preserving fertility function because of their extremely high malignancy. The relevant guidelines set strict standards: first, the patient must have a clear desire to have children; second, the tumor must be in the early clinical stage; finally, a comprehensive staging surgery that preserves fertility function is required to confirm that the tumor is indeed stage I, and fertility function cannot be preserved for stage I tumors of unfavorable histological types.

Regarding the survival rate of ovarian cancer, the five-year survival rate of patients in the early stage (such as stage I) can exceed 80% after radical surgery and standardized chemotherapy. For patients in the late stage (such as stage III and stage IV), according to foreign reports, the five-year survival rate is about 30%-40%, while in my country it is roughly equivalent to about 30%.

It is worth noting that more than 70% of ovarian epithelial tumors, especially those in advanced stages, will recur within 2-3 years after initial treatment. For patients who stop chemotherapy for more than half a year, especially those who relapse after more than a year, if there are new resectable lesions, it is recommended to perform surgical resection first, followed by chemotherapy.