Reference Work Entry

Blaustein’s Pathology of the Female Genital Tract

pp 679-784

Surface Epithelial Tumors of the Ovary

  • Jeffrey D. SeidmanAffiliated withDepartment of Pathology and Laboratory Medicine, Washington Hospital Center Email author 
  • , Kathleen R. ChoAffiliated withDepartment of Pathology, University of Michigan Medical School
  • , Brigitte M. RonnettAffiliated withDepartment of Pathology, Division of Gynecologic Pathology, Johns Hopkins University School of Medicine
  • , Robert J. KurmanAffiliated withDepartments of Gynecology, Obstetrics, Pathology and Oncology, Division of Gynecologic Pathology, Johns Hopkins University School of Medicine


Worldwide, ovarian cancer is the sixth most common cancer in women and the seventh most common cause of cancer death. There are about 204,000 new cases and 125,000 deaths annually [29]. In most Western countries, ovarian carcinoma is the fifth most common malignancy and ranks fourth in cancer mortality. In the Western hemisphere, it accounts for 4% of cancer in women and is the most frequent cause of death due to gynecological cancer. In US women, ovarian cancer ranks ninth in incidence and fifth in mortality, and accounts for 3% of cancers diagnosed and 5% of cancer deaths. It is estimated that in the United States in 2010, there were 21,880 new ovarian cancer cases and 13,850 deaths [137]. Approximately 1.4% of American women will develop ovarian cancer in their lifetime. In general, the disease is more common in industrialized countries where parity is lower, but there are notable exceptions such as Japan which has a low parity and low rate of ovarian cancer. The incidence varies widely among different ethnic groups. The lifetime risk varies widely from 0.45% in Japan to 1.7% in Sweden. Annual incidence rates of ovarian cancer range from less than 5 per 100,000 women in The Gambia, Brazil, Thailand, Algeria, and India, to greater than 13 per 100,000 in the United Kingdom, United States, Germany, and Scandinavia. In the United States, based on SEER (Surveillance, Epidemiology, and End Results (US National Cancer Institute)) data, the rate is 13.5 per 100,000 (2000–2004) [340]. Scandinavia has one of the highest annual incidence rates at greater than 16 per 100,000 women [337]. There has been little change in incidence over the past few decades with a few exceptions: in Korea, the age-standardized incidence increased by 25% from 3.8 to 4.7 per 100,000 from 1993 to 2002 [57], and over the same period, the incidence in Israel decreased by nearly one third from 9.6 to 6.6 per 100,000 [217]. The extent to which changes in diagnostic criteria or calculation methods may account for these changes is unclear. However, in the United States, changing the age-adjustment to the 2000 standard has artificially increased the incidence of ovarian cancer by about 20% [9]. In addition, the incidence of ovarian carcinoma appears to have decreased as peritoneal and tubal carcinomas have increased [110]. This may reflect a recent increase in the awareness of peritoneal and particularly tubal carcinomas among pathologists. Accordingly, relatively small changes in the incidence of ovarian carcinoma are probably due to these factors. Migration studies have shown that ovarian cancer rates approach those of the place of immigration rather than the place of emigration, suggesting a significant environmental component to ovarian cancer risk.