Endometriosis

Endometriosis, a common cause of pelvic pain, affects approximately 10% of reproductive-age females. Author Sawsan As-Sanie, MD, MPH, University of Michigan, discusses the epidemiology, pathophysiology, diagnosis, and treatment of endometriosis with JAMA Senior Editor Karen E. Lasser, MD, MPH.

Author/s:

Sawsan As-Sanie, Karen E. Lasser

What Is Ovarian Cancer?

Megan George — Fri, 05 Dec 2025 17:01:51 +0000

Date Added:

December 5, 2025

Journal/Publication:

JAMA

Publication Date:

December 4, 2025

URL:

What Is Ovarian Cancer?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jama.2025.18446

Keywords

MeSH

Poly(ADP-ribose) Polymerase Inhibitors

Carcinoma

Ovarian Epithelial

Minimally Invasive Surgical Procedures

Poly(ADP-ribose) Polymerases

Fallopian Tubes

Endometriosis

biopsy

Information for patients about ovarian cancer. James W. Mold, MD, MPH

View

Ovarian cancer is a malignancy of the ovary, the female reproductive organ that produces eggs.

How Common Is Ovarian Cancer?
Among women worldwide, ovarian cancer is the eighth most common malignancy and cause of cancer death. In 2022, ovarian cancer was diagnosed in about 325 000 individuals and caused 206 839 deaths worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 will die of it.1

What Are the Risk Factors for Ovarian Cancer?
Risk factors for ovarian cancer include older age (the most common age at diagnosis is 63 years), a family history of breast cancer or ovarian cancer, endometriosis (a chronic inflammatory disease in which uterine lining cells are found outside of the uterus), and never having given birth. About 25% of ovarian cancers are due to inherited genetic variants, primarily in BRCA1 and BRCA2 genes.

What Are the Symptoms of Ovarian Cancer?
At the time of diagnosis, most patients with ovarian cancer have symptoms such as abdominal pain, bloating, urgent or frequent urination, and/or increased abdominal size. Signs and symptoms of advanced ovarian cancer may include a mass in the abdominal area, weight loss, and trouble breathing due to abdominal swelling or from fluid surrounding the lungs.

How Is Ovarian Cancer Diagnosed and Staged?
Ovarian cancer is often diagnosed and staged based on findings from a pelvic ultrasound, abdominal computed tomography (CT) scan, and/or abdominal magnetic resonance imaging (MRI). Total-body positron emission tomography (PET) can detect cancer that has spread to more distant sites in the body. To help with staging, some patients may undergo diagnostic laparoscopy, a minimally invasive surgical procedure, in which clinicians look for a tumor within the abdomen and perform biopsies to assess for ovarian cancer.

Stage I ovarian cancer is limited to the ovary or fallopian tube. Stage II cancer has spread beyond the ovaries and fallopian tubes but is still confined within the pelvis. Stage III cancer involves sites outside the pelvis such as nearby lymph nodes or other areas of the abdomen. Stage IV cancer involves organs or tissues outside the abdominal cavity, such as the liver, spleen, or lungs.

How Is Ovarian Cancer Treated?
All patients diagnosed with ovarian cancer should undergo genetic testing, including for BRCA1/2 variants, to help guide treatment and counseling. First-line treatment for patients with early-stage (I and II) ovarian cancer is surgery, including removal of both ovaries and fallopian tubes, the uterus, lymph nodes, and fatty tissue covering the abdominal organs, followed by chemotherapy. Patients with stage I cancer who are considering having children may undergo more limited surgery with removal of the cancerous ovary and fallopian tube, leaving in place the other ovary and fallopian tube and the uterus.

Treatment for patients with stages III and IV (advanced) ovarian cancer includes both surgery and chemotherapy, often combined with individualized targeted therapies such as bevacizumab and/or poly–ADP ribose polymerase (PARP) inhibitors.

Prognosis After Treatment for Ovarian Cancer
Patients with stages I and II ovarian cancer have a 5-year overall survival rate of 70% to 95%. The 5-year overall rate for stages III and IV ovarian cancer is 10% to 40%. However, 5-year survival is about 70% among patients with advanced-stage ovarian cancer who have BRCA genetic variants and are treated with PARP inhibitors.

Author/s:

Rebecca Voelker

Ovarian Cancer: A Review

Megan George — Fri, 25 Jul 2025 13:29:18 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA

Publication Date:

July 21, 2025

URL:

Ovarian Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.9495

Keywords

Obstetrics and Gynecology

MeSH

Neoplasms, Glandular and Epithelial

Salpingo-oophorectomy

Lymph Node Excision

Chemotherapy, Adjuvant

Cytoreduction Surgical Procedures

A review of what we currently know about ovarian cancer. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

Importance: Ovarian cancer is the eighth most common cause of cancer and cancer death in women worldwide. In 2022, ovarian cancer was diagnosed in approximately 324 398 individuals, and 206 839 died of ovarian cancer worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 patients will die of ovarian cancer.

Observations: Approximately 90% of ovarian cancers are epithelial malignancies, of which 70% to 80% are high-grade serous ovarian cancers. Less common epithelial subtypes include endometrioid, clear cell, low-grade serous, mucinous, and carcinosarcoma. The median age at diagnosis of ovarian cancer is 63 years. Risk factors include older age, family history of breast or ovarian cancer, endometriosis, and nulliparity. Hereditary factors are associated with 25% of cases, predominantly linked to BRCA1/2 gene variants. At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses. Diagnostic and staging evaluation includes pelvic ultrasound; computed tomography of the chest, abdomen, and pelvis; and serum tumor markers such as carbohydrate antigen 125, carbohydrate antigen 19-9, and carcinoembryonic antigen. First-line treatment for early-stage ovarian cancer, defined as limited to the ovary or fallopian tube (stage I) or confined to the pelvis (stage II), is surgery (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy), followed by adjuvant chemotherapy (carboplatin and paclitaxel). With treatment, early-stage ovarian cancer has a 5-year overall survival of 70% to 95%. Advanced-stage ovarian cancer may be treated with primary cytoreductive surgery (removal of all visible cancer in the abdominal cavity) and adjuvant chemotherapy (carboplatin and paclitaxel) or with neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy. Most patients with advanced-stage ovarian cancer receive maintenance therapy with bevacizumab (a monoclonal antibody that blocks angiogenesis) and/or poly–adenosine diphosphate ribose polymerase (PARP) inhibitors. With treatment, the 5-year overall survival rate for advanced-stage ovarian cancer is 10% to 40%. However, individuals with BRCA-related gene variants have a 5-year overall survival rate of approximately 70% with PARP inhibitor treatment. Despite an initial remission rate of 80%, approximately 75% of patients with advanced-stage disease have ovarian cancer relapse within 2 years.

Conclusions and Relevance: Approximately 21 000 women are diagnosed with ovarian cancer annually in the US, and approximately 80% have advanced-stage ovarian cancer at diagnosis. First-line treatment of early-stage ovarian cancer is surgery and adjuvant platinum-based chemotherapy. Treatment of advanced-stage ovarian cancer includes cytoreductive surgery, platinum-based chemotherapy, and targeted maintenance therapies such as bevacizumab and/or PARP inhibitors.

Author/s:

Giuseppe Caruso, MD, S. John Weroha, MD, PhD, William Cliby, MD

Nonspecific Low Back Pain

Saige Blanchard — Tue, 10 May 2022 05:00:00 +0000

Date Added:

May 10, 2022

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

May 5, 2022

Issue:

Volume:

386

Pages:

1732-1740

URL:

Nonspecific Low Back Pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2032396

Keywords

back pain

Nonspecific Low Back Pain

MeSH

A review of what we think we know about non-specific low back pain. James W. Mold, MD, MPH

Free full text

View

Low back pain typically defined as pain below the costal margin and above the inferior gluteal folds with or without leg pain 1 is worldwide the most prevalent and most disabling of the conditions that are considered to benefit from rehabilitation 2 In a systematic review that included 165 studies from 54 countries the mean point prevalence of low back pain in the general adult population was approximately 12 with a higher prevalence among persons 40 years of age or older and among women the lifetime prevalence was approximately 40 3 Low back pain is classified as specific pain and other symptoms that are caused by specific pathophysiological mechanisms of nonspinal or spinal origin or nonspecific back pain with or without leg pain without a clear nociceptive-specific cause 4 Nonspinal causes of specific low back pain include hip conditions diseases of the pelvic organs e g prostatitis and endometriosis and vascular e g aortic aneurysm or systemic disorders spinal causes include herniated disk spinal stenosis fracture tumor infection and axial spondyloarthritis Lumbar disorders with radicular pain due to nerve-root involvement have a higher prevalence 5 to 10 than other spinal causes the two most frequent causes of such back pain are herniated disk and spinal stenosis 5 The overall prevalence of the other spinal disorders is low among patients with acute low back pain For example among 1172 patients who presented to primary care clinicians in Australia with acute low back pain only 11 0 9 were found to have serious spinal conditions mostly fractures during 1 year of follow-up 6 The authors of a Dutch study that involved primary care patients reported axial spondyloarthritis in almost one quarter of adults 20 to 45 years of age who presented with chronic low back pain 7 although these findings have not been replicated In contrast to low back pain caused by specific identifiable causes nonspecific low back pain probably develops from the interaction of biologic psychological and social factors 4 and it accounts for approximately 80 to 90 of all cases of low back pain 1 Low back pain is usually classified according to pain duration as acute 6 weeks subacute 6 to 12 weeks or chronic 12 weeks

Author/s:

Chiarotto, A., Koes, B. W.

Rethinking mechanisms, diagnosis and management of endometriosis

Devin Evans — Fri, 26 Feb 2021 06:00:00 +0000

Date Added:

February 26, 2021

Journal/Publication:

Nature Reviews Endocrinology

Publication Date:

September 5, 2020

Issue:

Volume:

Pages:

666-682

URL:

Rethinking mechanisms, diagnosis and management of endometriosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1038/s41574-019-0245-z

Keywords

PMID (1):

31488888

MeSH

Our understanding of endometriosis has evolved substantially over the last decade. This is a fairly recent review of the current conceptualization of this multi-system inflammatory disease. James W. Mold, MD, MPH

Free full text

View

Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.

Author/s:

Chapton, Charles, Marcellin, Louis, Borghese, Bruno, Santulli, Pietro