DRG Category: 737

Mean LOS: 6.8 days

Description SURGICAL: Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with CC

DRG Category: 755

Mean LOS: 5.5 days

Description MEDICAL: Malignancy, Female Reproductive System with CC

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Ovarian cancer is the primary cause of death from reproductive system malignancies in women. The American Cancer Society estimated that in 2008 in the United States, 26,650 new cases of ovarian cancer were diagnosed. Survival rate at 1 year is 77% and at 5 years is 44%. Only 19% of the cases are diagnosed before metastasis has occurred. Because of the lack of early detection and the rapid progression of the disease, the number of deaths caused by ovarian cancer has risen. No long-term improvement in the survival rate has occurred in the past 30 years.

Three types of ovarian cancers exist owing to the three types of tissue in the ovary: primary epithelial tumors, germ cell tumors, and gonadal stromal (sex cord) tumors. Primary epithelial tumors comprise approximately 90% of all ovarian cancers and include serous and mucinous cystadenocarcinomas, endometrioid tumors, and mesonephric tumors. They arise in the ovarian epithelium (known as müllerian epithelium). Germ cell tumors, which arise from an ovum, include endodermal sinus malignant tumors, embryonal carcinoma, immature teratomas, and dysgerminoma. Sex cord tumors, which arise from the ovarian stroma (the foundational support tissues of an organ), include granulosa cell tumors, thecomas, and arrhenoblastomas.

Because of the location of the ovaries in the abdominal cavity, ovarian cancers grow and spread silently until they affect the surrounding organs or cause abdominal distention. At the appearance of these symptoms, metastases to the fallopian tubes, uterus, ligaments, and other intraperitoneal organs occur. Tumors can spread through the lymph system and blood into the chest cavity.

As the disease progresses, the patient experiences multiple system complications. Peripheral edema, ascites, and intestinal obstruction can complicate the course of the disease. Patients develop severe nutritional deficiencies, electrolyte disturbances, and cachexia. If the lungs are involved, the patient develops malignant recurrent pleural effusions.