A study of the prevalence of different ovarian tumors and complications after surgery in patients diagnosed by histopathology biopsy at University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus

A study of the prevalence of different ovarian tumors and complications after surgery in patients diagnosed by histopathology biopsy at University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A study of the prevalence of different ovarian tumors and complications after surgery in patients diagnosed by histopathology biopsy at University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus Waed Zidan, Wafaa Mhmad Jrad, Diaa Jihad Al-Saeed, Diaa Haj Ali, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6206807/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the globe. Also, It is the fifth most common cause of death in females all over the world. Often, complex surgery will be needed harbouring the risk of severe postoperative complications. These postoperative complications may delay adjuvant therapy and therefore have a bad impact on survival. Research Materials and Methods: Our study aims to shed light on the prevalence of ovarian cancer and the incidence of different types of complications through patients attending the University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus. A retrospective cohort study (COHORT) was conducted on a random group of patients from January 2022 to December 2024. Results: The sample included 290 female patients who suffered from different ovarian cancer types and were diagnosed by histopathology biopsy and treated surgically. It was found that the peak incidence of ovarian cancer is between the ages of 50 and 59 with a percentage of 35.17%. The most common tumors were the epithelial tumors 264 (91%), followed by secondary ovarian tumors 16 (5.5%), furthermore, the Most common sites of primary tumors identified so far are from the breast and colon. Conclusion: epithelial tumors are the most frequent. The findings confirm that most cases are diagnosed at advanced stages (III and IV), necessitating radical treatment. Additionally, postoperative complications were observed in 9% of cases, with mortality within 28 days being the most common. Obstetrics & Gynecology ovarian tumors complications histopathology biopsy Background Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the globe.[ 1 ] Also, It is the fifth most common cause of death in females all over the world, for its high rate of mortality among patients suffering from it.[ 2 ] The WHO has classified ovarian cancer into the following types: 1) Epithelial tumors, 2) Mesenchymal tumors, 3) Mixed epithelial and mesenchymal tumors, 4) Sex-cord stromal tumors, 5) Germ cell tumors, 6)Miscellaneous tumors, 7)Tumor-like lesions.[ 3 ] furthermore, Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis.[ 1 ] The diagnosis is made by vaginal ultrasound and a biomarker known as CA-125, but those two methods have failed to prevent the high rates of deaths caused by OC. [ 4 ] The first-line treatment for OC is primary debulking surgery (PDS), followed by adjuvant chemotherapy and, in selected cases, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).[ 5 ] The surgical objective is to maximize the number of patients achieving complete tumor removal (cytoreduction), decrease surgical complications, and potentially reduce short-time mortality/morbidity.[ 6 – 8 ] Often, complex surgery will be needed harbouring the risk of severe postoperative complications.[ 9 ] however, The most common major complications are ascites (28%), bowel obstruction (12%), pleural effusion (10%), and bladder obstruction (3%). Disorders of nutrition were indicated in the medical literature with various descriptions, from "loss of appetite" to intensive interventions such as parenteral nutrition (9%).[ 10 ] Finally, These postoperative complications may delay adjuvant therapy and therefore have a bad impact on survival.[ 11 ] Research Materials and Methods Aim of our study Our study aims to shed light on the prevalence of ovarian cancer and the incidence of different types of complications through patients attending the University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus. Study design, setting, and participants A retrospective cohort study (COHORT) was conducted on a random group of patients from January 2022 to December 2024. The research approval was given by the Ethics Committee of the Faculty of Medicine, Al-Sham Private University, Damascus, Syria. A paper survey was conducted based on a review of patient files in the hospital's medical records department and extracted the information and data necessary to complete our study. In our study, We classified the founded ovarian tumors among our sample according to the WHO classification (2020) [3] into five types (Epithelial tumors, Germ cell tumors, Sex-cord stromal tumors, Mesenchymal tumors, and secondary tumors). Accordingly, the survey was filled out and the data was reviewed under the supervision of the research supervisor. Every participant has signed the informed consent. Inclusion criteria patients between 15 - 85 years old patients attended to University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus only ovarian cancer patients diagnosed by histopathology of tumor biopsy and treated surgically Exclusion criteria ovarian cancer patients diagnosed by CT-scan, Eco Ultrasound, CA-125 Biomarker Patients under 15 years old or older than 85 years old Ethics approval and consent to participate Ethical approval was obtained from the Ethical Committee of the Al-Sham Private University, the necessary approval was provided to University Obstetrics and Gynecology Hospital and Al-Zahrawi hospital in Damascus, and permission was obtained from both hospitals to review patients’ files. Statistical Analysis: We used Excel 2010, and the Statistical Package for the Social Sciences version 26.0 (SPSS Inc., Chicago, IL, United States). Results 1- sample distribution among age groups The sample included 290 female patients who suffered from different ovarian cancer types and were diagnosed by histopathology biopsy and treated surgically. Participants are classified into eight groups according to age (Table 1). It was found that the peak incidence of ovarian cancer is between the ages of 50 and 59 with a percentage of 35.17%, followed by the age group from 60 to 69 years 22.06%, while the lowest incidence rates of ovarian cancer are in the age groups from 80 to 85 and from 15 to 19 years with a percentage of 1.37% for each. Table 1: participants' classification according to age. Age n % 15 - 19 4 1.37 % 20 - 29 22 7.58 % 30 - 39 18 6.2 % 40 - 49 54 18.62 % 50 - 59 102 35.17 % 60 - 69 64 22.06 % 70 - 79 22 7.58 % 80 - 85 4 1.37 % 2- distribution of ovarian cancer among sample individuals according to its type We classified the founded ovarian tumors among our sample into five types (Epithelial tumors, Germ cell tumors, Sex-cord stromal tumors, Mesenchymal tumors, and secondary to another tumor), and We found that the most common tumors were epithelial tumors 264 (91%), followed by secondary ovarian tumor 16 (5.5%). (Table 2) shows the number of patients with each major ovarian cancer type and the percentage it represents of the entire sample. Table 2: distribution of ovarian cancer among sample individuals Ovarian cancer type N % Epithelial tumors 264 91 % Germ cell tumors 8 2.8 % Sex-cord stromal tumors 2 0.7 % Mesenchymal tumors 0 0 secondary to another tumor 16 5.5 % serous tumors were the most common epithelial tumor 126 (47.7% of epithelial tumor), followed by Mucinous tumors 22.7% , and endometroid tumors 12.9% (Table 3). Furthermore, Teratoma was the predominant germ cell tumor, accounting for 50% of all germ cell tumors. Finally, the Most common sites of primary tumors identified so far are from the breast and colon. Table 3: distribution of ovarian cancer among sample individuals according to its sub-types Epithelial tumors N % Serous tumors 126 47.7 % Mucinous tumors 60 22.7 % Endometrioid tumors 34 12.9 % Undifferentiated and dedifferentiated carcinoma 24 9.1 % Clear cell tumors 18 6.8 % Adenocarcinoma 2 0.8 % Brenner tumors 0 0 % Carcinosarcoma 0 0 % Total 264 100 % Germ cells tumor N % Teratoma 4 50 % Dysgerminoma 2 25 % Endodermal sinus tumor (Yolk sac tumor) 2 25 % Embryonal carcinoma 0 0 % Choriocarcinoma 0 0 % Gonadoblastoma 0 0 % Total 8 Sex-cord stromal tumors N % Adult granulosa cell tumor 2 100 % Thecoma 0 0 % Sertoli-Leydig cell tumor 0 0 % Lipid cell tumor 0 0 % Fibroma 0 0 % Total 2 100 % Secondary tumors N % Breast 6 33.3 % Colon 6 33.3 % Stomach 2 11.1 % Lymphoma 2 11.1 % Endometrial 0 0 % Total 18 100 % 3- distribution of the sample according to tumor stage Frozen sections were examined by histopathology during and after surgery to determine the tumor stage. We noticed that 162 (56%) of patients had advanced stage III and IV tumors and needed radical treatment (Table 4). Table 4: distribution of the sample according to tumor stage Stage N % Stage I 34 12 % Stage II 22 8 % Stage III 164 56 % Stage IV 70 24 % Total 290 100 % 4- morbidity and major complications after surgical management The incidence of severe complications for patients who underwent surgery was 26 patients, 9% of our sample. The most common serious complication was death within 28 days after surgery, with 10 cases out of 26 cases, followed by pulmonary embolism, with 6 cases (Table 5). Table 5: morbidity and major complications after surgical management Complication N Death within 28 day 10 Embolism 6 Fistula 2 Severe bleeding 2 Intestinal obstriction 2 Schizophrenia 2 Suicide 2 Total 26 Discussion We compared the results of our study with the studies of the National Cancer Institute, the American Cancer Society, and the National Center for Health Statistics.[12] The age group with the highest incidence of ovarian cancer was higher than our study, as it showed that it affects women aged 65 years and older, with a rate of 45% of all ovarian cancers. On the other hand, It agreed with our study, as they showed that epithelial ovarian cancer is the most common type of ovarian cancer. Also, It agreed with our study that 70% of cases are diagnosed in advanced stages III and IV. We also compared the complications after surgery with a study that occurred in the southwestern part of the Netherlands [13]. The number of patients included in the study was greater than our study and for a longer follow-up period, as it included 2434 patients for a period of 17 years from 1989-2005, while our study included 145 patients for three years 2022-2024. additionally, We observed death within 30 days in the Dutch study of about 76 patients out of 2434 at a rate of 3.1%, This is a rate close to our study, where the rate was 5%. Finally, pulmonary complications incidence in the Dutch study is higher, as it showed 18% of patients suffering from pulmonary embolism, while in our study it showed only 3%. As for the rest of the complications of severe bleeding, fistulas, intestinal and psychological complications, they were not studied in the Dutch study Limitations - A large number of files and the lack of sufficient information for study hindered the process of collecting cases - There are difficulties in accessing some files of patients admitted to cardiac care - Some files do not include complete clinical tests, which created difficulty in selecting the files included. Conclusion Our study highlights the prevalence and distribution of ovarian cancer types among patients at two hospitals in Damascus, emphasizing that epithelial tumors are the most frequent. The findings confirm that most cases are diagnosed at advanced stages (III and IV), necessitating radical treatment. Additionally, postoperative complications were observed in 9% of cases, with mortality within 28 days being the most common. These results align with global data, reinforcing the need for early detection strategies and improved surgical management to enhance patient outcomes. Declarations Acknowledgments None Availability of data and materials All authors have read and approved the final version of the manuscript. The Corresponding author had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis. Competing of Interest The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References Mueller JJ, Zhou QC, Iasonos A et al (2016) Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center. Gynecol Oncol 140(3):436–442. 10.1016/j.ygyno.2016.01.008 Zamwar UM, Anjankar AP, Aetiology (2022) Epidemiology, Histopathology, Classification, Detailed Evaluation, and Treatment of Ovarian Cancer. Cureus 14(10):e30561 Published 2022 Oct 21. 10.7759/cureus.30561 Adhikari L, Hassell LA WHO classification. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumorwhoclassif.html . Accessed March 6th, 2025 Development of new medical treatment for epithelial ovarian cancer recurrence, Mancari R, Cutillo G, Bruno V et al (2020) Gland Surg 9:1149–1163. 10.21037/gs-20-413 Wright AA, Bohlke K, Armstrong DK et al (2016) Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of clinical oncology clinical practice guideline. J Clin Oncol 34:3460–3473 Kehoe S, Hook J, Nankivell M et al (2015) Primary chemotherapy vs primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 386:249–257 Kobal B, Noventa M, Cvjeticanin B et al (2018) Primary debulking surgery vs primary neoadjuvant chemotherapy for high grade advanced stage ovarian cancer: comparison of survivals. Radiol Oncol 52:307–319 Chiofalo B, Bruni S, Certelli C, Sperduti I, Baiocco E, Vizza E (2019) Primary debulking surgery vs. interval debulking surgery for advanced ovarian cancer: review of the literature and meta-analysis. Minerva Med 110:330–340 Koscielny A, Ko A, Egger EK, Kuhn W, Kalff JC, Keyver-Paik MD (2019) Prevention of anastomotic leakage in ovarian cancer debulking surgery and its impact on overall survival. Anticancer Res 39(9): 5209–5218, PMID: 31519635. 10.21873/anticanres.13718 Herrinton LJ, Neslund-Dudas C, Rolnick SJ et al (2007) Complications at the end of life in ovarian cancer. J Pain Symptom Manage 34(3):237–243. 10.1016/j.jpainsymman.2006.11.011 Grimm C, Harter P, Alesina PF, Prader S, Schneider S, Ataseven B, Meier B, Brunkhorst V, Hinrichs J, Kurzeder C, Heitz F, Kahl A, Traut A, Groeben HT, Walz M, du Bois A (2017) The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery. Gynecol Oncol 146(3):498–503 PMID: 28610745. 10.1016/j.ygyno. 2017.06.007 Yancik R (1993) Ovarian cancer. Age contrasts in incidence, histology, disease stage at diagnosis, and mortality. Cancer 71(2 Suppl):517–523. 10.1002/cncr.2820710205 Gerestein CG, Damhuis RA, de Vries M, Reedijk A, Burger CW, Kooi GS (2009) Causes of postoperative mortality after surgery for ovarian cancer. Eur J Cancer 45(16):2799–2803. 10.1016/j.ejca.2009.06.004 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6206807","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":427472141,"identity":"a509108e-2daa-4d09-8f7f-007357c50159","order_by":0,"name":"Waed Zidan","email":"","orcid":"","institution":"6th year Student, Faculty of Medicine, Al-Sham Private University, Damascus, Syria.","correspondingAuthor":false,"prefix":"","firstName":"Waed","middleName":"","lastName":"Zidan","suffix":""},{"id":427472142,"identity":"e2624212-c0c6-4457-bf39-5a1609474515","order_by":1,"name":"Wafaa Mhmad Jrad","email":"","orcid":"","institution":"6th year 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high rate of mortality among patients suffering from it.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe WHO has classified ovarian cancer into the following types: 1) Epithelial tumors, 2) Mesenchymal tumors, 3) Mixed epithelial and mesenchymal tumors, 4) Sex-cord stromal tumors, 5) Germ cell tumors, 6)Miscellaneous tumors, 7)Tumor-like lesions.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] furthermore, Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe diagnosis is made by vaginal ultrasound and a biomarker known as CA-125, but those two methods have failed to prevent the high rates of deaths caused by OC. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe first-line treatment for OC is primary debulking surgery (PDS), followed by adjuvant chemotherapy and, in selected cases, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] The surgical objective is to maximize the number of patients achieving complete tumor removal (cytoreduction), decrease surgical complications, and potentially reduce short-time mortality/morbidity.[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOften, complex surgery will be needed harbouring the risk of severe postoperative complications.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] however, The most common major complications are ascites (28%), bowel obstruction (12%), pleural effusion (10%), and bladder obstruction (3%). Disorders of nutrition were indicated in the medical literature with various descriptions, from \"loss of appetite\" to intensive interventions such as parenteral nutrition (9%).[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFinally, These postoperative complications may delay adjuvant therapy and therefore have a bad impact on survival.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e"},{"header":"Research Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eAim of our study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study aims to shed light on the prevalence of ovarian cancer and the incidence of different types of complications through patients attending\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethe University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design, setting, and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective cohort study (COHORT) was conducted on a random group of patients from January 2022 to December 2024. The research approval was given by the Ethics Committee of the Faculty of Medicine, Al-Sham Private University, Damascus, Syria.\u003c/p\u003e\n\u003cp\u003eA paper survey was conducted based on a review of patient files in the hospital\u0026apos;s medical records department and extracted the information and data necessary to complete our study.\u003c/p\u003e\n\u003cp\u003eIn our study, We classified the founded ovarian tumors among our sample according to the WHO classification (2020) [3] into five types (Epithelial tumors, Germ cell tumors, Sex-cord stromal tumors, Mesenchymal tumors, and secondary tumors).\u003c/p\u003e\n\u003cp\u003eAccordingly, the survey was filled out and the data was reviewed under the supervision of the research supervisor.\u003c/p\u003e\n\u003cp\u003eEvery participant has signed the informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003epatients between 15 - 85 years old\u003c/li\u003e\n \u003cli\u003epatients attended to University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus\u003c/li\u003e\n \u003cli\u003eonly ovarian cancer patients diagnosed by histopathology of tumor biopsy and treated surgically\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eovarian cancer patients diagnosed by CT-scan, Eco Ultrasound, CA-125 Biomarker\u003c/li\u003e\n \u003cli\u003ePatients under 15 years old or older than 85 years old\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Committee of the Al-Sham Private University, the necessary approval was provided to University Obstetrics and Gynecology Hospital and Al-Zahrawi hospital in Damascus, and permission was obtained from both hospitals to review patients\u0026rsquo; files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used Excel 2010, and the Statistical Package for the Social Sciences version 26.0 (SPSS Inc., Chicago, IL, United States).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1- sample distribution among age groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample included 290 female patients who suffered from different ovarian cancer types and were diagnosed by histopathology biopsy and treated surgically.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants are classified into\u0026nbsp;eight groups according to age (Table 1). It was found that the peak incidence of ovarian cancer is between the ages of 50 and 59 with a percentage of 35.17%, followed by the age group from 60 to 69 years 22.06%, while the lowest incidence rates of ovarian cancer are in the age groups from 80 to 85 and from 15 to 19 years with a percentage of 1.37% for each.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eparticipants\u0026apos; classification according to age.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e15 - 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e1.37 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e20 - 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e7.58 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e30 - 39\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e6.2 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e40 - 49\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e18.62 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e50 - 59\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e35.17 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e60 - 69\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e22.06 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e70 - 79\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e7.58 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.0952%;\"\u003e\n \u003cp\u003e80 - 85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.4286%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e1.37 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edistribution of ovarian cancer among sample individuals according to its type\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe classified the founded ovarian tumors among our sample into five types (Epithelial tumors, Germ cell tumors, Sex-cord stromal tumors, Mesenchymal tumors, and secondary to another tumor), and We found that the most common tumors were epithelial tumors 264 (91%), followed by secondary ovarian tumor 16 (5.5%). (Table 2) shows the number of patients with each major ovarian cancer type and the percentage it represents of the entire sample.\u003c/p\u003e\n\u003cp\u003eTable 2: distribution of ovarian cancer among sample individuals\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOvarian cancer type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEpithelial tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e91 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eGerm cell tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2.8 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eSex-cord stromal tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.7 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMesenchymal tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003esecondary to another tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e5.5 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eserous tumors were the most common epithelial tumor 126 (47.7% of epithelial tumor), followed by Mucinous tumors 22.7% , and endometroid tumors 12.9%\u0026nbsp;(Table 3). Furthermore, Teratoma was the predominant germ cell tumor, accounting for 50% of all germ cell tumors.\u003c/p\u003e\n\u003cp\u003eFinally, the Most common sites of primary tumors identified so far are from the breast and colon.\u003c/p\u003e\n\u003cp\u003eTable 3: distribution of ovarian cancer among sample individuals according to its sub-types\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpithelial tumors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eSerous tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e47.7 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMucinous tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e22.7 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEndometrioid tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eUndifferentiated and dedifferentiated carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e9.1 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eClear cell tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e6.8 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAdenocarcinoma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.8 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eBrenner tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eCarcinosarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGerm cells tumor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTeratoma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e50 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eDysgerminoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEndodermal sinus tumor (Yolk sac tumor)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEmbryonal carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eChoriocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eGonadoblastoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex-cord stromal tumors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAdult granulosa cell tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eThecoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eSertoli-Leydig cell tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eLipid cell tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eFibroma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary tumors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eBreast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e33.3 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eColon\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e33.3 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eStomach\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e11.1 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eLymphoma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e11.1 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEndometrial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edistribution of the sample according to tumor stage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrozen sections were examined by histopathology during and after surgery to determine the tumor stage. We noticed that 162 (56%) of patients had advanced stage III and IV tumors and needed radical treatment (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: distribution of the sample according to tumor stage\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eStage I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eStage II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eStage III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e56 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eStage IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e24 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4-\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003emorbidity and major complications after surgical management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of severe complications for patients who underwent surgery was 26 patients, 9% of our sample. The most common serious complication was death within 28 days after surgery, with 10 cases out of 26 cases, followed by pulmonary embolism, with 6 cases (Table 5).\u003c/p\u003e\n\u003cp\u003eTable 5: morbidity and major complications after surgical management\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eDeath within 28 day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eEmbolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eFistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSevere bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eIntestinal obstriction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSchizophrenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSuicide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe compared the results of our study with the studies of the National Cancer Institute, the American Cancer Society, and the National Center for Health Statistics.[12] The age group with the highest incidence of ovarian cancer was higher than our study, as it showed that it affects women aged 65 years and older, with a rate of 45% of all ovarian cancers. On the other hand, It agreed with our study, as they showed that epithelial ovarian cancer is the most common type of ovarian cancer. Also, It agreed with our study that 70% of cases are diagnosed in advanced stages III and IV.\u003c/p\u003e\n\u003cp\u003eWe also compared the complications after surgery with a study that occurred in the southwestern part of the Netherlands [13]. The number of patients included in the study was greater than our study and for a longer follow-up period, as it included 2434 patients for a period of 17 years from \u0026nbsp;1989-2005, while our study included 145 patients for three years 2022-2024. additionally, We observed death within 30 days in the Dutch study of about 76 patients out of 2434 at a rate of 3.1%, This is a rate close to our study, where the rate was 5%. Finally, pulmonary complications incidence in the Dutch study is higher, as it showed 18% of patients suffering from pulmonary embolism, while in our study it showed only 3%.\u003c/p\u003e\n\u003cp\u003eAs for the rest of the complications of severe bleeding, fistulas, intestinal and psychological complications, they were not studied in the Dutch study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- A large number of files and the lack of sufficient information for study hindered the process of collecting cases\u003c/p\u003e\n\u003cp\u003e- There are difficulties in accessing some files of patients admitted to cardiac care\u003c/p\u003e\n\u003cp\u003e- Some files do not include complete clinical tests, which created difficulty in selecting the files included.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlights the prevalence and distribution of ovarian cancer types among patients at two hospitals in Damascus, emphasizing that epithelial tumors are the most frequent. The findings confirm that most cases are diagnosed at advanced stages (III and IV), necessitating radical treatment. Additionally, postoperative complications were observed in 9% of cases, with mortality within 28 days being the most common. These results align with global data, reinforcing the need for early detection strategies and improved surgical management to enhance patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final version of the manuscript. The Corresponding author had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMueller JJ, Zhou QC, Iasonos A et al (2016) Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center. 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Eur J Cancer 45(16):2799\u0026ndash;2803. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejca.2009.06.004\u003c/span\u003e\u003cspan address=\"10.1016/j.ejca.2009.06.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ovarian tumors, complications, histopathology biopsy","lastPublishedDoi":"10.21203/rs.3.rs-6206807/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6206807/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eOvarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the globe. Also, It is the fifth most common cause of death in females all over the world.\u003c/p\u003e\n\u003cp\u003eOften, complex surgery will be needed harbouring the risk of severe postoperative complications. These postoperative complications may delay adjuvant therapy and therefore have a bad impact on survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Materials and Methods: \u003c/strong\u003eOur study aims to shed light on the prevalence of ovarian cancer and the incidence of different types of complications through patients attending\u003cstrong\u003e \u003c/strong\u003ethe University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus. A retrospective cohort study (COHORT) was conducted on a random group of patients from January 2022 to December 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe sample included 290 female patients who suffered from different ovarian cancer types and were diagnosed by histopathology biopsy and treated surgically.\u003c/p\u003e\n\u003cp\u003eIt was found that the peak incidence of ovarian cancer is between the ages of 50 and 59 with a percentage of 35.17%. The most common tumors were the epithelial tumors 264 (91%), followed by secondary ovarian tumors 16 (5.5%), furthermore, the Most common sites of primary tumors identified so far are from the breast and colon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eepithelial tumors are the most frequent. The findings confirm that most cases are diagnosed at advanced stages (III and IV), necessitating radical treatment. Additionally, postoperative complications were observed in 9% of cases, with mortality within 28 days being the most common.\u003c/p\u003e","manuscriptTitle":"A study of the prevalence of different ovarian tumors and complications after surgery in patients diagnosed by histopathology biopsy at University Obstetrics and Gynecology Hospital and Al-Zahrawi Hospital in Damascus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-13 05:08:27","doi":"10.21203/rs.3.rs-6206807/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"01de3161-c0b4-48dd-af25-c81ffa72db47","owner":[],"postedDate":"March 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45546800,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2025-03-13T05:08:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-13 05:08:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6206807","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6206807","identity":"rs-6206807","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}