Ovarian cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Huda A. Karman, M.D.
Overview
Ovarian cancer is a malignant tumor, of any histology, on or within an ovary. Because many ovarian tumors are benign but have the potential to become malignant, a broad definition of ovarian cancer includes all ovarian tumors, malignant and benign. Epithelial ovarian carcinoma is considered as one entity that includes ovarian cancer, fallopian tube cancer, and peritoneal cancer because they share similar behavior and clinical characteristics. Usually they are diagnosed as an ovarian mass (primary ovarian cancer) with tubal extension and/or peritoneal metastasis and in the absence of ovarian mass, peritoneal carcinoma. The first link between many ovarian and breast cancers and the single gene on chromosome 17 was described first by Dr. King in 1990. Dr. King named the genes as BRCA1 and BRCA2 in 1991 and 1994 consequently. Evidence have shown that epithelial ovarian cancer has three possible sites of origin, tubal, and other Mullerian epithelial pelvic origins as endometriosis or endosalpingiosis. The understanding of the pathogenesis of ovarian cancer has been progressed throughout the years. The types of ovarian cancer are classified based on the origin of the primary mass and based on the histological findings. Neoplasms with ovarian origin are described histologically as endometrioid, mucinous, clear cell, low-grade serous carcinomas and borderline neoplasms. Two hypothesis developed regarding the origin of primary ovarian cancer, endometriosis or Müllerian inclusion cysts. Ovarian cancer causes are not fully known but there are some theories suggest that inflammatory cytokines play a role in transforming the ovarian epithelium with repeated ovulations. Another theory relates the ovarian epithelium injury to the direct effect of persistent gonadotrophin release. Risk factors of ovarian cancer include age, hormonal and reproductive factors as infertility, genetic factors as BRCA gene mutations and Lynch syndrome, and environmental factors as smoking and asbestos. Ovarian cancer is unfortunately usually diagnosed in its late stages. Symptoms and signs if present can include palpable adnexal mass, bloating, urinary urgency and frequency, early satiety, pelvic or abdominal pain, or weight loss. Definitive diagnosis can only be made by the surgical exploration of the tumor, it origin and extent, metastasis, and its histological characteristics. Ovarian cancer treatment depends on stage and grade classification of the tumor and also on the functioning level of the patient. Management can be only surgery (stage IA & IB), adjuvant chemotherapy (stages with high risk features), or neoadjuvant chemotherapy if the tumor is unresectable or the patient is in poor condition. Drugs that are used for ovarian cancer are doxorubicin, paclitaxel, and bevacizumab. Gemcitabine and topotecan are also used for recurrent cases.