Paradigm Shift in the Management Strategy for Epithelial Ovarian Cancer

Abstract

The hypothesis on the pathogenesis of epithelial ovarian cancer continues to evolve. Although epithelial ovarian cancer had been assumed to arise from the coelomic epithelium of the ovarian surface, it is now becoming clearer that the majority of serous carcinomas arise from epithelium of the distal fallopian tube, whereas clear cell and endometrioid cancers arise from endometriosis. Molecular and genomic characteristics of epithelial ovarian cancer have been extensively investigated. Our understanding of pathogenesis of the various histologic types of ovarian cancer have begun to inform changes to the strategies for management of epithelial ovarian cancer, which represent a paradigm shift not only for treatment but also for prevention, which previously had not been considered achievable. In this article, we will discuss novel attempts at the prevention of high-grade serous ovarian cancer and treatment strategies for two distinct entities in epithelial ovarian cancer: low-grade serous and clear cell ovarian carcinomas, which are relatively rare and resistant to conventional chemotherapy.

Epithelial ovarian cancer: Evolution of management in the era of precision medicine

“…Ovarian clear cell carcinoma (OCCC) represents approximately 5% of ovarian cancers in North America and Europe; it is more prevalent in Japan, where it tends to occur in almost 25% of all patients with EOC . Microscopically, OCCCs show combinations of tubules, solid areas, and complex papillae, and cells with prominent nucleoli and clear cytoplasm filled with glycogen.…”

“…Emerging evidence from an evaluation of 25 OCCC samples for gene expression changes and chromosomal instability suggests that OCCCs may cluster into 3 prognostic groups . Compared with HGSOCs, most OCCCs are characterized by considerably fewer CNAs, and mutations in TP53 and BRCA1 / BRCA2 genes are uncommon . Recently, a pilot study highlighted a unique subset of OCCCs that have microsatellite instability associated with enhanced immunogenicity, which may be susceptible to immunotherapy.…”

The Landscape and Therapeutic Implications of Molecular Profiles in Epithelial Ovarian Cancer

“…In another way, compared with high grade serous ovarian cancer, most clear-cell ovarian cancers are characterized by considerably fewer copy number alterations, and mutations in TP53 and BRCA1/BRCA2 genes are uncommon [ 51 ]. However, recently, a pilot study highlighted a unique subset of clear-cell ovarian cancer that have microsatellite instability associated with enhanced immunogenicity, which may be susceptible to immunotherapy.…”

LncSOX4 serves an oncogenic role in the tumorigenesis of epithelial ovarian cancer by promoting cell proliferation and inhibiting apoptosis

“…Epithelial ovarian cancer, as the commonest type of ovarian cancer, usually occurs in women >50 years old. Among all cancer types in female patients, ovarian cancer has the highest mortality rate, and the majority of patients with EOC are diagnosed at a late stage due to its nonspecific signs and symptoms ( 17 , 18 ). As a result, the 5-year survival rate of EOC is <30% ( 19 ).…”