Epithelial Ovarian, Fallopian Tube, and Peritoneal Cancer

Abstract

Overview Ovarian cancer is one of the most treatable solid tumors, as the majority will respond temporarily to surgery and cytotoxic agents. The disease, however, frequently persists and recurs in 70% of cases, having the highest fatality‐to‐case ratio of all the gynecologic cancers. Ovarian cancer is neither a common nor a rare disease, with a lifetime risk of 1 in 70 and a prevalence in the postmenopausal population in the United States of 1 in 2500, which impact strategies for early detection and prevention. Germ line mutations of BRCA1 and BRCA2 are associated with 10–15% of ovarian cancers and increase the risk of ovarian cancer dramatically. Factors that contribute to persistent ovulation increase the risk in women with sporadic disease, whereas use of oral contraceptives decreases the risk of disease post menopause. While epithelial ovarian cancers have been thought to arise from the ovarian surface epithelium or in the lining of inclusion cysts beneath the ovarian surface, many high‐grade serous “ovarian” carcinomas as well as peritoneal cancers are now believed to arise in the fimbriae of fallopian tube, rather than the ovary or peritoneum. Epithelial ovarian cancers can exhibit serous, endometrioid, mucinous, or clear cell histotypes. Low‐grade type I ovarian cancers grow slowly, can evolve from tumors of low malignant potential, bear Ras mutations in a majority of cases, express wild type TP53, often are detected in early stage (I–II), and respond less frequently to platinum‐ and taxane‐based therapy. High‐grade type II ovarian cancers grow rapidly, arise from precursors with TP53 mutations, are driven by DNA copy number changes, are diagnosed in late stage (III–IV), and frequently respond to combination chemotherapy. Owing to a lack of specific symptoms or an effective screening strategy, more than 70% of ovarian cancers are diagnosed in an advanced stage (III–IV). Primary treatment of epithelial ovarian cancer involves cytoreductive surgery and 6–8 cycles of carboplatin and paclitaxel. For those women with small volumes of disease after surgery, intraperitoneal administration of chemotherapy improves survival. Recurrent disease cannot be cured with currently available agents, but survival can be prolonged with combinations of cytotoxic agents including retreatment with paclitaxel and carboplatin. Palliative agents include liposomal doxorubicin, gemcitabine, topotecan, bevacizumab, pemetrexed, and etoposide. Experimental therapy for low‐grade cancers involves MEK inhibitors, whereas trials of PI3K pathway inhibitors and PARP inhibitors are underway in patients with high‐grade epithelial ovarian cancers. Combinations of targeted agents will be required.

Comparison of Intra Operative Cytology and Frozen Section with Permanent Pathologic Results in Ovarian Masses

“…It accounts for 4% of all female cancers and 31% of cancers of the female genital tract. Ovarian cancer is the 4th most common cause of death from malignancy in women (2). Almost it can be said that, the ovarian cancer has the widest pathologic variety between gynecological cancers and each pathology has a significant effect on the extent of surgery and follow up.…”

A Current Method in Gynecological Cancer Prediction: 'Micronucleus': Review

“…About 10% of the reported cases of ovarian cancer are genetically acquired. 15 Cervical cancer mostly affects the lower part of the uterus, just the spot where it joins with the vagina. Cervical cancer used to be the commonest gynecologic cancer across the globe.…”

“…The commonest examples are: endometrial cancer, ovarian cancer and cervical cancer, while the less common ones are: Fallopian tube, vulva, vagina, uterine wall (sarcoma) and placenta (pregnancy tissue: molar pregnancy). [14][15][16] The most occurring gynecologic cancer is endometrial cancer. Studies have shown that the disease will affect about 2% to 3% of women.…”

Retrospective study of clinico-pathological features of ovarian tumors

“…Benign masses are seen in premenopausal and majority of malignant masses are seen in postmenopausal women. 1 Ovarian carcinomas represents 6 th most common cancer in the females and 4 th leading cause of cancer death in women. 2 Symptoms may include abdominal pain, fatigue, bloating, constipation, urinary symptoms, weight loss etc.…”