Immunohistochemical Expression of Human Epididymis 4 (He4) in Ovarian Serous Carcinoma in Hospital Serdang from the Year 2006- 2013

Abstract

Incidence and demography of ovarian cancer: Ovarian cancer is neither a common nor a rare disease. It is the fifth most common cause of cancer death in women worldwide and is the leading cause of death from gynaecological cancer in the western countries [1]. In 2004, about 25,580 women was diagnosed with ovarian cancer (OC) in United States and 16.090 (62%) died from the disease [2]. This owes mainly to presentation with advanced-stage disease (International Federation of Gynecology and Obstetrics [FIGO] stage III-IV) due to late symptoms and the lack of effective screening for early disease, as well as increasing chemoresistance along with tumor progression.In Malaysia, ovarian cancer is the fourth leading cause of cancer related deaths and the fifth commonest cause of cancer in women. According to the National Cancer Registry (NCR) 2007, about 658 cases of ovarian cancer diagnosed in 2007 accounted for 6.5% of all female cancer cases (i.e. gynaecological and breast cancers). Out of 426 cases reported, 52% were diagnosed at stage III and IV that is characterized by intraperitoneal spread and distant metastasis. According to the World Health Organization (WHO), ovarian cancer are classified based on histological types, because it is an important surrogate for genetic, prognostic, and, increasingly, predictive information about the response to treatment [3]. This classification categorizes ovarian cancer with regards to their derivation from coelomic surface epithelial cells, germ cells and mesenchyme (the stroma and the sex cord). The malignant epithelial tumor, is the most common group, accounting for 90% of total ovarian cancer. The four most common subtypes of OC are serous, endometrioid, clear cell and mucinous [4]. Among the OC, ovarian serous carcinoma (OSC) is the most common subtypes. General clinical features:Ovarian cancer generally affects women in postmenopausal state with a peak between 55 and 65 years old. At the time of diagnosis, three quarters of patients have locally advanced (FIGO Stage III) or disseminated disease that is characterized by diffuse intraperitoneal spread and/or ascites. FIGO Stage III tumors characteristically metastasize widely within the abdominal cavity, as evidenced by the presence of both solid nodules on the peritoneum and malignant ascites. The symptoms of ovarian carcinoma is non-specific and similar to those seen in other benign condition. This is the possible reason for the delayed seeking of medical attention. The early symptoms include abdominal distension (bloating, increased abdominal size), pelvic and/or abdominal pain, problems with eating (loss of appetite, feeling full quickly), and frequent urination [5]. Based on the study done by Brain, et al. [5], the most well-identified symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were identified by less than of half the sample. The Human Epididymis 4 (HE4) gene ...