Risk Factors for Ovarian Cancer

Abstract

Ovarian cancers remain a perplexing group of diseases that continue to raise questions over their etiology and clinical behavior. They are the most fatal of gynecological cancers. Despite a global lifetime risk of only 1-2%, they contribute the highest mortality and the lowest 5-year (overall) survival rate of just 35%. The three broad histological groups: epithelial, sex cord-stromal and germ cell cancers have different biologic behavior and may constitute different clinical disease entities. Of the eight subtypes in the epithelial group, high-grade serous are universally the most common and have the worst prognosis. Globally making 65-85% of all ovarian cancers, most of the focus on risk factors has been directed on the epithelial group but the importance of other primary malignancies cannot be overemphasized as a step towards understanding their etiology and clinical behavior. The normal ovary has none of the epithelia that produce the range of epithelial ovarian cancers or there is an obvious premalignant stage, symptoms are very vague, screening and early diagnosis are difficult and indeed unrewarding. No specific etiology is known for any of the histologic groups. However, commonly mentioned risk factors like increasing age, genetics, nulliparity, prolonged infertility, use of fertility drugs, high animal fat, obesity, endometriosis, polycystic ovary syndrome, previous history of cancer, use of hormone replacement therapy, pelvic inflammatory disease and smoking may not apply to all the subtypes, while factors like increasing parity, breast feeding, use of oral contraceptive pills, hysterectomy, tubal ligation and use of antioxidants may differ in the degree of protection they provide. There may also be geographical and probably racial variations in the relevance of some of the risk factors. Thorough understanding of the predisposing and protective factors of the various histologic subtypes is an important step understanding the disease and therefore improving treatment outcome or providing effective prevention.

Utility of Matrix Metalloproteinases in the Diagnosis, Monitoring and Prognosis of Ovarian Cancer Patients

“…Hereditary ovarian and breast cancer syndrome is the most common. 27,34 Patients whose mother and/or sister(s) also suffer from ovarian cancer are particularly vulnerable. Interestingly, a family history of breast and uterine cancer in a mother or sister also increases a woman's likelihood of developing ovarian cancer.…”

“…Because endometrial lesions tend to become malignant, patients with endometriosis, especially those located within the ovaries, have a higher risk of developing ovarian cancer; this risk is 50% higher than in the general population. 34,54 Ovarian cancer in patients with endometriosis is known as endometriosis-associated ovarian cancer (EAOC). Histologically, the most common EAOC tumor types are clear cell, endometrioid, and low-grade serous carcinoma.…”

“…Because talc can be contaminated with carcinogens, such as asbestos and quartz, more research on the potential links between talc and the development of ovarian cancer is warranted. 34,73 Besides the factors that increase the risk of ovarian cancer, there are numerous protective factors, including tubal ligation, oral contraceptive use, and pregnancy. 5,34 Large studies have determined that tubal ligation reduces the risk of ovarian cancer.…”

“…It is also notable that ovarian cancer has a worse prognosis in older patients compared to younger patients, mainly due to less aggressive treatment approaches and higher disease stage at the time of diagnosis. 2,5,33,34…”

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“…Perlu dilakukan penelitian lebih lanjut agar dapat terungkap faktor-faktor yang mempengaruhi metastasis. 17 Berdasarkan hasil penelitian ini, terdapat hubungan antara NLR dengan kejadian metastasis intraperitoneal (lihat Tabel 5).…”