Journal of Oncology Translational Research

The challenge of early diagnosis of ovarian carcinoma

Abstract

Dr. Liane Deligdisch

Ovarian Carcinoma (OC) is the most lethal gynaecological tumour. While other female pelvic tumours such as uterine cervical cancer display a spectacular
decline due to identification of early stages and precursors, the incidence and mortality of OC remains about the same for the past five decades. The main
reason for this is the late clinical diagnosis in the majority of cases and the lack of reliable tumor markers for early stage neoplasms. The most common OC
is the Ovarian Serous Carcinoma (OSC) characterized by its lack of symptoms during the early stages. Less common OC, Endometrioid Carcinoma (EOC)
, Clear Cell and Mucinous Carcinomas (CCC and MC) become symptomatic in earlier stages due to symptoms outside the ovaries (pelvic masses, vaginal
bleeding, infertility, abdominal pain). Our clinical-pathologic studies revealed that Stage I OC confined to the ovary(ies) are diagnosed in less than one third
of OSC while the overall less common EOC, CCC and MC represent the majority of Stage I OC. Patients with OSC are older on average, are more often BRCA
positive and may have a personal /family history of breast cancer. Patients with EOC, CCC and MC are younger on average, have histories of infertility and/or
hyperestrogenism (endometrial polyps, hyperplasia, leiomyomas).. Patients with atypical endometriosis are at risk to develop EOC and CCC. Early diagnosis for
the more aggressive OSC is occasionally made due to more frequent medical exams because of family history or previous breast cancer.
Our study of Prophylactic salpingo-oophorectomy specimens by histologic, morphometric and molecular biology methods identified precursor/precancerous
lesions in the ovarian and fallopian tube epithelium (tubo-ovarian dysplasia) adjacent to invasive cancer and in patients at risk for OC. These findings are
shedding light into early ovarian carcinogenesis and may have implications in the choice of strategies for this still mostly elusive cancer.