Ovarian Cancer Types
The term “ovarian cancer” is often used to describe cancers that start in the cells of the ovary, fallopian tube, or peritoneum. These cancers are closely linked and treated in the same way. When the term “ovarian cancer” is used, it includes both the fallopian tube cancer and peritoneal cancer, because the starting point of cancer may be unclear.
These types of cancer begin when healthy cells in these areas change and go out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, which means it can grow and spread to other parts of the body (metastasis). A benign tumor means that the tumor may develop but will not spread.
Ovarian cyst forms on the surface of the ovaries and may occur during a woman’s normal menstrual cycle and is usually removed without treatment. Simple ovarian cysts are not cancerous.
Studies and research suggest that most ovarian/fallopian cancers are high-grade serious carcinoma (HGSC) and in most cases, the cancer starts at the distal or outer end of the fallopian tubes and then spreads to the surface of the ovaries and beyond.
Because ovarian surfaces, fallopian tubes, and peritoneal cells share the same cell types, most of these cancers look-alike in the microscopes. Peritoneal cancer can develop even after the removal of the ovaries and fallopian tubes. As with ovarian cancer, some peritoneal cancers can start in the fallopian tube and spread from the tip of the fallopian tubes to the peritoneal cavity.
Types of ovarian and fallopian tube cancer
Epithelial carcinoma accounts for about 85% to 90% of ovarian/fallopian tube cancers. The main types of epithelial tumors include serous carcinoma, endometrioid carcinoma, clear cell carcinoma, mucosal carcinoma, mixed tumors, and some rare malignancies, including Brenner’s cancers and metastatic cancer.
There are differences in the behavior of these cancers and which treatments will work best.
The vast majority of epithelial cancers are serous carcinomas. These cancers are most often high-grade serous carcinoma.
Malignant tumors of the germ cells.
This unusual type of ovarian cancer develops in the cells that produce the ovarian eggs. Genital malignancies usually occur in women from the age of 10 to 29 years.
Types of genital tumors are dysgerminoma, immature teratoma, yolk sac tumors, and fetal carcinomas.
Ovarian layer malignancies.
This rare form of ovarian cancer develops in connective tissue cells, granular cells, and theca cells, which hold the ovaries. Over 90% of these stratified tumors are called granulocytic tumors, of the adult type or childhood type.
The cancer of the fallopian tube was once considered rare, but we now know that most cancers that had previously been identified as “ovarian cancer” actually begin in the fallopian tubes. Most cancers that occur in the fallopian tube begin at the outer end of the fallopian tube. Almost all of these are cancerous cancers and most of them are high-grade serious carcinomas.
The following factors may increase the risk of ovarian/fallopian tube cancer.
A strong family history of breast or ovarian/vaginal cancer puts women at a higher risk for ovarian cancer. Doctors believe this is due to the fact that many of these families carry genetic mutations (gene changes) that are transferred from generation to generation. If you are concerned that ovarian cancer may have occurred in your family, it is important to have an accurate family history, including breast cancer in the family. By understanding your family history, you and your doctor can take steps to reduce your risk and improve your health.
About 10% to 15% of ovarian/fallopian tube cancers occur because a genetic mutation or change has been transmitted within a family. A mutation in the BRCA1 or BRCA2 gene is associated with an increased risk of developing these cancers. A woman with an average risk has only a 1% to 2% risk of developing ovarian/fallopian tube cancer. A woman with a BRCA1 mutation has a 40% risk and a woman with a BRCA2 mutation has from 10% to 20% risk.
While less common, ovarian/fallopian tube cancers associated with mutations in the BRCA gene may also occur in women who do not have a family history of breast or ovarian cancer. About 40% of women with ovarian/fallopian tube cancer who have been found to have a BRCA mutation do not have a family history. Because of this, all women with ovarian/fallopian tube cancer who are under the age of 70 should be tested for mutations in the BRCA1 and BRCA2 genes, regardless of their family history.
There are several other genetic conditions that cause ovarian/fallopian tube cancer. Some of the most common include:
Lynch syndrome. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, increases the risk of ovarian/fallopian tube cancer and uterine cancer, colon cancer, and many other cancers.
Peutz-Jeghers Syndrome (PJS). PJS is caused by a specific genetic mutation. The syndrome is associated with many polyps in the digestive tract – which become non-cancerous tumors – and the appearance of pigment (dark spots on the skin) on the face and hands. The syndrome Peutz-Jeghers increases the risk of ovarian/fallopian tube cancer, breast cancer, colorectal cancer, and other cancers.
Nevoid Basal Cell Carcinoma Syndrome (NBCCS) syndrome. Women with NBCCS, which is also called Gorlin syndrome, have an increased risk of developing fibroids. Fibroids are benign fibrous tumors of the ovaries. There is a small risk that these viruses will develop into a type of ovarian cancer called fibrosarcoma.
Li-Fraumeni syndrome and ataxia-telangiectasia. Women with Li-Fraumeni syndrome or ataxia-telangiectasia have a slightly increased risk of developing ovarian cancer.
There may be other inherited syndromes associated with these types of cancer and research in this field is ongoing. Only genetic testing can determine if a woman has a genetic mutation.
A woman’s risk of developing ovarian/fallopian tube cancer increases in accordance with the age. Women of all ages are at risk for these cancers, but women over the age of 50 are more likely to develop malignancies. About half of women diagnosed with ovarian/fallopian tube cancer are 63 or older.
Recent studies show that women who were obese in early adulthood have an increased risk of developing ovarian/fallopian tube cancer.
When the internal lining of the uterus grows and develops outside the uterus, affecting other nearby organs, it is called endometriosis. This condition can cause many problems, but there is effective treatment. Researchers continue to study whether endometriosis is a risk factor for ovarian cancer.
Women from North America, northern Europe, or Ashkenazi Jewish race have an increased risk of ovarian cancer.
Women who have never had a child have unexplained infertility (inability to have children) and may have an increased risk of ovarian/fallopian tube cancer.
Hormone replacement therapy.
Women who had been treated with estrogen-only hormone replacement therapy (HRT) after menopause may be at higher risk for ovarian/fallopian tube cancer. The higher the risk, the higher the woman who uses the treatment. The risk decreases over time after the end of treatment.
For most types of cancer, a biopsy is the only sure way for a doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for histological examination conducted in a pathological laboratory.
This list describes options for diagnosing the type of cancer. Not all of the tests listed below are used for every person. Your doctor will look at the following factors while choosing a diagnostic test:
The type of cancer suspected
Your age and general health
The results of previous medical examinations
While early detection and treatment are important, this is often not possible for ovarian/fallopian tube cancer. There are no effective early detection methods. Often, women have no symptoms until the tumor has grown or when the cancer is metastasizing. About 70% of ovarian/fallopian tube cancers are diagnosed when the cancer is advanced and has spread to other parts of the body, most commonly the abdomen.
It is a medical procedure in which the peritoneal fluid that has been collected/created in the person’s abdomen is removed. This accumulation of fluid is called ascites. A sample of the fluid is examined under a microscope for the presence of cancer (see “Biopsy” below).
A biopsy is the removal of a small amount of tissue for microscopic examination by a pathologist (histological examination). The pathologist is the doctor who specializes in interpreting and evaluating cells, tissues, and organs in order to diagnose diseases.
Ovarian / fallopian tube cancer biopsies are often conducted during the first surgery. During surgery, doctors remove as much of the tumor as possible. A tumor sample will be analyzed by the pathologist after the operation. Based on the histological examination of the tumor, the pathologist will make the final diagnosis.
Additional diagnostic techniques:
Biochemical testing, CA125 levels in blood serum
Axial and magnetic resonance imaging
Ovarian / fallopian tube cancer is usually difficult to find in the early stages. This is because the symptoms are often vague until cancer progresses further.
It is possible that women with ovarian/fallopian tube cancer may have no symptoms. It is also important to note that the symptoms are non-specific and can be caused by a different medical condition that is not cancer.
Symptoms of ovarian/fallopian tube cancer may include:
Gastric or abdominal pain
Difficulty in feeding or feeling full quickly
Urinary symptoms, such as an urgent need to urinate or frequent urination
Pain during intercourse
Swelling in the pelvis or abdomen
Targeted treatment for ovarian cancer
The targeted therapy is a therapy that targets specific genes, cancer proteins, or the tumor’s microenvironment which contributes to the growth and survival of cancer. This type of treatment prevents the growth and spread of cancer cells while limiting damage to healthy cells.
Recent studies show that not all cancers have the same goals. In order to find the most effective treatment, your doctor may perform tests to identify genes, proteins, and other factors in your tumor. This helps doctors better treat each patient with the most effective treatment whenever possible. In addition, a lot of research is being done to find out more about specific molecular targets and new treatments for cancer.
For ovarian/fallopian tube cancer, some targeted therapies are directed at specific genes in specific types of ovarian cancer. Typical chemotherapy has been shown to be effective in treating most ovarian/fallopian tube cancers. Typically, high-grade serious carcinoma has mutations in TP53 gene and about 20% have mutations in the BRCA genes.
Mutations in the BRCA gene, even if it is only in the tumor and not in the blood, can increase the effectiveness of certain classes of drugs, such as poly-ADP-ribose polymerase inhibitors (PARP inhibitors).
Other less common types of ovarian/fallopian tube cancers include low-grade cancer, endometrioid cancer, interstitial cancer, and mucosal cancer. These tumors have a variety of mutations, including mutations in KRAS, BRAF, PI3KCA, and PTEN genes, which means that there may be targeted treatment. Clinical trials studying these mutations are ongoing.
PARP inhibitors block an enzyme involved in restoring damaged DNA. By blocking this enzyme, DNA within cancer cells may be less likely to be repaired, leading to cell death and possibly slowing or stopping tumor growth. The BRCA genes (BRCA1 and BRCA2) are normally involved in DNA repair and a mutation in these genes interferes with this pathway function. The PARP inhibitors render difficult the growth and division of cells that otherwise have a BRCA mutation.
Frequently Asked Questions (FAQ)
According to the NCCN’s (National Comprehensive Cancer Network), patients with invasive ovarian cancer (serous, non-mucosal carcinomas, high-grade serious carcinoma) carrying mutations in BRCA1 & BRCA2 genes have been shown to have improved prognosis and anticipation in chemotherapy in respect of diagnosed with ovarian cancer without mutations in BRCA1 & BRCA2 genes. More specifically, these patients show:
- higher 5-year survival rates
- higher Progression-Free Survival
- better response to chemotherapy than patients with ovarian cancer without mutations in BRCA1 & BRCA2 genes
The SomArray Ovarian is conducted on the biopsy material or lumpectomy (paraffin block) on which your histology examination has been conducted.
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