Ovarian Cancer: An Overview of Introduction, Types, Pathogenesis

Introduction

Table of Contents

Ovarian cancer is a malignant tumor arising from ovarian tissues and is a leading cause of gynecologic cancer–related mortality worldwide. It is often called a “silent killer” because early-stage disease is frequently asymptomatic, resulting in late diagnosis and poorer outcomes.

Types of Ovarian Cancer

Ovarian cancers are classified based on the cell of origin:

Epithelial Ovarian Cancer (≈90%)
- Serous (high-grade, low-grade)
- Mucinous
- Endometrioid
- Clear cell
Germ Cell Tumors
- Dysgerminoma
- Yolk sac tumor
- Teratoma
Sex Cord–Stromal Tumors
- Granulosa cell tumor
- Thecoma, fibroma

Pathogenesis

Originates from ovarian surface epithelium, fallopian tube epithelium, or germ/stromal cells
Accumulation of genetic alterations:
- BRCA1/BRCA2 mutations
- TP53 mutations (especially high-grade serous carcinoma)
Chronic ovulation → repeated epithelial injury and repair
Hormonal influences and inflammatory microenvironment promote malignant transformation
Tumor spreads by peritoneal seeding, lymphatics, and hematogenous routes

Laboratory Diagnosis

1. Tumor Markers

CA-125 – most commonly used (not specific)
HE4
AFP, β-hCG, LDH (germ cell tumors)
Inhibin A/B (sex cord–stromal tumors)

2. Imaging

Pelvic ultrasound (first-line)
CT scan / MRI for staging
PET-CT for metastasis evaluation

3. Histopathology

Biopsy or surgical specimen examination
Immunohistochemistry (IHC) for tumor typing

4. Molecular Testing

BRCA mutation testing
HRD (Homologous recombination deficiency) analysis

Treatment

1. Surgery

Primary debulking surgery (total hysterectomy + bilateral salpingo-oophorectomy)
Optimal cytoreduction improves survival

2. Chemotherapy

Platinum-based regimens (Carboplatin + Paclitaxel)
Neoadjuvant or adjuvant chemotherapy

3. Targeted Therapy

PARP inhibitors (e.g., for BRCA-mutated tumors)
Anti-angiogenic agents (Bevacizumab)

4. Radiotherapy

Limited role; mainly palliative

Prevention

Genetic counseling and BRCA testing for high-risk women
Prophylactic salpingo-oophorectomy in BRCA mutation carriers
Oral contraceptive use (reduces risk)
Early evaluation of persistent pelvic or abdominal symptoms
Regular follow-up in high-risk individuals

Keynotes

Ovarian cancer is often diagnosed late due to nonspecific symptoms.
Epithelial tumors are the most common.
CA-125 is useful for monitoring, not screening.
Surgery plus chemotherapy is the mainstay of treatment.
Genetic testing guides personalized therapy.
Early detection significantly improves prognosis.

Ovarian Cancer: An Overview of Introduction, Types, Pathogenesis, Lab Diagnosis, Treatment, Prevention, and Keynotes