Ovarian tumors
Ovarian cancer accounts for 6% of
all female cancers; it is the fifth
most common cancer in women in
the US (excluding skin cancer) and it
is the 3rd most common cause of
death by cancer. The most common
ovarian cancer, serous high grade
carcinoma is very aggressive and
requires combination therapy with surgery and chemo (and biological drugs). Mean age
of insurgence of ovarian cancer is 40-50 years. Notice that for ovarian tumors, we may
have benign and malignant tumors but also intermediate or borderline neoplasms.
Risk factors
- Nulliparity: higher frequency of carcinoma in unmarried women and in married
women with low parity → these women have menstrual cycles with trauma of the
surface epithelium of the ovary1 every month for about 40 years. Unbalance
between estrogen and progesterone may be a cause of ovarian cancer e.g. for the
endometrioid variant, but not for high grade serous carcinoma that is largely
genetically determined.
- Family history: 5-10% ovarian cancers are familial → BRCA1 and BRCA2
mutations increase susceptibility, with 16% women having cancer by age 70;
Lynch syndrome also increases risk.
Protective factors include prolonged use of oral contraceptives.
Symptoms: ovarian masses don’t give symptoms unless they’re advanced. That’s
because the ovary is an anatomical structure that gives the mass space to grow. So,
usually the symptoms are also aspecific:
- lower abdominal/pelvic weight;
- the real symptom linked to ovarian tumor is ascites, that is a sign of advanced
cancer because is a sign of metastatization to the liver.
Screening: there is not a proper screening for ovarian cancer, as it is for cervical or breast
cancers, for example. This means that the most important screening is to go to the
gynecologist at least once every 3 years (also because a fraction of these tumors affects
younger women in their 30s 40s). Tumors are in fact detected upon gynecological
examination or through imaging (US or CT).
Classification (WHO) of ovarian cancers
The first classification of ovarian cancer is between primary and secondary (metastatic).
1. Surface epithelial cells (surface epithelial-stromal cell tumors)
a. 65-70% ovarian tumors
b. 90% are malignant
1
The ovary has a monolayer of cuboidal epithelium on its surface, similar to peritoneum
, c. Age group affected: 20 years and above.
d. Types: Serous tumor (low and high grade), mucinous tumor, endometrioid,
clear cell, Brenner, cystadenofibroma
2. Germ cell tumors
a. 15-20% ovarian tumors
b. 3-5% malignant
c. 0-25+ years
d. Types: teratoma or dermoid cyst (most frequent ovarian cystic tumor in
young women), dysgerminoma, endodermal sinus tumor,
choriocarcinoma
3. Sex cord-stromal cell tumors
a. 5-10% ovarian tumors
b. 2-3% malignant
c. Types: fibroma, granulosa-tehca cell tumor, sertoli-leydig cell tumor
4. Metastasis to ovaries
a. 5% ovarian tumors
b. 100% malignant
Surface epithelial cell tumors
Surface epithelial tumors mostly arise from the Müllerian epithelium. The
classification of these tumors is based on both differentiation and extent of proliferation
of the epithelium. The 3 major histologic types based on the differentiation of the
neoplastic epithelium are: serous, mucinous and endometroid tumors. These epithelial
proliferations are classified as:
- Benign: often further subclassified based on the components of the tumors:
o Cystadenoma: if it includes cystic areas;
o Cystadenofibroma: if it includes cystic and fibrous areas
o Adenofibroma: if it includes predominantly fibrous areas.
- Borderline: those tumors of indeterminate malignancy; indeed, they have
metastatic potential (present some features of cytological or architectural atypia),
but they don’t infiltrate the underlying stroma.
- Malignant:
o Cystoadenocarcinoma:
when they have also a
cystic component.
These tumors can be relatively small or
can grow to fill the entire pelvis before
they are detected.
Epithelial ovarian tumors may come from:
- the endometrium (from
endometriosis) → endometrioid
carcinoma and clear cell
carcinoma
Ovarian cancer accounts for 6% of
all female cancers; it is the fifth
most common cancer in women in
the US (excluding skin cancer) and it
is the 3rd most common cause of
death by cancer. The most common
ovarian cancer, serous high grade
carcinoma is very aggressive and
requires combination therapy with surgery and chemo (and biological drugs). Mean age
of insurgence of ovarian cancer is 40-50 years. Notice that for ovarian tumors, we may
have benign and malignant tumors but also intermediate or borderline neoplasms.
Risk factors
- Nulliparity: higher frequency of carcinoma in unmarried women and in married
women with low parity → these women have menstrual cycles with trauma of the
surface epithelium of the ovary1 every month for about 40 years. Unbalance
between estrogen and progesterone may be a cause of ovarian cancer e.g. for the
endometrioid variant, but not for high grade serous carcinoma that is largely
genetically determined.
- Family history: 5-10% ovarian cancers are familial → BRCA1 and BRCA2
mutations increase susceptibility, with 16% women having cancer by age 70;
Lynch syndrome also increases risk.
Protective factors include prolonged use of oral contraceptives.
Symptoms: ovarian masses don’t give symptoms unless they’re advanced. That’s
because the ovary is an anatomical structure that gives the mass space to grow. So,
usually the symptoms are also aspecific:
- lower abdominal/pelvic weight;
- the real symptom linked to ovarian tumor is ascites, that is a sign of advanced
cancer because is a sign of metastatization to the liver.
Screening: there is not a proper screening for ovarian cancer, as it is for cervical or breast
cancers, for example. This means that the most important screening is to go to the
gynecologist at least once every 3 years (also because a fraction of these tumors affects
younger women in their 30s 40s). Tumors are in fact detected upon gynecological
examination or through imaging (US or CT).
Classification (WHO) of ovarian cancers
The first classification of ovarian cancer is between primary and secondary (metastatic).
1. Surface epithelial cells (surface epithelial-stromal cell tumors)
a. 65-70% ovarian tumors
b. 90% are malignant
1
The ovary has a monolayer of cuboidal epithelium on its surface, similar to peritoneum
, c. Age group affected: 20 years and above.
d. Types: Serous tumor (low and high grade), mucinous tumor, endometrioid,
clear cell, Brenner, cystadenofibroma
2. Germ cell tumors
a. 15-20% ovarian tumors
b. 3-5% malignant
c. 0-25+ years
d. Types: teratoma or dermoid cyst (most frequent ovarian cystic tumor in
young women), dysgerminoma, endodermal sinus tumor,
choriocarcinoma
3. Sex cord-stromal cell tumors
a. 5-10% ovarian tumors
b. 2-3% malignant
c. Types: fibroma, granulosa-tehca cell tumor, sertoli-leydig cell tumor
4. Metastasis to ovaries
a. 5% ovarian tumors
b. 100% malignant
Surface epithelial cell tumors
Surface epithelial tumors mostly arise from the Müllerian epithelium. The
classification of these tumors is based on both differentiation and extent of proliferation
of the epithelium. The 3 major histologic types based on the differentiation of the
neoplastic epithelium are: serous, mucinous and endometroid tumors. These epithelial
proliferations are classified as:
- Benign: often further subclassified based on the components of the tumors:
o Cystadenoma: if it includes cystic areas;
o Cystadenofibroma: if it includes cystic and fibrous areas
o Adenofibroma: if it includes predominantly fibrous areas.
- Borderline: those tumors of indeterminate malignancy; indeed, they have
metastatic potential (present some features of cytological or architectural atypia),
but they don’t infiltrate the underlying stroma.
- Malignant:
o Cystoadenocarcinoma:
when they have also a
cystic component.
These tumors can be relatively small or
can grow to fill the entire pelvis before
they are detected.
Epithelial ovarian tumors may come from:
- the endometrium (from
endometriosis) → endometrioid
carcinoma and clear cell
carcinoma
