Ovarian Cancer
Peter, Cate, Joanna, Sheema
Demographics of Ovarian Cancer
About 22,000 women diagnosed yearly
o 1 in 72 women will get in her lifetime
Older women are more at risk
o 1/2 of women diagnosed are over 63
Survival rate much lower than other types of cancer that
affect women
o (44.3% 5 year survival rating)
Risk Factors:
a family history of ovarian or breast cancer
having had cancer
never having been pregnant
obesity
infertility
Components of Female Reproductive System
Gonads: Ovaries
Reproductive Tract: Uterus, Uterine
Tubes/Fallopian tubes, Vagina
External Genitalia (vulva): labia majora, labia
minora, clitorus, barthollins glands
Components of Female Reproductive System
Ovaries
Definition:
-Ovum-producing reproductive organ.
-Females contain two almond shaped ovaries.
-Suspended by ligaments from the pelvic girdle
-Located in the Ovarian Fossa: alongside the lateral wall of
the uterus
Ovaries
Normal Functioning: Produce ovum, through process
called Oogenesis.
-Also produce estrogen and progesterone
Overview of Cancer
Cancer can be caused by:
Genetic Changes
Genomic Amplification
Point Mutations
Translocations
Overview of Cancer Continued...
What are
Tumors?
Carcinogenesis?
Metastasis?
Types of Ovarian Cancer
-3 major types of tumors
1. Epithelial (most common)
2. Germ cell
3. Sex-cord stromal (least
common)
Stages of Ovarian Cancer
-4 Main Stages:
Stage 1- Growth limited to ovaries
Stage 2- Growth in one or both ovaries
Stage 3- Growth has spread to pelvic and peritoneal
cavity
Stage 4- Tumor has spread to liver
Pathology of Epithelial Ovarian Cancer
Epithelial ovarian cancer composed of 2
types of tumors
1. Type I
2. Type II
Type I Tumors
Indolent (cause little pain)
Present at early stage
Includes low-grade serous, endometrioid,
and clear cell mucinous carcinomas
Involves mutations in KRAS, BRAF, and
ERBB2 genes
Type II Tumors
Diagnosed as high-grade serous,
endometrioid and undifferentiated
carcinomas
Highly aggressive
Present at advanced stage
Involves mutations in TP53 gene
Carcinogenesis
3 sites of potential origin
1. Ovarian surface epithelium
2. Fallopian tube epithelium
3. Mesothelium covering surface of
peritoneal cavity
Incessant Ovulation Theory
This theory postulates that surface
epithelium give rise to carcinoma
Frequent rupture and repair of ovarian
follicle increase likelihood of genetic
alterations of surface epithelium
These genetic alterations contribute to
formation of malignant tumors
Metastasis
Ovarian carcinoma cells undergo epithelialto-mesenchymal transition (EMT)
o
o
The molecule E-cadherin loosens the intercellular
adhesion between cancer cells
This causes up-regulation of N and P cadherin,
which causes cells to become invasive and proliferate
Metastasis
Ovarian cancer cells then detach from
primary tumor as single cells or clusters
Cells then spread to peritoneum and
omentum through peritoneal fluid
Cells interact with mesothelial cells covering
basement membrane
Metastasis
Cells then undergo mesenchymal-to-epithelial
transition
o Allows them to respond to paracrine growth factors
and rapidly proliferate
This is accomplished through various integrin proteins
o Up-regulate MMP-2 gene, which cleaves fibronectin
and vitronectin into smaller fragments
o Cancer cells adhere more strongly to these smaller
fragments
Symptoms
bloating
pelvic or abdominal pain
low appetite
urinary symptoms
menstrual changes
pain during sex
Diagnosis
pelvic exam
Imaging
ultrasound
CT
Blood test
Biopsy
Prognosis
Ovarian Cancer Stage and Corresponding
Relative 5-year Survival Rates for Invasive
Epithelial Ovarian Cancer
Stage
Relative 5-year Survival Rate
85-94%
II
70-78%
III
39-59%
IV
17%
Treatments
Four types:
Surgery
Radiation
Chemotherapy
Targeted
May be used together for aggressive cancers
Treatments-Surgery
Hysterectomy
Partial: Uterus
Total: Uterus and Cervix
Oophorectemy
Unilateral or Bilateral
Omentectomy
Useful for early stages and isolated tumors
Treatments-Radiation
External Radiation Therapy
Machine
Internal Radiation Therapy
Sealed Radioactive Substance
Intraperitoneal Radiation Therapy
Radioactive liquid
Dependent on stage and type
Treatments-Chemotherapy
Mechanism: killing cells or inhibiting
division
Systemic
Oral or injection
Regional
Intraperitoneal
Combination
Dependant on stage and type
Treatments-Targeted
Mechanism: identification and attack of
specific cells
Monoclonal antibody
Given by infusion
Can carry drugs, toxins, or radioactive material
Often used with chemotherapy
The End
Any questions?
Source
"OVARIAN CANCER: Types of Ovarian Cancer." OVARIAN CANCER: Types of Ovarian
Cancer. Johns Hopkins Pathology, 18 Oct. 2001. Web. 20 May 2015.
Lengyel, Ernst. "Ovarian Cancer Development and Metastasis." The American Journal of
Pathology 177.3 (2010): 1053-064. NCBI. Web. 23 May 2015.
Fox, Stuart Ira. Human Physiology. Dubuque, IA: Wm. C. Brown, 1996. Print.
http://www.plannedparenthood.org/learn/womens-health/ovarian-cancer#sthash.07mu2Z8I.dpuf
http://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq#section/_156
http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-survival-rates
http://www.webmd.com/sex-relationships/guide/your-guide-female-reproductive-system
http://www.news-medical.net/health/Cancer-Pathophysiology.aspx
http://medical-dictionary.thefreedictionary.com/carcinogenesis
