Ovarian Cancer Lecture 1.doc

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Anatomy and Cell Biology
Anatomy and Cell Biology 4461B
Geordie Shepherd

TS Lecture 1: Introduction to Ovarian Cancer Ovarian Cancer: Etiology • Current Dogma: arises from the ovarian surface epithelium (OSE) • OSE: unspecialized single layer of cuboidal epithelial cells on the surface of the ovary Incessant Ovulation Theory: repeated proliferation and repair of the OSE after every ovula- • tion. Epithelium may be more apt to mutate with every ovulation Pituitary/gonadotropin Hypothesis: Normally, the surface epithelium invaginates and forms • inclusion cysts but overstimulation with gonadotropin might lead to metaplasia of epithelial cells within the microenvironment of the ovarian stroma • Alternative sources of epithelial ovarian cancer • Some types of ovarian tumors (high-grade serous) may rise from invasive lesions in the fimbria of the fallopian tubes • Endometriod and clear cell can sometimes be seen to arise from endometriod lesions • Some mucinous ovarian tumors may originate from the GI tract Heritability • More than 600 different mutations in BRCA1 and 450 different mutations in BRCA2 have been identified. This makes genetic screening difficult • Some populations (ex. French Canadians) have a higher frequency of certain mutations in BR- CA1 and BRCA2 due to the founder effect. Presence of few specific mutations make genetic screening easier. • Heritable disease is usually earlier in onset than sporadic disease Usually accompanied with a known breast/ovarian cancer in first/second degree relatives • • Usually has better prognosis than in women with sporadic disease Progression • Direct dissemination of cancer cells from the primary tumor into the peritoneal cavity • Adhesion of ovarian cancer cells onto serosal surfaces of organs with minimal invasion • Lymph node metastasis is less common • Development of ascites: fluid due to a combination of vascular leakage and lymphatic block- age Clinical Management • Stages II-IV are treated with surgery and chemotherapy (metastatic disease) • Stage
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