Ovarian Epithelial Cancer
Disease Details
Family Health Simplified
- Description
- Ovarian epithelial cancer is a malignant tumor arising from the outer layer of cells covering the ovary, often presenting with vague abdominal symptoms and commonly diagnosed at an advanced stage.
- Type
- Ovarian epithelial cancer is a type of cancer that begins in the layer of cells that cover the ovaries. It is primarily sporadic, but about 10-15% of cases are hereditary, often linked to mutations in BRCA1 or BRCA2 genes. The inheritance of these mutations follows an autosomal dominant pattern.
- Signs And Symptoms
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Ovarian epithelial cancer, which originates on the surface of the ovary, can have subtle signs and symptoms, particularly in the early stages. Common symptoms may include:
1. Abdominal bloating or swelling.
2. Quickly feeling full when eating.
3. Weight loss.
4. Discomfort in the pelvic area.
5. Changes in bowel habits, such as constipation.
6. Frequent need to urinate.
If any of these symptoms are persistent or worsen, it is important to consult a healthcare provider for further evaluation. Early detection can improve treatment outcomes. - Prognosis
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Ovarian cancer usually has a relatively poor prognosis. It is disproportionately deadly because it lacks any clear early detection or screening test, meaning most cases are not diagnosed until they have reached advanced stages.Ovarian cancer metastasizes early in its development, often before it has been diagnosed. High-grade tumors metastasize more readily than low-grade tumors. Typically, tumor cells begin to metastasize by growing in the peritoneal cavity. More than 60% of women presenting with ovarian cancer have stage-III or stage-IV cancer, when it has already spread beyond the ovaries. Ovarian cancers shed cells into the naturally occurring fluid within the abdominal cavity. These cells can then implant on other abdominal (peritoneal) structures, including the uterus, urinary bladder, bowel, lining of the bowel wall, and omentum, forming new tumor growths before cancer is even suspected.
The five-year survival rate for all stages of ovarian cancer is 46%; the one-year survival rate is 72% and the ten-year survival rate is 35%. For cases where a diagnosis is made early in the disease, when the cancer is still confined to the primary site, the five-year survival rate is 92.7%. About 70% of women with advanced disease respond to initial treatment, most of whom attain complete remission, but half of these women experience a recurrence 1–4 years after treatment. Brain metastasis is more common in stage III/IV cancer but can still occur in cancers staged at I/II. People with brain metastases survive a median of 8.2 months, though surgery, chemotherapy, and whole brain radiation therapy can improve survival.Ovarian cancer survival varies significantly with subtype. Dysgerminomas have a very favorable prognosis. In early stages, they have a five-year survival rate of 96.9%. Around two-thirds of dysgerminomas are diagnosed at stage I. Stage-III dysgerminomas have a five-year survival of 61%; when treated with BEP chemotherapy after incomplete surgical removal, dysgerminomas have a 95% two-year survival rate. Sex-cord-stromal malignancies also have a favorable prognosis; because they are slow-growing, even those with metastatic disease can survive a decade or more. Low malignant potential tumors usually only have a bad prognosis when there are invasive tumor implants found in the peritoneal cavity.Complications of ovarian cancer can include spread of the cancer to other organs, progressive function loss of various organs, ascites, and intestinal obstructions, which can be fatal. Intestinal obstructions in multiple sites are the most common proximate cause of death. Intestinal obstruction in ovarian cancer can either be a true obstruction, where tumor blocks the intestinal lumen, or a pseudo-obstruction, when tumor prevents normal peristalsis. Continuous accumulation of ascites can be treated by placing a drain that can be self-drained. - Onset
- Ovarian epithelial cancer generally occurs in postmenopausal women, with the majority of cases diagnosed in women aged 50 to 70. It has a subtle onset, often with nonspecific symptoms such as abdominal bloating, pelvic pain, difficulty eating, and urinary frequency. The exact trigger for the malignant transformation of epithelial cells in the ovaries is not fully understood, but factors like genetics (BRCA1 and BRCA2 mutations), hormone replacement therapy, and family history can increase risk.
- Prevalence
- Ovarian epithelial cancer is one of the most common types of ovarian cancer, and it generally occurs in women aged over 50. Approximately 1 in 78 women are estimated to develop ovarian cancer in their lifetime, which translates to a lifetime risk of about 1.3%. The exact prevalence can vary depending on population and geographic location.
- Epidemiology
- Globally, in 2018, the incidence of ovarian cancer was 6.6 per 100,000 and mortality was 3.9. Globally, about 160,000 people died from ovarian cancer in 2010. This was an increase from 113,000 in 1990. The number of new cases per year in Europe is approximately 5–15 per 100,000 women. In Europe, Lithuania, Latvia, Ireland, Slovakia, and the Czech Republic have the highest incidences of ovarian cancer, whereas Portugal and Cyprus have the lowest incidences. In 2008, the five-year survival rate was 44%. This has increased since 1977 when the survival rate was 36%.
- Intractability
- Ovarian epithelial cancer can be challenging to treat, especially if diagnosed at an advanced stage. While it is not entirely intractable, its management often requires a combination of surgery, chemotherapy, and sometimes targeted therapy. Early detection significantly improves prognosis, but many cases are diagnosed later due to nonspecific symptoms. Advances in treatments continue to enhance survival rates, but complete eradication can be difficult in advanced stages.
- Disease Severity
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Ovarian epithelial cancer is a serious and potentially life-threatening disease. The severity of the disease often depends on the stage at which it is diagnosed:
1. **Stage I**: Cancer is confined to one or both ovaries. It's generally the least severe stage.
2. **Stage II**: Cancer has spread to other pelvic tissues. Severity increases as treatment becomes more complex.
3. **Stage III**: Cancer has spread to the abdominal lining or lymph nodes. This stage is more severe and can be challenging to treat.
4. **Stage IV**: Cancer has spread to distant organs like the liver or lungs. This is the most severe stage with the poorest prognosis.
The overall survival rate decreases significantly with higher stages, emphasizing the importance of early detection and treatment. The severity is influenced by the cancer's spread, patient's overall health, and response to treatment. - Healthcare Professionals
- Disease Ontology ID - DOID:4001
- Pathophysiology
- Ovarian cancer forms when errors in normal ovarian cell growth occur. Usually, when cells grow old or get damaged, they die, and new cells take their place. Cancer starts when new cells form unneeded, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called an ovarian tumor or growth. These abnormal cancer cells have many genetic abnormalities that cause them to grow excessively. When an ovary releases an egg, the egg follicle bursts open and becomes the corpus luteum. This structure needs to be repaired by dividing cells in the ovary. Continuous ovulation for a long time means more repair of the ovary by dividing cells, which can acquire mutations in each division.Overall, the most common gene mutations in ovarian cancer occur in NF1, BRCA1, BRCA2, and CDK12. Type I ovarian cancers, which tend to be less aggressive, tend to have microsatellite instability in several genes, including both oncogenes (most notably BRAF and KRAS) and tumor suppressors (most notably PTEN). The most common mutations in Type I cancers are KRAS, BRAF, ERBB2, PTEN, PIK3CA, and ARID1A. Type II cancers, the more aggressive type, have different genes mutated, including p53, BRCA1, and BRCA2. Low-grade cancers tend to have mutations in KRAS, whereas cancers of any grade that develop from low malignant potential tumors tend to have mutations in p53. Type I cancers tend to develop from precursor lesions, whereas Type II cancers can develop from a serous tubal intraepithelial carcinoma. Serous cancers that have BRCA mutations also inevitably have p53 mutations, indicating that the removal of both functional genes is important for cancer to develop.In 50% of high-grade serous cancers, homologous recombination DNA repair is dysfunctional, as are the notch and FOXM1 signaling pathways. They also almost always have p53 mutations. Other than this, mutations in high-grade serous carcinoma are hard to characterize beyond their high degree of genomic instability. BRCA1 and BRCA2 are essential for homologous recombination DNA repair, and germline mutations in these genes are found in about 15% of women with ovarian cancer. The most common mutations in BRCA1 and BRCA2 are the frameshift mutations that originated in a small founding population of Ashkenazi Jews.Almost 100% of rare mucinous carcinomas have mutations in KRAS and amplifications of ERBB2 (also known as Her2/neu). Overall, 20% of ovarian cancers have mutations in Her2/neu.Serous carcinomas may develop from serous tubal intraepithelial carcinoma, rather than developing spontaneously from ovarian tissue. Other carcinomas develop from cortical inclusion cysts, which are groups of epithelial ovarian cells inside the stroma.
- Carrier Status
- Carrier status for ovarian epithelial cancer is often associated with genetic mutations, particularly in the BRCA1 and BRCA2 genes. Individuals carrying these mutations have a significantly increased risk of developing ovarian epithelial cancer, as well as breast cancer. Genetic testing can determine whether a person carries mutations in these genes and assess their risk.
- Mechanism
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Ovarian epithelial cancer is the most common type of ovarian cancer, originating in the cells on the surface of the ovary.
**Mechanism:**
The exact mechanism of ovarian epithelial cancer development is not fully understood, but it generally involves the uncontrolled growth and division of cells on the ovary's surface. Mutations in these cells can lead to malignant transformation, where the cells gain the ability to invade surrounding tissues and metastasize to distant organs.
**Molecular Mechanisms:**
1. **Genetic Mutations:** Key mutations in certain genes are implicated in ovarian epithelial cancer. Mutations in BRCA1 and BRCA2 significantly increase the risk of developing the disease. Additionally, mutations in TP53, which codes for the tumor suppressor protein p53, are found in over 90% of cases of high-grade serous carcinoma, the most common type of ovarian epithelial cancer.
2. **PI3K/AKT Pathway:** Dysregulation of the PI3K/AKT signaling pathway is common, leading to increased cell proliferation and survival. Mutations or amplifications in components like PIK3CA and AKT can drive oncogenesis.
3. **RAS/MAPK Pathway:** Alterations in the RAS-MAPK pathway, including mutations in KRAS, BRAF, and ERBB2, are also seen in ovarian epithelial cancers. These changes can result in increased cell division and growth.
4. **Epigenetic Changes:** Aberrant DNA methylation and histone modification can lead to the silencing of tumor suppressor genes and the activation of oncogenes, contributing to cancer progression.
5. **Angiogenesis:** The process of new blood vessel formation is critical for tumor growth and metastasis. Vascular Endothelial Growth Factor (VEGF) and other angiogenic factors are often overexpressed in ovarian epithelial cancers.
6. **Inflammatory Microenvironment:** Chronic inflammation in the ovarian microenvironment can promote genetic instability and cellular transformation, facilitating cancer development.
Understanding these molecular mechanisms is crucial for developing targeted therapies and improving outcomes for patients with ovarian epithelial cancer. - Treatment
- Ovarian epithelial cancer treatment typically includes a combination of surgery and chemotherapy. Surgery aims to remove as much of the tumor as possible, which may involve a hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), and omentectomy (removal of the omentum). Chemotherapy often follows surgery to target any remaining cancer cells, commonly using platinum-based drugs like carboplatin and cisplatin, sometimes in combination with paclitaxel. Some cases may also benefit from targeted therapy or, in certain scenarios, radiation therapy. Decisions on treatment plans are personalized based on the stage and specific characteristics of the cancer, as well as the overall health of the patient.
- Compassionate Use Treatment
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Compassionate use treatments and off-label or experimental treatments for ovarian epithelial cancer typically involve access to new or investigational therapies that are not yet widely available. These may include:
1. **PARP Inhibitors**: Although approved for certain cases, their use in other stages or genetic profiles might be considered off-label. Drugs like olaparib, niraparib, and rucaparib fall into this category.
2. **Immune Checkpoint Inhibitors**: Drugs such as pembrolizumab and nivolumab, primarily approved for other cancers, may be used experimentally to enhance the immune system's ability to fight ovarian epithelial cancer.
3. **Anti-angiogenic Agents**: Bevacizumab is approved in some settings but may be used off-label for different stages or specific patient groups.
4. **Targeted Therapy**: Agents like vascular endothelial growth factor (VEGF) inhibitors and other molecularly targeted drugs might be available through experimental studies or compassionate use programs.
Patients seeking these treatments typically need to discuss eligibility and potential benefits with their oncologists, and they may need to enroll in clinical trials or special access programs. - Lifestyle Recommendations
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For ovarian epithelial cancer, lifestyle recommendations include:
1. **Healthy Diet**: Maintain a diet rich in fruits, vegetables, and whole grains while limiting red and processed meats.
2. **Regular Exercise**: Engage in regular physical activity to achieve and maintain a healthy weight.
3. **Avoid Smoking**: Refrain from smoking as it can increase the risk of many cancers, including ovarian cancer.
4. **Limit Alcohol**: Drink alcohol in moderation, if at all.
5. **Regular Medical Check-ups**: Attend regular medical screenings and check-ups for early detection and management.
6. **Oral Contraceptives**: Some studies suggest that the use of oral contraceptives might reduce the risk of ovarian cancer.
7. **Breastfeeding**: If possible, breastfeeding may slightly reduce the risk.
These recommendations can help reduce the risk and support overall health, but they are not guaranteed to prevent ovarian cancer. Regular consultation with healthcare providers is essential for personalized advice and early detection. - Medication
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The specific medications used for treating ovarian epithelial cancer can include chemotherapy agents such as:
1. Paclitaxel (Taxol)
2. Carboplatin (Paraplatin)
3. Cisplatin
4. Bevacizumab (Avastin)
Targeted therapies and hormone therapies may also be considered, depending on the individual case. Always consult with a healthcare provider for personalized treatment options. - Repurposable Drugs
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Repurposable drugs for ovarian epithelial cancer that have shown promise in various studies include:
1. **Metformin:** Typically used for type 2 diabetes, it has potential anti-cancer properties.
2. **Aspirin:** Anti-inflammatory drug which might help in reducing cancer risk or progression.
3. **Statins:** Commonly used to lower cholesterol, they may have anti-cancer effects.
4. **Beta-blockers:** These heart medications could potentially slow cancer progression.
5. **PARP inhibitors (e.g., Olaparib):** Though not originally developed for ovarian cancer, they are now used due to efficacy in treating BRCA-mutated ovarian cancer.
Research is ongoing to confirm the effectiveness and safety of these drugs for ovarian epithelial cancer. Consult with healthcare providers for potential clinical trials and treatment options. - Metabolites
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For ovarian epithelial cancer, there are several metabolites that have been researched for their potential role in the disease's progression and diagnosis. Commonly studied metabolites include:
1. **CA-125 (Cancer Antigen 125)**: This is a protein that may be found in higher levels in ovarian cancer patients. It is used as a biomarker for monitoring the disease.
2. **LDH (Lactate Dehydrogenase)**: Elevated levels can be associated with tumor growth and metabolism.
3. **HE4 (Human Epididymis Protein 4)**: Another biomarker that is often elevated in ovarian epithelial cancer.
Note: "nan" typically denotes "not a number" or missing data; it is not applicable in this context. - Nutraceuticals
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Nutraceuticals, substances derived from foods that provide health benefits beyond basic nutrition, have shown potential in the context of ovarian epithelial cancer for supportive care and possibly adjunctive treatment. Key nutraceuticals studied include:
- **Curcumin**: Known for its anti-inflammatory and antioxidant properties, it may help inhibit cancer cell growth and induce apoptosis.
- **Resveratrol**: Found in grapes and red wine, it has demonstrated potential in inhibiting cancer cell proliferation.
- **Green tea polyphenols (EGCG)**: These have antioxidant properties and may reduce the growth and spread of cancer cells.
- **Omega-3 fatty acids**: Present in fish oil, they exhibit anti-inflammatory effects and may help slow tumor growth.
While promising, it is essential to consult healthcare providers before using nutraceuticals, as they are not substitutes for conventional cancer treatments. - Peptides
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Ovarian epithelial cancer, a type of cancer originating from the surface layer of the ovary, has been a subject of research involving peptides and nanoparticles (nanotechnology).
Peptides can serve various roles, including acting as therapeutic agents or as biomarkers for early detection and treatment monitoring. Research is ongoing to identify specific peptides associated with ovarian epithelial cancer that might improve targeted therapy or diagnosis.
Nanotechnology, particularly nanoparticles, is being explored for drug delivery systems, imaging, and diagnostic purposes. Nanoparticles can be designed to deliver chemotherapy drugs directly to cancer cells, thereby minimizing damage to healthy tissues and enhancing the efficacy of the treatment. They can also be used in imaging techniques to improve the detection and characterization of tumors.