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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