ReviewOncologyEarly detection and treatment of ovarian cancer: shifting from early stage to minimal volume of disease based on a new model of carcinogenesis
Section snippets
Current Approach to Ovarian Cancer Screening
The serum assay for the tumor marker CA125, alone or in combination with pelvic or transvaginal ultrasound, continues to be evaluated as a potential screening test for ovarian cancer. At present, screening tests are not recommended for use in the general population and are considered to have limited use in the high-risk population because of their insufficient sensitivity and their inability to detect early stage disease.
Evaluating potential screening tests for ovarian cancer has been extremely
New Model of Ovarian Carcinogenesis
Correlation of the results of recent molecular genetic studies with clinical and histopathologic findings has led us to propose a new model of ovarian carcinogenesis. In this model all ovarian surface epithelial tumors are divided into 2 groups designated type I and type II. Type I tumors tend to present as stage I, low-grade neoplasms that develop slowly from well-recognized precursors and behave in an indolent fashion. They include low-grade micropapillary serous carcinoma, mucinous,
Implications of the Model for Early Detection and Treatment
The proposed model draws attention to the fact that ovarian cancer is a heterogeneous group of diseases that not only behave differently but also develop differently. Therefore, different approaches to detection and treatment are required. Type I tumors tend to be low grade, low stage, and slow growing. Current approaches for their detection based on pelvic examination and transvaginal ultrasound are appropriate in most cases. However, type I tumors constitute only 25% of ovarian cancers, so
Conclusions
A new model for the pathogenesis of ovarian cancer, which divides surface epithelial tumors into 2 groups, designated type I and type II, is proposed. Type I tumors are slow growing, are generally confined to the ovary at diagnosis, and develop from well-established precursor lesions that are termed borderline tumors. Type I tumors included low-grade micropapillary serous carcinoma, mucinous, endometrioid, and clear cell carcinomas. They are genetically stable and characterized by mutations in
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2017, Cancer LettersCitation Excerpt :Type-1 cells are characterized by a slow-growing phenotype, and women diagnosed in stage 1 disease who exhibit type-1 cells (25–30% at diagnosis), have a high 5-year survival rate (90%). On the contrary, type-2 cells mainly express a mutated or null isoform of the gene TP53 (60–80% of cases), or aberrations in BRCA1 (30–50%) and BRCA2 (15–30%) genes [16–18], and the majority of the detected ovarian cancers belong to the aggressive type-2 at diagnosis [19]. It has been shown that several tumors, including ovarian cancer, are characterized by the presence of cell subpopulations with stem-like features, commonly defined as cancer stem cells (CSCs), which have the ability to initiate tumor formation in immunocompromised mice [20–22].
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Reprints not available from the authors.