Ovarian cancer

Classification

Stages

• FIGO I: FIGO stage I describes a tumour limited to the ovaries or fallopian tubes.
• FIGO IC: A stage FIGO IC is present with capsule rupture, tumour on the surface, or positive washings or ascites cytology.
• FIGO II: FIGO stage II means spread within the lesser pelvis.
• FIGO III: FIGO stage III describes peritoneal metastases outside the lesser pelvis or retroperitoneal lymph node metastases.
• FIGO IV: FIGO stage IV includes distant metastases, with malignant pleural effusion considered IVA.

Three groups

• Tissue of origin: Based on their tissue of origin, they are classified into epithelial tumours, germ cell tumours, and sex cord-stromal tumours.
• Frequency: The majority of all ovarian carcinomas are epithelial tumours.
• Fourth group: A fourth, non-primary group consists of metastases from other organs to the ovary.

Aetiopathogenesis

Who is tested

• Test material: Testing is performed on the germline from blood and additionally the tumour for somatic mutations and homologous recombination deficiency.
• Prevalence: About one in five ovarian cancers carries a germline mutation in BRCA1 or BRCA2.

Clinical features

Why it is detected late

• Early symptoms: The early symptoms of ovarian cancer are non-specific — increased abdominal girth, a feeling of fullness, loss of appetite, digestive and urinary problems.
• Spread: The spread is predominantly intraperitoneal through the shedding of tumour cells along the peritoneal surfaces.
• Frequent co-involvement: Due to the route of spread, ovarian cancer frequently involves the bowel with its serosal lining.

More facts from the study questions

• FIGO stage I describes a tumour confined to the ovaries or fallopian tubes.
• This represents the earliest stage of the disease.
• FIGO stage IC applies to a tumour confined to the ovaries if additional criteria are met.
• These include capsule rupture, tumour growth on the ovarian surface, or positive ascites/peritoneal washings.
• FIGO stage IV comprises distant metastases.
• A malignant pleural effusion is specifically classified as stage IVA.
• FIGO stage II is defined as tumour spread within the pelvis.
• This can include involvement of the uterus, bladder, or rectum, for example.
• Peritoneal metastases outside the pelvis correspond to FIGO stage III.
• FIGO stage II describes spread that is confined to the pelvis.

Histology

Epithelial tumours

• Most common type: The most common type of ovarian carcinoma is high-grade serous carcinoma.
• Origin of HGSC: According to current understanding, its origin is often in the fimbrial end of the fallopian tube, arising from a serous tubal intraepithelial carcinoma.
• Association: Clear cell and endometrioid carcinomas are associated with endometriosis.

Diagnosis

Clinical work-up

• Clinical examination: Additionally, a clinical examination is performed rectovaginally, of the inguinal lymph nodes and the supraclavicular region.

CA 125

• Definition: CA 125 is a glycoprotein of the coelomic epithelium that is elevated in about 80 percent of serous ovarian carcinomas.
• False-positive elevation: CA 125 is falsely elevated in endometriosis, fibroids, adnexitis, pregnancy, liver cirrhosis, ascites, and any peritoneal irritation.

HE4 and ROMA

• Advantage of HE4: The advantage of human epididymis protein 4 (HE4) over CA 125 is that it does not rise in endometriosis and is therefore more specific.
• ROMA index: The ROMA index calculates CA 125 and HE4 with the menopausal status to determine a risk probability.
• Utility: The utility of the ROMA index lies in the triage of unclear adnexal masses, supplementary to ultrasound — not as a replacement for it.

Keep learning in the app

Further reading (selection)

1. StatPearls: Epithelial Ovarian Cancer (NCBI Bookshelf)
2. DocCheck Flexikon, Ovarialkarzinom
3. DocCheck Flexikon, Ovarialtumor
4. DocCheck Flexikon, CA 125
5. DocCheck Flexikon, BRCA1

Cross-references