Accepted Abstracts: J Cancer Sci Ther
Ovarian Carcinoma (OC) is the most lethal gynecologic tumor, with 22.240 new cases and 14.030 deaths in the USA in 2013. While cervical and endometrial carcinoma underwent a spectacular decline over the past 5 decades due to detection of precursors and early cancer stages, no significant decrease of OC occurred during this period. Most OC are diagnosed in Stage III when the tumor is spread to the abdominal cavity and the 5 year survival is about 35%. Precursors of OC are subtle changes in the ovarian and fallopian tube epithelium, difficult to assess because of the lack of clinical symptoms. They were studied in patients at risk for OC, with family or personal histories of breast and/or OC, bearing a mutation of BRCA genes. These patients however represent a minority, about 90% of OC being sporadic. Microscopic and molecular genetic studies identified changes on the ovarian and fallopian tube surface epithelium that may precede overt cancer, such as dysplasia, carcinoma in situ, P53 mutation (a potent discriminating factor of OC). These changes were identified in specimens removed prophylactically from women at risk for OC (a procedure that prevents the development of most OC), and in the vicinity of invasive OC. The diagnosis of stage I OC, when the tumor is confined to the ovary(ies) is rare. The early stage OC patients have a 5 year survival rate of about 90%. The early symptoms of OC are few and non-specific, and Ca125, the most frequently used tumor marker, is neither sensitive nor specific enough. While early OC is clinically silent in most cases, associated pathologic changes are likely to be symptomatic: pelvic and especially ovarian endometriosis manifested as painful pelvic masses, and uterine polyps, endometrial hyperplasia/neoplasia causing abnormal vaginal bleeding. The associated OC are often histologically different (endometrioid, clear cell or mucinous OC) from those diagnosed in late stages, unfortunately the most numerous, which are serous OC. The latter however are more often diagnosed in Stage I in patients under close medical surveillance due to known risk factors (family or personal history, BRCA positivity). New surgical approaches to the ovaries and search for specific and sensitive tumor markers will hopefully advance this recent insight into precursors and early stage diagnosis of OC to clinically effective ways to improve the present poor prognosis of OC.