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epithelial-ovarian-cancer-pathogenesis-and-clinical-findings

Epithelial Ovarian Cancer: Pathogenesis and clinical findings Authors: Brian Yu Chieh Cheng, Yan Yu* Reviewers: Mehul Gupta, Hannah Yaphe, Sarah Glaze* * MD at time of publication See Epithelial Ovarian Cancer Risk Factors slide BRCA1 or BRCA2 mutationà faulty double strand DNA repairà↑ mutations & loss of controlled cell division Asymptomatic serous tubal intraepithelial carcinoma (STIC) lesions of the fallopian tube fimbria develop overtime STIC cells may break off from the fallopian tube & become trapped during inclusion cyst formation As part of the ovarian cycle, the coelomic epithelium (CE) of the ovary is ruptured & repaired after ovulation Incomplete repair of the CE results in invagination of the rupture site, forming a benign cortical inclusion cyst CE cells trapped during cyst formation undergoes metaplasia to tubal or other types of epithelium Endometriosis Endometriosis causes endometrial tissue to start growing on ovarian CE Endometrial cells trapped during cyst formation progresses to endometrioma or “chocolate cysts” Immune cell infiltration & cytokine release inside the ovary results in dysregulated inflammation Cancer cells proliferate in distant organs, invading & destroying native cells Organ failure Metastatic spread to liver, lung, brain & lymph nodes Lymphadenopathy Systemic immune activation ↑ metabolic consumption ↑ capillary surface area & permeability Fatigue & weight loss ↑ fluid entry into Ascites peritoneal cavity Further somatic mutation accumulation leads to malignant transformation of epithelium Tumor growth stimulates new blood vessel formation to supply itself with nutrients & O2 Omental / peritoneal seeding of cancer cells Early-stage disease Asymptomatic Epithelial Ovarian Cancer In late-stage disease, tumor may secrete a glycoprotein called mucin 16, also known as CA-125 (sensitive but non-specific biomarker for ovarian cancer) ↑ serum CA-125 levels Cancer cells proliferate inward & eventually ruptures the ovary Cancer cells are released into the peritoneal cavity Tumor growth in local organs (bladder/uterus) progresses to symptomatic cancer ↑ tumor volume & local tumor spread directly disrupts neighboring structures Pelvic/abdominal pain Palpable pelvic/abdominal mass Altered urinary frequency Compression of colon/bladder Change in bowel habits Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published August 15, 2021 on www.thecalgaryguide.com