Abstract
Epithelial ovarian cancer is often considered a single pathological entity, but increasing evidence suggests that it is rather a group of different neoplasms, each with unique pathological characteristics, molecular features, and clinical behaviours. This heterogeneity accounts for the different sensitivity to antineoplastic drugs and makes the treatment of ovarian tumours a challenge.For early-stage disease, as well as for heavily pre-treated patients with recurrent ovarian cancer, the benefit of chemotherapy remains uncertain.Clear-cell, mucinous, low-grade serous, and endometrioid carcinomas show different molecular characteristics, which require different therapeutic approaches. In the era of personalised cancer medicine, understanding the pathogenesis and the genetic background of each subtype of epithelial ovarian tumour may lead to a tailored therapy, maximising the benefits of specific treatments and possibly reducing the side effects. Furthermore, personal factors, such as the patient’s performance status, should be taken into account in the management of ovarian cancer, with the aim of safeguarding the patients’ quality of life.
Highlights
IntroductionOvarian cancer is the sixth most common cancer diagnosed among women and the leading cause of death from gynaecologic malignancies worldwide [1]
Ovarian cancer is the sixth most common cancer diagnosed among women and the leading cause of death from gynaecologic malignancies worldwide [1].Ovarian neoplasms include epithelial ovarian cancer, which represents about 90% of all ovarian tumours, and non-epithelial ovarian cancer, including stromal and germ cell tumours
Epithelial ovarian cancer is classified into five main histologic subtypes: highgrade serous, which accounts for 70% of all epithelial cancer, low-grade serous, endometrioid, mucinous, and clear-cell tumours [2]
Summary
Ovarian cancer is the sixth most common cancer diagnosed among women and the leading cause of death from gynaecologic malignancies worldwide [1]. Epithelial ovarian cancer is classified into five main histologic subtypes: highgrade serous, which accounts for 70% of all epithelial cancer, low-grade serous, endometrioid, mucinous, and clear-cell tumours [2]. Type-2 cancers include high-grade serous, high-grade endometrioid, malignant mixed mesodermal, and undifferentiated ovarian tumours These subtypes differ for the genetic mutations and the precursor lesions: they show different prognosis, patterns of spread and response to chemotherapy [4]. Diagnosis of type-I ovarian cancer often occurs at an early stage, when the neoplasm is confined to one or both ovaries These tumours are genetically stable: each histological subtype presents a typical molecular profile and specific cell-signalling pathways that might become a target for new therapies [5]. Tumour limited to both ovaries (capsules intact) or fallopian tubes
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