Abstract
High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian carcinoma. Many HGSCs are now believed to originate in the fallopian tube epithelium; ovarian surface epithelium is another possible origin. Thus, current screening methods, i.e., ultrasonography and serum CA-125 measurements, have a limitation in their early detection. Recently, circulating biomarkers, such as tumor DNA, autoantibody, and microRNA, have been investigated to detect HGSCs. As cancer cells in the fallopian tube flow into the endometrial cavity, the detection of exfoliated cells, tumor DNA, and proteome from samples obtained from the endometrial cavity or the cervix may be useful. The risk of ovarian serous carcinoma is affected by the use of oral contraceptive and menopausal hormone therapy (MHT). MHT regimens causing endometrial bleeding increase serous carcinoma risk, hence, incessant retrograde bleeding from the endometrial cavity into the Douglas pouch appears to play an important role in high-grade serous carcinogenesis. In this review, we provide an overview of current and novel screening methods and prevention approaches for ovarian and fallopian tube HGSC.
Highlights
Ovarian cancer is the most lethal gynecological malignancy since most cases are diagnosed at an advanced stage when the metastases are extensive
Ovarian cancer screening needs to detect both early fallopian tube and ovarian lesions, as fallopian tube epithelium (FTE) and Ovarian surface epithelium (OSE) are cells-of-origin for high-grade serous carcinoma (HGSC) of the ovary [34,35,36,37]
cancer antigen (CA)-125 is not recommended in low-risk women and high-risk women with BRCA mutations, for BRCA mutation carriers who have not yet undergone risk-reducing salpingo-oophorectomy (RRSO) ovarian cancer screening may be considered at age 30–35 years [113]
Summary
Ovarian cancer is the most lethal gynecological malignancy since most cases are diagnosed at an advanced stage when the metastases are extensive. In an effort to detect ovarian cancer at an early stage when the disease has a more favorable prognosis, ovarian cancer screening has been performed for more than three decades [1,2]. Current methods for ovarian cancer screening, i.e., transvaginal ultrasonography (TV-US) and serum cancer antigen (CA)-125 measurements, did not reduce the mortality rate [3,4,5]. Our understanding of the origins and pathogenesis of ovarian cancer has substantially progressed, and novel methods for early detection of ovarian cancer have been developed. The etiology of ovarian cancer remains unclear, some novel hypotheses have been proposed to explain epidemiological risk factors. We discuss current and novel screening methods for ovarian cancer, in particular, high-grade serous carcinoma (HGSC), based on its carcinogenesis.
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