The quest for a clearer understanding of ovarian carcinoma.

Ovarian cancer is usually a virulent malignancy. Most patients present with extension beyond the ovary, often in the upper abdomen; cures are rare in such patients. Despite gains from contemporary chemotherapy regimens and whole abdominal radiation techniques, the overall impact on survival has been minimal: One out of every 100 women will die from ovarian malignancy, which is the fourth leading cause of all female cancer deaths. lmproved survival in ovarian cancer will probably result from two factors-improved therapy and earlier detection. Modeling systems should provide a stronger scientific basis for radiation and chemotherapy testing. while further research on tumor-associated antigens and the host-tumor relationship may pave the way for the serologic diagnosis of early disease. Ovarian carcinoma is not a single entity, since malignant cells arise from stromal tissue as well as the surface mesothelium. In most discussions, however, “ovarian cancer” is considered synonymous with the epithelial type of ovarian malignancy which arises from the surface mesothelial, or epithelial, cells. Although stromal tumors, functioning hormonal lesions and sex cord malignancies are fascinating and often curable, they do not represent the public health menace of epithelial ovarian malignancy. and will not be considered in the remainder of this discussion. Little is known regarding hormonal relationships of this cancer, and receptor studies are in their infancy. Nothing postulated as an etiologic agent has had meaningful scientific support to date. Epidemiologic data, however, has provided a few clues. Relative infertility4 may be more common in patients with ovarian cancer. although this has been disputed.” Early pregnancy may play a protective role’ as it does with breast cancer. Scandinavian. Swiss and North American women have a high incidence of ovarian carcinoma. while Latin Americans do not.” Some authors, reviewing the extremely IOU incidence of carcinoma in ovariotomies published from the 1800’s. have concluded that ovarian carcinoma may primarily be a disease of the 20th century.lx The macroscopic and microscopic growth patterns of this cancer are unique. Clinical observations suggest that advanced ovarian disease frequently occurs in conjunction with small, often non-palpable ovaries.’ (Kolstad, P., oral communication, April, 1980). It has a characteristic surface-spreading pattern of growth: the cancer cells will rarely, if ever, invade viscous structures. Death is caused by inanition secondary to small bowel obstruction, or respiratory compromise from pleural and abdominal effusions. Hematogenous metastases to the brain, lung parenchyma, skin or bone is very rare, and parenchymal liver disease is uncommon. Such a pattern of growth has led some authors to postulate that epithelial ovarian cancer shares many growth characteristics with mesotheliomas.” As such, abdominal and pleural disease in this malignancy may not represent geographic “spread” as we normally think of it, but rather a cancerous change developing on mesothelial surfaces. most likely derived from multiple foci of premalignant atypia. Histologically, these malignancies are fascinating in their recapitulation of other gynecobogic and pelvic tissues. Serous tumors, often with visible cilia, resemble fallopian tube mucosa, while mutinous tumors are similar to endocervical or colonic tissue, and have high levels of carcino-embryonic antigen.15 Endometrioid tumors, as the name suggests, are often identical to endometrial carcinoma, and in fact, frequently co-exist with them. Mesonephroid tumors have a clear cell architecture similar to genito-urinary malignancies and those adenocarcinomas seen in fetuses exposed to diethylstilbestroL6 A reasonably large percentage of the remaining cancers are either undifferentiated or possess an admixture of these