Nezhat Farr R, Apostol Radu, Nezhat Camran, Pejovic Tanja
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mount Sinai Roosevelt, Division of Minimally Invasive Gynecologic Surgery, Winthrop University Hospital, State University of New York at Stony Brook, College of Medicine, New York, NY.
Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Mount Sinai-St. Luke's and Roosevelt Hospital System, New York, NY.
Am J Obstet Gynecol. 2015 Sep;213(3):262-7. doi: 10.1016/j.ajog.2015.03.044. Epub 2015 Mar 25.
Despite advances in medicine, ovarian cancer remains the deadliest of the gynecological malignancies. Herein we present the latest information on the pathophysiology of ovarian cancer and its significance for ovarian cancer screening and prevention. A new paradigm for ovarian cancer pathogenesis presupposes 2 distinct types of ovarian epithelial carcinoma with distinct molecular profiles: type I and type II carcinomas. Type I tumors include endometrioid, clear-cell carcinoma, and low-grade serous carcinoma and mostly arise via defined sequence either from endometriosis or from borderline serous tumors, mostly presenting in an early stage. More frequent type II carcinomas are usually high-grade serous tumors, and recent evidence suggests that the majority arise from the fimbriated end of the fallopian tube. Subsequently, high-grade serous carcinomas usually present at advanced stages, likely as a consequence of the rapid peritoneal seeding from the open ends of the fallopian tubes. On the other hand, careful clinical evaluation should be performed along with risk stratification and targeted treatment of women with premalignant conditions leading to type I cancers, most notably endometriosis and endometriomas. Although the chance of malignant transformation is low, an understanding of this link offers a possibility of prevention and early intervention. This new evidence explains difficulties in ovarian cancer screening and helps in forming new recommendations for ovarian cancer risk evaluation and prophylactic treatments.
尽管医学取得了进步，但卵巢癌仍然是最致命的妇科恶性肿瘤。在此，我们介绍卵巢癌病理生理学的最新信息及其对卵巢癌筛查和预防的意义。卵巢癌发病机制的新范式假定存在两种具有不同分子特征的卵巢上皮癌：I型和II型癌。I型肿瘤包括子宫内膜样癌、透明细胞癌和低级别浆液性癌，大多通过明确的序列由子宫内膜异位症或交界性浆液性肿瘤发展而来，大多呈早期表现。更为常见的II型癌通常是高级别浆液性肿瘤，最近的证据表明，大多数起源于输卵管的伞端。随后，高级别浆液性癌通常在晚期出现，这可能是由于输卵管开口处快速的腹膜播散所致。另一方面，对于患有导致I型癌症的癌前病变（最显著的是子宫内膜异位症和子宫内膜瘤）的女性，应进行仔细的临床评估，并进行风险分层和靶向治疗。尽管恶性转化的几率很低，但了解这种联系提供了预防和早期干预的可能性。这一新证据解释了卵巢癌筛查的困难，并有助于形成关于卵巢癌风险评估和预防性治疗的新建议。
