Ovarian Cancer

1. pathophysiology:

1.1. growth factor signals - promotes tumor cell growth & angiogenesis -formation & stabilization of new blood vessels - binding of Fibroblast Growth Factor (FGF) and Fibroblast Growth Factor Receptor (FGFR)-stimulates tumor cell growth via autocrine mechanism

1.2. Platelet derived growth factor (PDGF) binds and activates with PDGF receptor (PDGFR) - angiogenesis- tumor cell growth via autocrine stimulation

1.3. Vascular endothelial growth factor (Veg F) binds with Veg F Receptor (Veg F R)- angiogenesis- promotes proliferation, migration & survival of vascular endothelial cells- Veg F induced by signals mediated by other growth factor

2. pathophysiologic factor:

2.1. ovarian cancer is a prevalent gynecological malignancy with potent immune-suppression capabilities; regulatory T cells (Tregs) are significant contributors to this immune suppression.

2.2. ovarian cancer presents with high levels of Tregs (regulatory T cells) and TNF (Tumor Necrosis Factor) expressing TNFR (Tumor Necrosis Factor Receptor)

3. risk factors:

3.1. family history

3.2. women with BRCA1 & BRCA2 Tumor suppressor genes

3.3. women with hereditarynonpolyposis colorectal cancer (HNPCC) (Lynch II syndrome)

3.4. age

3.5. hormonal therapies

3.6. pregnancy history

4. treatments:

4.1. Cytoreductive surgery

4.2. Chemotherapy

4.3. Radiation therapy

5. common findings:

5.1. 90% sporadic

5.2. 10% are inherited familial syndromes

5.3. accounts 3% of cancer in women

5.4. most common type is Epithelial Carcinoma which accounts 80% of malignant epithelial ovarian cancer

5.5. most patients are diagnosed in higher stages 3 & 4

6. diagnostic tests:

6.1. ultrasound

6.2. CT scan

6.3. MRI

6.4. PET/CT

7. diagnostic markers:

7.1. elevated serum CA125

7.2. lysophosphatidic acid (LPA)

7.3. high levels of VEGF

7.4. elevated levels of the anti-apoptotic protein Bcl-2

7.5. high levels of PDGF

7.6. high levels of FGF

8. symptoms:

8.1. persistent abdominal distention

8.2. loss of appetite

8.3. early satiety

8.4. pelvic pain