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Ovarian Cancer Activity
Published on: June 24, 2025
Ovarian Cancer Activity featured image
Written By: Hellen Ampoti
Author:
Hellen Ampoti Bsc. Biomedical science, Biological and Biomedical Sciences, University of Cape Coast
Reviewed by:
Bhavika Anilkumar MPharm
Daniel Callaghan MSci Biomedical Sciences

Introduction

Ovarian cancer is a type of cancer which occurs in the ovaries, where ovarian cells proliferate abnormally and uncontrollably, leading to advanced presentation in the peritoneal cavity.1 To understand ovarian cancer, the ovaries must first be considered.  Superior to the ovary is the infundibulum of the uterine tube. The innermost part of the ovary is the medulla, followed by the cortex, which contains the ovarian follicles, then a connective tissue called tunica albuginea made up of collagen, then finally the outermost part consisting of epithelial ( simple cuboidal) cells.3 The ovaries are responsible for hormonal production and reproductive development (development of female secondary characteristics and egg production).4 Due to the increased proliferation rate, early detection is important to curb its effects. Nevertheless, about 90% of women in stage I, where the tumour is confined to the ovaries, can be cured. 

Understanding ovarian cancer

Causes and risk factors of ovarian cancer

These factors may be influenced by risk factors such as:

 1. Genetic predisposition (BRCA1, BRCA2 mutations)

BRCA1 and BRCA2 genes are tumour suppressor genes associated with more than 20% to 23% of ovarian carcinomas. About 65% to 85% of hereditary ovarian cancers are associated with germ-line mutations in BRCA genes.14 They are responsible for DNA repair through homologous recombination.15 They also maintain DNA stability and regulate the cell cycle.16 Genetic mutations in BRCA genes cause DNA repair defects, accumulation of genetic mutations, uncontrolled cell cycle and genetic instability, which leads to overproliferation of cells containing mutated genetic make-up, leading to epithelial-mesenchymal transition of cells, loss of cell-cell adhesion, and altered cell polarity.17

 2. Age and hormonal factors

Age is one of the non-modifiable factors that influence the risk of ovarian cancer. Women diagnosed at an older age, above 63, have a lower rate of survival as compared to younger women.18 There is also an increased incidence of ovarian cancer with increasing age.19 During ageing, there is telomerase shortening, which can lead to genetic instability and result in ovarian cancer formation and development.22,2 Estrogen has also been implicated in cancer growth due to its circulating levels in the ovaries.24

3. Lifestyle and environmental factors

Lifestyle and environmental factors such as smoking, drinking of alcohol, obesity, dietary habits, hormone replacement therapy (HRT), exposure to genotoxic substances such as pesticides, and talc can be considered as modifiable risk factors to Ovarian carcinogenesis.27

Types of ovarian cancer

There are three main types of Ovarian Cancer. They are:

 1. Epithelial ovarian tumours 

Epithelial Ovarian tumours originate from the epithelial cells lining the wall of the ovaries. The ovarian wall is lined by simple cuboidal cells. Epithelial Ovarian tumours are the most common type of Ovarian tumours or cancers. There are subtypes of epithelial ovarian cancers,

 They are; 

  • High Grade Serous Carcinoma (HGSC): This is the most common type of Ovarian Carcinoma. It is seen in about 70% of Ovarian Cancer cases. Several studies propose that HGSC arises from the fallopian tube and rapidly proliferate30
  • Low Grade Serous Carcinoma (LGSC): It generally has a better prognosis than HGSC and is found to affect younger women. It is known to present with a reduced growth rate and is found in 5% of ovarian cancer cases.
  • Mucinous Carcinoma: This is characterised by the presence of mucus-like material in the tumour and precancerous lesions. Mucinous Carcinoma affects about 2 to 5% of people with Ovarian Carcinomas. KRAS and P53 mutations occur in this Ovarian Carcinoma. Also, HER2 amplification is observed in this Carcinoma34
  • Endometrioid Carcinoma (EnOC): This is a type of Epithelial ovarian Carcinoma characterised by the presence of endometriosis and associated with inactivation of the MMR gene and mutation of CTNNB1, PIK3CA, KRAS, ARIDIA, and PTEN
  • Clear cell Carcinoma: It is distinguished from other subtypes via IHC markers, revealing a negative test for WT1 and ER/PR, and a positive test for Napsin A/HNF-1β3

Epithelial cuboidal cell diagram

 2. Germ cell tumours

Germ cell tumours are a type of Ovarian carcinoma that arises from cells that develop in the eggs (primordial germ cells) of the embryonic gonad. It is a rare condition and usually manifests in the reproductive stage of girls(teenage stage), affecting one ovary and manifesting abdominal pain, palpable mass and an elevated serum level.35,36 Types of Germ cell tumours are:

  • Mature teratoma: These are also known as dermoid cysts. They are benign cystic neoplasms that contain mature tissues (e.g., hair and skin ) from all three embryonic layers37
  • Immature teratoma: These contain anaplastic immature tissues (embryonic nerve cells and muscle tissues)  from all three embryonic layers38
  • Dysgerminoma: This arises from the germ cells of the ovaries. It is the most common type of malignant Germ cell ovarian carcinoma39
  • Yolk sac tumour: This is a rare, aggressive, malignant endodermal sinus tumour that originates from the germ cells of the ovary40
  • Mixed germ cell tumour: This is a type of tumour that consists of more than one type of germ cell component(teratoma, dysgerminoma, yolk sac tumour)41

 3. Stromal tumours

They are a rare and slow-growing type of ovarian cancer which arises from the stromal cells of the ovarian follicles. Types of Stromal tumours include :

  • Fibroma: These are slow-growing ovarian cancer cells that arise from fibroblast42
  • Thecoma: They are benign tumors that arise from the theca cells and lead to vaginal bleeding43
  • Adult granuloma cell tumour: These are the most common type of Ovarian Cancer. They can be malignant and have a poor prognosis. They arise from granuloma cells44
  • Juvenile granuloma cell tumour: These are malignant Ovarian Cancers that affect girls or women under 30. They also arise from the granuloma cells of the ovaries45
  • Sertoli-leydig cell tumour: These are malignant Ovarian Cancers, which arise from the sex-cord stromal cells, such as the Leydig and Sertoli cells and produce androgen, which disrupts hormonal balance46

Symptoms and warning signs

Symptoms and warning signs of ovarian cancer vary depending on the type or subtype of ovarian cancer, age and other factors of the woman. Below are a few common and significant symptoms. 

  1. Pain and Swelling or Bloating or Abdominal and Pelvic Cavity
  2. Cachexia
  3. Urinary urgency or frequency
  4. Hormonal imbalance leading to irregular menstruation, dysmenorrhoea, Hirsutism, virilisation, Deepening of voice, among other symptoms
  5. Distant metastasis can result in liver damage, Lung disease, and others
  6. Anemia and vaginal bleeding; Angiogenesis and cancer growth increase blood vessels and demand for blood by cancer cells resulting in anemia and vaginal bleeding47

Diagnosis and screening methods

Clinical history 

A clinical history, which includes the patient's personal and family history, symptoms, and genetic or hereditary risk assessment, should be taken as the first medical protocol when a patient arrives at the hospital. This is to carefully rule out all other possible causes for a clearer diagnosis. 

Physical examination

A physical examination involves an abdominal examination, where a palpation is done on the abdomen to assess size and consistency for any tenderness or mass. Lymph node palpation is also required to inspect the lymph nodes' size, consistency and tendency.

Imaging tests (Ultrasound, CT scans, MRI, Transvaginal imaging)

Different imaging tests are used for the diagnosis of Ovarian cancer. They include ultrasound, MRI, and  Transvaginal imaging. These imaging tests are highly sensitive, specific, and non-invasive. They are used to visualise the tumours without surgical risk for proper diagnosis, management and monitoring of cancer growth.

Blood tests (CA-125 and other biomarkers)

Cancer Antigen-125 (CA-125) or Carbohydrate Antigen is the most widely used biomarker for the detection of Ovarian Cancer. It is a glycoprotein encoded by MUC16 and located on ovarian cancer cells, and released from the surface of the cancer cells into the bloodstream.48

Biopsy 

This involves the use of image-guided peritoneal core biopsy, where a small sample of abnormal tissue is removed or aspirated from the abnormal mass, and undergoes histopathological techniques to reveal the cancer. Microscopic examination reveals the presence or absence of tumour, the stage or type of cancer cells and the metastatic ability of the tumour.53

Genetic testing

Germ-line genetic testing of BRCA1/2 and Ovarian Cancer susceptibility genes is usually done for women suspected of having ovarian cancer( especially Epithelial Ovarian Cancer).52 Women with BRCA1/2  genes have a higher risk of developing the disease. It is also important to know the cancer cells' origin. 

Treatment and management

Surgical interventions

  • Oophorectomy (removal of ovaries): Oophorectomy refers to the surgical removal of one or both ovaries52
  • Hysterectomy (removal of the uterus): Hysterectomy refers to the surgical removal of the uterus53
  • Chemotherapy and targeted therapy: Chemotherapy is the use of drugs to target the cancer cells and gradually kill them54
  • Radiation therapy (rare but possible): Radiation therapy, or radiotherapy, uses electromagnetic radiation such as X-rays to kill the cancer cells55
  • Immunotherapy and clinical trials: This involves amplifying immune cells to fight the cancer cells56
  • Supportive care and palliative treatment: This involves alleviating pain, stress and symptoms during cancer treatment57

Prevention and risk reduction strategies

  • Genetic counselling and preventive measures
  • Lifestyle modifications (diet, exercise, avoiding carcinogens)
  • Use of oral contraceptives (potential protective effects)
  • Regular health check-ups and monitoring

Summary

Ovarian Cancer is the abnormal outgrowth of cells in the ovaries. It advances toward the pelvis and then to the peritoneal Cavity. The types include epithelial ovarian carcinoma, germ cell carcinoma, and stromal carcinoma.  Symptoms of ovarian cancer include Hormonal imbalance and cachexia. Anorexia, Pain and swelling, Vaginal bleeding and others depending on the type and stage. Several methods are used in detection and diagnosis. They include Clinical history, physical examination,  biopsy, Genetic testing, blood test, biomarkers, and different scans. Treatments include: palliative and support, chemotherapy, radiotherapy, immunological therapies and others. 

Reference

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Hellen Ampoti

Bachelor of Science in Biomedical Science

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