[Stage I ovarian carcinoma: two distinct malignancies?]

Ovarian cancers are the most lethal gynecologic malignancies and are rarely diagnosed in their early stages. The most common of these tumors--serous papillary carcinoma--is generally asymptomatic in the early stages. Non serous carcinomas (endometrioid and clear-cell carcinomas) have a higher chance of early diagnosis, as the associated endometriosis can cause pelvic pain, while endometrial hyperplasia/neoplasia can lead to vaginal bleeding. In addition, serous papillary carcinomas tend to be bilateral with peritoneal involvement, while non serous papillary carcinomas are often unilateral. Non serous papillary carcinomas tend to occur in younger, hyperestrogenic, often infertile patients. Serous papillary carcinomas potentially arise from dysplastic epithelial cells lining the ovarian surface and inclusion cysts, while the substrate of non serous papillary tumors is atypical endometriotic tissue. Tumor markers also tend to differ between the two forms of ovarian cancer. Pelvic laparoscopy and prophylactic oophorectomy have offered new insights into the mechanisms and early stages of ovarian malignancies.