Clinical factors and biomarkers in ovarian tumors development

Ovarian cancer is a disease difficult to detect in early stages due to nonspecific symptoms and has a rapid progression with frequent relapses after radical surgical procedure. For these reasons, ovarian cancer generally represents the fourth cause of death through cancer in females, while in our country it is surpassed only by cervix cancer. The reduced survival is associated with the absence of symptoms, especially in early stages. Therefore, the diagnosis is delayed, when the metastases are already present and the prognosis is poor. While the etiology of the ovarian cancer is less understood, the histopathological studies and experiments regarding ovarian cancer development suggest that the majority of the tumors refined to the surface epithelium, a cuboidal layer that lays the ovary. It is still unclear if the molecular changes in this layer generate a neoplastic precursor that can be used for establishing an early diagnosis. None of the changes of the involved genes (p53, k-Ras, Her-2/neu, c-Myc, etc.) does seem to follow certain steps. We analyzed histological and immunohistochemical a group of 60 female patients admitted during January 2004 and January 2005 in Surgery Clinic of "Sfantul Ioan" Emergency Hospital, Bucharest. Our study reveals that a high percent (68.33%) of females had a correct diagnosis at admission, only five patients (8.33%) being diagnosed with other diseases. In 86.66% of cases, total hysterectomy with bilateral anexectomy has been made, in two cases (3.33%) tumor resection was the only needed therapy and in 19 cases (31.66%) peritoneal implants were found. More than 75% were serous tumors, 20% mucinous carcinoma and 5% borderline ovarian tumors. We found three cases of borderline tumors (5%) that histopathological proved to be serous tumors. The analysis of hormone receptors showed estrogen receptors in 32 cases (71.1%) of serous ovarian adenocarcinoma, in seven cases (58.33%) of mucinous adenocarcinoma, all three cases (100%) of borderline tumors and in four cases (21.05%) of the 19 with peritoneal implants. Progesterone receptors were found in 27 cases (60%) of serous carcinoma, five cases (41.66%) of mucinous carcinoma, one case (33.33%) of borderline tumors and five cases (26.31%) with peritoneal metastases. Immunohistochemical study of CerbB-2 showed positively only in 37 cases (82.22%) of serous carcinomas, five cases (41.66%) of mucinous carcinomas, one case (33.33%) of borderline tumor and eight cases (42.10%) with peritoneal metastases. All tumor types presented positives for CA125 (91.1% in serous tumors, 83.33% in mucinous tumors, 33.33% in borderline tumors and 73.68% in tumors with peritoneal implants. The investigated proliferative factors p53 and Ki-67 demonstrated correlation with tumor aggressiveness. Lack of positivity in borderline tumors and strong positivity in serous and mucinous carcinomas shows correlations with literature. This study outlines that an immunohistochemical analysis of certain antibodies cannot offer useful data regarding the prognosis or the screening for ovarian cancer.