Malignant ovarian tumours
How most ovarian carcinomas begin in tubal or endometriotic epithelium, how the five main carcinoma types differ, how germ cell and stromal tumours behave, and why spread across the peritoneum makes ovarian cancer silent until late.
By the end, you can
- Explain the tubal origin of high-grade serous carcinoma and the roles of TP53 and BRCA1/2.
- Compare the five main types of ovarian carcinoma by origin, genetics and behaviour.
- Describe the malignant germ cell and sex cord–stromal tumours and the markers or hormones they make.
- Explain transcoelomic spread, the formation of ascites and what ovarian staging records.
- Relate the vague symptoms and the limits of CA-125 to the way ovarian cancer grows.
What it is
Malignant ovarian tumours are cancers arising in or presenting in the ovary. Most are carcinomas (epithelial), of five main types: high-grade serous, low-grade serous, endometrioid, clear cell and mucinous. The rest are malignant germ cell tumours, mostly in girls and young women, malignant sex cord–stromal tumours, chiefly the granulosa cell tumour, and metastases from other organs. Because many "ovarian" carcinomas start in the uterine tube or peritoneum, they are often grouped as tubo-ovarian or pelvic serous cancer.
5 types to tell apart
- High-grade serous carcinoma
- The commonest and most lethal type; begins mostly in the fimbriae of the uterine tube; TP53 mutated; often BRCA-related; usually found after spread.
- Other carcinomas
- Low-grade serous (from serous borderline tumours; slow), endometrioid and clear cell (from endometriosis), and mucinous (often large and one-sided).
- Borderline tumours
- Epithelial tumours with proliferation and atypia but no destructive invasion; usually in younger women, with a good outlook.
- Malignant germ cell tumours
- Dysgerminoma, yolk sac tumour, immature teratoma and others; fast-growing tumours of girls and young women, often with blood markers.
- Sex cord–stromal and metastatic tumours
- Granulosa cell tumour (oestrogen, late recurrence) and Sertoli–Leydig cell tumour (androgens); and metastases, such as Krukenberg tumours from the stomach.
US spelling: tumours → tumors, tumour → tumor.
Normal function
An ovary open to the peritoneal cavity
Each lies free in the peritoneal cavity, held only by its ligaments and vessels, with the of the draped over it. At ovulation the follicle ruptures through the ovarian surface, and the tube’s lining, with ciliated and secretory cells, is bathed in follicular fluid.
Nothing separates the ovary and tube from the rest of the abdomen. Peritoneal fluid circulates from the pelvis up the paracolic gutters, especially on the right, to the underside of the diaphragm, where lymphatic openings absorb it. It passes over the greater omentum, a fatty apron rich in immune cell clusters that catches particles.
The ovary’s three cell families, epithelium, germ cells and sex cord–stromal cells, each give rise to malignant tumours, and other cancers can spread to it.
Underlying change · Step 1 of 5
High-grade serous carcinoma begins in the tube
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 5
The other carcinomas and borderline tumours
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 3 of 5
Germ cell and sex cord–stromal cancers
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 5
Spread across the peritoneum
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 5
Silent growth and vague symptoms
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 9 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .