الفهرس 
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Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country’s fifth most common cause of cancer mortality in women. It is estimated that 21,290 new diagnoses and 14,180 deaths from this neoplasm will occur in the United States; less than 40% of women with ovarian cancer are cured. (Siegel et al., 2015)
The incidence of ovarian cancer increases with age. A 30% to 60% decreased risk for cancer is associated with younger age at pregnancy and first birth (≤25 years), Family history (primarily patients having 2 or more first-degree relatives with ovarian cancer)—including linkage with BRCA1 and BRCA2 genotypes. (Lancaster et al., 2015)
Randomized data do not yet support routine screening for ovarian cancer in the general population, and routine screening is not currently recommended by any professional society. Some physicians follow women with high-risk factors (eg, those with BRCA mutations, those with a family history) using CA-125 monitoring and endovaginal ultrasound. (Smith et al., 2015)
Malignant primary ovarian tumors fall into three main groups epithelial, sex cord/stromal and germ cell tumors. Epithelial tumors, that is, ovarian carcinomas (OCs), the most common group, accounting for 90% of cancers. It is widely recognized at present that the different histological subtypes of OC are five different diseases , each with its own morphological, immunohistochemical, molecular and clinical characteristics. These include low-grade serous carcinoma (LGSC), high-grade serous carcinoma (HGSC), mucinous carcinoma (MC), endometrioid carcinoma (EC) and clear cell carcinoma (CCC). LGSCs often harbor KRAS and BRAF mutations, whereas the majority of HGSCs have TP53 mutations and gross genomic aberrations manifested as aneuploidy. Mutations in the ARID1A, PIK3CA, PTEN and KRAS genes characterize CCC, whereas ECs, in common with their uterine counterparts, have mutations in ARID1A, CTNNB1and PTEN, as well as microsatellite instability. (Gilks et al., 2008)
Ovarian cancer has been a silent killer because it has been relatively asymptomatic until late stages. Currently, the pelvic examination, transvaginal ultrasonography and serum CA-125 levels are the standard modalities in detecting ovarian cancer. HE4 was superior to CA-125 in separating benign, borderline ovarian tumors, cancers of the fallopian tubes, as well as early-stage EOC. (Wu et al., 2012).