{"title":"Ovarian Cancer Overview: Molecular Biology and Its Potential Clinical Application","authors":"J. Assis, D. Pereira, A. Nogueira, R. Medeiros","doi":"10.5772/INTECHOPEN.73863","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.73863","url":null,"abstract":"Over the previous two decades, there has been a shift in the ovarian cancer paradigm to consider it as a multiplicity of disease types rather than a single disease, requiring specialized medical management from molecular diagnosis through to treatment. Despite the achieved improvements in diagnosis, surgery, and systemic treatment, ovarian cancer remains the leading cause of death from gynecological tumors in western countries. The study of ovarian cancer at a molecular level could reveal potential biomarkers of disease diagnosis and progression, as well as possible therapeutic targets in areas such as angiogenesis and homologous recombination deficiencies. Although this area of research is proving invaluable concerning newer therapeutic approaches, platinum-based chemotherapy continues to be the core of the first-line treatment. Genomic screening focusing on the identification of prognostic and predictive markers is considered one of the leading areas for future ovarian cancer research.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"337 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116684156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Role of Lymphadenectomy in Ovarian Epithelial Cancer","authors":"H. Nagar","doi":"10.5772/INTECHOPEN.72702","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.72702","url":null,"abstract":"High-grade serous ovarian/tubal cancer commonly spreads via the peritoneal and lym- phatic routes. This chapter discusses the anatomical lymphatic drainage of the ovary and tube with reference to spread from different epithelial ovarian cancer types. The role of lymph node surgery in apparent early stage curative disease will be discussed with reference to staging and directing the need for adjuvant chemotherapy. In advanced disease, the role of lymph node sampling versus systematic dissection surgery as part of cytoreduction is assessed. The result of two randomised controlled trials (RCTs) published on the subject will be analysed along with the ongoing Lymphadenectomy in Ovarian Neoplasia (LION) study. The chapter adopts an evidence-based approach to the role of lymph node surgery in women with epithelial ovarian/tubal cancer. No significant difference was recorded in 5 years year overall survival (47 vs. 48.4%). A significant 7-month extension in progression free survival (PFS) was demonstrated (29.4 vs. 22.4 months). The SLD group had a significantly longer operating time, blood loss and blood transfusion. Subsequently, the authors have suggested that the study may be underpowered to detect an overall survival difference.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126482922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Vera, Rocío Retamales-Ortega, Maritza P. Garrido, M. Vega, C. Romero
{"title":"Signaling Pathways Related to Nerve Growth Factor and miRNAs in Epithelial Ovarian Cancer","authors":"C. Vera, Rocío Retamales-Ortega, Maritza P. Garrido, M. Vega, C. Romero","doi":"10.5772/INTECHOPEN.73804","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.73804","url":null,"abstract":"Epithelial ovarian cancer (EOC) is a disease that causes 140,000 deaths every year. Nerve growth factor (NGF) and its high affinity receptor TRKA play important roles in fol licular maturation, follicle-stimulating hormone (FSH) receptor acquisition and ovu - lation in normal ovary. Also, NGF has many roles in EOC cells: increasing survival, proliferation, cyclooxigenase-2 (COX-2), vascular endothelial growth factor (VEGF) and metalloproteinase ADAM17 expression. Besides, NGF inhibits calreticulin transloca tion from the endoplasmic reticulum to cell surface, possibly diminishing the efficacy of immunogenic therapies in EOC. Additionally, NGF acts as an angiogenic factor by a direct stimulation of migration, differentiation and proliferation of endothelial cells. Among the numerous factors actually described to be important in many types of can -cer, including EOC, are the microRNAs (miRs). Indeed, it has been found that miR-143 is downregulate in EOC, which correlates with an increase of COX-2; concomitantly, NGF increases COX-2 as mentioned. Furthermore, NGF increases miR-222 and its target is the metalloproteinase inhibitor TIMP3, increasing the ADAM17 function. Also, NGF increases cMYC transcription factor in EOC, which decreases miR-23 levels regulating proteins involved in cell cycle and tumor growth. Therefore, NGF/TRKA signaling path ways alter the expression of many proteins and deregulate miRs in EOC, leading to the progression of this cancer.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126002135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Management of Ovarian Cancer","authors":"R. Bharathan","doi":"10.5772/INTECHOPEN.80891","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80891","url":null,"abstract":"Advanced ovarian cancer remains a disease with a poor prognosis. Surgical therapy remains the cornerstone of treatment with essential contribution from chemotherapy. The combination therapy continues to offer the best treatment strategy. Complete cytoreductive surgery is still the most important prognostic marker. The role of primary debulking surgery in advanced ovarian cancer remains under investigation through high quality rigorous clinical trials. The current evidence regarding primary versus interval debulking surgery has drawn much criticism regarding patient recruitment and quality of surgery, both of which are key pillars in achieving complete cytoreduction. It is expected that greater centralisation and development of ‘ ovarian cancer surgery teams ’ will further enhance clinical outcomes.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115922694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chemotherapy for Primary and Recurrent Epithelial Ovarian Cancer","authors":"N. Naqos","doi":"10.5772/INTECHOPEN.80890","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80890","url":null,"abstract":"Epithelial ovarian cancer is the second most common gynecological cancer. It causes more deaths despite advances in treatment over the last few decades. Following explorative surgery and after histological assessment, the tumor can be formally “staged” according to the size, extent and location of the cancer. Staging during surgery determines the appropriate treatment regimen and the long-term outcome (prognosis). Recommendations for treatment after surgery are dependent on the stage of the cancer. Chemotherapy is recommended after surgery for stage III or IV ovarian cancer; certain tumor factors determine its use in stage I or II disease.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130986623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Past, Present and Future of Diagnostic Imaging in Ovarian Cancer","authors":"S. Suppiah","doi":"10.5772/INTECHOPEN.74449","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.74449","url":null,"abstract":"Ovarian cancers (OC) include a group of diseases with variable prognoses. While most conventional imaging techniques rely on the detection of tumour burden and distant spread to identify treatment plans, more emphasis is now being placed on screening for early detection and also for more accurate staging using molecular imaging techniques. It is generally accepted that there are some incremental benefits of using serum CA125 levels coupled with cross-sectional diagnostic imaging to aid in the diagnosis, staging and treatment planning of OC. This chapter provides a review of tests and diag- nostic imaging modalities that aid in the detection and staging of OC with a particular focus on F18-Fluorodeoxyglucose positron emission tomography/computed tomog- raphy (F18-FDG PET/CT) imaging. This chapter also proposes a diagnostic algorithm for the management of ovarian cancer. F18-FDG PET/CT imaging can act as a catalyst for the development of personalised medicine by stimulating advancements in targeted therapy. In conclusion, diagnostic imaging with particular focus in molecular imaging has the potential for altering management plans, which can ultimately help improve the prognosis of ovarian cancer.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124551210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgery for Recurrent Ovarian Cancer","authors":"D. Barton","doi":"10.5772/INTECHOPEN.71587","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.71587","url":null,"abstract":"Most patients with ovarian cancer (OC) have the epithelial subtype (EOC) and present with advanced stage disease. Despite improved surgical and medical management of primary disease, the majority of patients will develop recurrence and ultimately die of disease. The current surgical goal in primary EOC is complete surgical cytoreduction (CSC) as this significantly improves disease-specific survival and overall survival. CSC is a major independent prognostic factor in primary EOC. Recurrent ovarian cancer (ROC) can be diagnosed in the symptomatic or in the asymptomatic patient on clinical evidence, tumour marker results and/or imaging. There are data from cases series and retrospective series on the role of surgery in ROC but there is not yet level I evidence of secondary surgical cytoreduction improving overall survival. The published data emphasise that, as with primary disease, the surgical goal is CSC. In selecting patients for secondary cytoreductive surgery a number of predictive models have been proposed and tested. Patients with ROC who have undergone CSC have a better prognosis than those treated with chemotherapy alone or those in whom the surgical goal was not achieved. The counter-argument is that there is bias in the surgical reports — those patients not operated on chemotherapy alone, or who had incomplete cytoreduction and/or who had chemotherapy had less favourable disease- associated and patient-associated factors than those who had CSC. To address these concerns, there are currently three ongoing randomised controlled trials on surgery for ROC.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133751682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient Selection for Ovarian Cancer Debulking Surgery","authors":"J. Bálega","doi":"10.5772/INTECHOPEN.71585","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.71585","url":null,"abstract":"Complete surgical cytoreduction is the most important adverse prognostic factor for survival in ovarian cancer. To achieve this, surgeons often have to perform radical and ultraradical procedures with associated significant postoperative morbidity and mortality. Adverse events are most pronounced in patients with borderline or suboptimal capacity to withstand the stress related to surgery. In frail, elderly, malnourished patients, surgeons face limitations to exercise maximum surgical effort; therefore, alternative treatment strategies are required. Neoadjuvant chemotherapy offers a safe and effective way to enhance recovery after delayed debulking surgery in patients who are not optimal candidates for primary debulking surgery.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123092064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Novel Systemic Treatments in High Grade Ovarian Cancer","authors":"A. Samani, C. Chan, J. Krell","doi":"10.5772/INTECHOPEN.71583","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.71583","url":null,"abstract":"Most patients with ovarian cancer present at an advanced stage and are never cured. To improve outcomes a variety of novel systemic strategies are being developed. Traditional cytotoxic chemotherapy is being optimised, anti-angiogenic strategies are already in the clinic and several PARP inhibitors have gained regulatory approval. In addition, immunotherapy is showing promise and novel targeted strategies including against folate receptor alpha are also generating excitement. As our therapeutic choice increases, a chal-lenge will be how to best utilize the options available. Here we discuss recently estab- lished and other emerging therapies with a focus on key concepts rather than detailed synopses of trial designs and outcomes.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121235354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ubiquitin Signaling in Ovarian Cancer: From Potential to Challenges","authors":"Sumegha Mitra","doi":"10.5772/INTECHOPEN.75485","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.75485","url":null,"abstract":"Ubiquitin proteasome system (UPS) is an emerging arena in cancer intervention. Dysregulation of various UPS components has been implicated with many cancers, and this knowledge is starting to be exploited for its role in cancer initiation, progression, and therapeutics. UPS regulates both protein turnover and non-proteolytic regulatory function of the proteins involved in cell cycle, signal transduction, DNA repair, histone modi- fication, and transcription. In addition, chromosomal aberrations and genomic alterations often present in the cancer cell genomes lead to excess of conformationally challenged aggregation-prone proteins and proteotoxic stress that make cancer cells more dependent on UPS-mediated protein degradation than normal cells. This proposition is the basis of the clinical use of proteasome inhibitor, Bortezomib, to treat multiple myeloma and mantle cell lymphoma targeting cancer cells and mostly sparing the normal cells. This chapter provides an overview of various components of UPS which are implicated in cancer and regulate ubiquitin-mediated oncogenic signaling in ovarian cancer.","PeriodicalId":249149,"journal":{"name":"Ovarian Cancer - From Pathogenesis to Treatment","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126576301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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