Invasive breast carcinoma - IARC

Surface epithelial-stromal tumours
K.R. Lee
P. Russell
F.A. Tavassoli
C.H. Buckley
J. Prat P. Pisani
M. Dietel P. Schwartz
D.J. Gersell
D.E. Goldgar
A.I. Karseladze
E. Silva
S. Hauptmann R. Caduff
J. Rutgers R.A. Kubik-Huch
Definition
S u rface epithelial-stromal tumours are
the most common neoplasms of the
ovary. They originate from the ovarian
surface epithelium or its derivatives and
occur in women of reproductive age and
beyond. They are histologically composed
of one or more distinctive types of
epithelium, admixed with a variable
amount of stroma.Their biological behaviour
varies with histological type.
Epidemiology
Cancer of the ovary represents about
30% of all cancers of the female genital
organs. In developed countries it is
about as common as cancers of the corpus
uteri (35%) and invasive cancer of
the cervix (27%). The age-adjusted incidence
rates vary from less than 2 new
cases per 100,000 women in most of
Southeast Asia and Africa to over 15
cases in Northern and Eastern Europe.
The economically advanced countries of
North America, Europe, Australia, New
Zealand and temperate South America
show the highest rates. In the United
States more women die from ovarian
cancer today than from all other pelvic
gynaecological cancer sites combined
{1066}. Incidence rates have been either
stable or have shown slow increases in
most western countries, whereas they
have risen steadily in parts of Eastern
Asia.
convincing mechanism linking the risk
factors with malignant transformation has
been proposed.
Several dietary factors have been related
to ovarian cancer {819}. There is emerging
evidence that the Western lifestyle, in
particular, obesity, is associated with an
increased risk {388}.
Clinical features
Signs and symptoms
Women with ovarian cancer have a poor
p rognosis. The mean 5-year survival
rate in Europe is 32% {256}. This unfavourable
outcome is largely ascribed
to a lack of early warning symptoms and
a lack of diagnostic tests that allow early
detection. As a result, appro x i m a t e l y
70% of patients present when this cancer
is in an advanced stage, i.e. it has
metastasized to the upper abdomen or
beyond the abdominal cavity {394}. It is
now recognized that the overwhelming
majority of women diagnosed with ovarian
cancer actually have symptoms, but
they are subtle and easily confused with
those of various benign entities, part i c u-
larly those related to the gastro i n t e s t i n a l
tract {1024,2106}.
Physical signs associated with early
stage ovarian cancer may be limited to
palpation by pelvic examination of a
mobile, but somewhat irregular, pelvic
mass (stage I). As the disease spreads
into the pelvic cavity, nodules may be
found in the cul-de-sac, particularly on
bimanual rectovaginal examination
(stage II). Ascites may occur even when
the malignancy is limited to one or both
ovaries (stage IC). As the disease
involves the upper abdomen, ascites
may be evident. A physical examination
of the abdomen may demonstrate flank
bulging and fluid waves associated with
the ascites. Metastatic disease is commonly
found in the omentum, such that
the latter may be readily identified in the
presence of advanced stage (stage III)
ovarian cancer as a ballottable or palpable
mass in the mid-abdomen, usually
superior to the umbilicus and above
the palpable pelvic mass. Finally, the
Aetiology
Two factors consistently associated with
a reduced risk of the disease are high
parity and the use of oral contraceptives
{1295,2474}. Three recent studies have
shown an increased risk of ovarian cancer
in postmenopausal women treated
with high-dose estrogen re p l a c e m e n t
therapy for 10 years or greater {963,
2373,2399}. Very little is known of the
aetiology of non-familial cases. The protective
effects of pregnancies and of oral
contraception suggest a direct role for
ovulation in causing the disease, but no
Fig. 2.01 Global incidence rates of ovarian cancer. Age-standardized rates (ASR) per 100,000 population and
year. From Globocan 2000 {846}.
Surface epithelial-stromal tumours
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