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Diagnosis: Understanding Your Pathology Report|
The pathology of the ovary is complex, but this is intended as a simple guide. To provide more information relating to your prognosis and treatment, we must first explore your diagnosis. Thus, it is important for you to obtain the exact diagnosis in your pathology report and to ask your doctor the following questions. First, what is the origin of the ovarian tumor; i.e., is it categorized as either epithelial, germ cell or stromal cell type? Secondly, it is important to understand whether the tumor is benign, borderline or malignant.
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Types of Tumors|
Cancer is not a single disease, but encompasses well over a hundred distinct diseases of different organs. Normally cells divide only when additional cells are required for normal body function. However, at certain times the controls that regulate when a cell divides are lost. This results in accumulation of more and more cells without order. Eventually these cells grow into a mass and this is termed a 'tumor'. It is important to understand that not all tumors are cancer:|
There are THREE main types of ovarian tumors (click on type diagnosed):
The treatment of ovarian cancer is dependent on the histologic (pathologic) diagnosis. This histologic diagnosis is rendered by a pathologist based on tissue sampled from the ovarian tumor that was removed at the time of surgery. The diagnosis is based on a histologic classification of ovarian tumors that is extremely complex because the ovary has a greater diversity of tumors than any other organ in the body. Over 100 types of ovarian tumors have thus far been characterized. The treatment and management of the different types of tumors differs greatly underscoring the importance of the correct histologic diagnosis. Because ovarian tumors are relatively uncommon and because there are so many different types, most pathologists do not have extensive experience with them and the histologic diagnosis may therefore be compromised. Accordingly, it is prudent to have a pathologist who has special expertise in gynecologic pathology, preferably someone who has extensive experience with ovarian tumors, to review the microscopic slides. Dr. Kurman has been interested in ovarian cancer for over 25 years and has written extensively on the subject.
Ovarian tumors can be broadly classified into three categories, those derived from the
surface epithelium, the germ cells and the specialized stroma. Tumors derived from the surface of the ovary account for the vast majority of ovarian tumors (approximately 80%) and are referred to as surface epithelial tumors. It is these tumors that constitute what is generally considered "ovarian cancer." Surface epithelial tumors are further subdivided into three categories, benign, borderline (low-malignant potential [LMP] or atypical proliferative) and invasive carcinoma. The behavior of the benign tumors and invasive carcinomas is reasonably well understood, but there is considerable controversy surrounding the diagnosis, prognosis and treatment of the intermediate (borderline) group. These tumors tend to occur in younger women and can often be treated conservatively. Conservative treatment allows women to preserve their fertility and retain ovarian hormone production which would be lost if both ovaries were removed as occurs with the treatment of invasive carcinoma. Conservative treatment, however, is dependent upon the correct, histologic (pathologic) diagnosis. It is in the category of "borderline" tumors where most of the errors in the diagnosis of ovarian tumors occur. Surface epithelial tumors are also subclassified based on the pattern of cellular differentiation and tumor grade (more information). Finally, the stage and amount of residual tumor after surgery provide important information that is used for predicting behavior and planning subsequent treatment (cross-reference).
Germ cell tumors are among the least common ovarian tumors, accounting for approximately 10-15% of ovarian tumors. They are derived from the oocytes (eggs). These tumors, like the surface epithelial tumors, can also be benign or malignant. There is, however, no intermediate group. The benign tumors are nearly always mature cystic teratomas or so-called "dermoids" and are successfully treated by the removal of the tumor with preservation of the uninvolved ovarian tissue. No further treatment is necessary. Malignant germ cell tumors require intensive multiagent chemotherapy after their removal (more information). The treatment is completely different from the chemotherapy administered after surgical treatment of a surface epithelial tumor.
Finally, the least common type of ovarian tumor accounting for approximately 5-10% of ovarian tumors are those derived from the stromal component of the ovary (see diagram). Since hormone production (female sex hormones such as estradiol and progesterone and male hormones such as testosterone, dehydroepiandrosterone [DHEA] and androstendione) occurs in the stroma, tumors derived from this part of the ovary can be associated with abnormal production of sex steroid hormones. This can lead to abnormal vaginal bleeding in reproductive age and postmenopausal women and precocious puberty in children. Ovarian tumors that produce male sex hormones can cause hirsutism (increased growth of hair on various parts of the body) and in extreme cases virilization characterized by an increase in body hair, deepening of the voice, balding, increase in muscle mass, and enlargement of the clitoris.