Epidemiology in ovarian carcinoma: Lessons from autopsy

Abstract

OBJECTIVE We challenge epidemiologic knowledge regarding ovarian carcinoma (OC) by bridging the gap between clinical and autopsy data. METHODS Autopsy reports, histological slides and clinical files from 660 patients in whom OC was diagnosed from 1975-2005 were studied (autopsy cohort, n=233; Clinical Cancer Registry from the local gyneco-oncologic center, n=427). RESULTS Out of the autopsy cohort, we identified four distinct subgroups of patients: 1) OC was diagnosed before autopsy, n=156 (67.0%). 2) OC was an incidental finding, n=16 (6.8%).3) The ovarian tumors were not primary OC but rather metastases from other primary tumors; this revised diagnosis was first made by using current histopathological knowledge/techniques, n=24 (10.3%). 4) Death was directly due to OC in its final stage and OC was first diagnosed by autopsy, n=37 (15.9%); when these cases were added to the Clinical Cancer Registry to an adjusted OC incidence model, the autopsy cases comprised 8.8% of the adjusted cohort and almost doubled the percentage of oldest patients ( 80 years at diagnosis) from 4.9% to 9.3% (p=0.013). CONCLUSIONS Epidemiological data from the 1970s-1990s may overestimate true incidence because up to 10% of carcinomas in the ovary were not properly classified. Patients who were first diagnosed with OC by autopsy comprise a distinct subgroup. These are patients who have not been seen by specialized oncologists and thus play no role in their perception of the disease. Nevertheless, these cases have impact on prevalence and incidence data of OC and in an era of reduced autopsy rates will probably be overlooked. Nevertheless, these cases have impact on prevalence and incidence data of OC and in an era of 54 reduced autopsy rates will probably be overlooked.

Molecular Mechanisms Regulating Organ-Specific Metastases in Epithelial Ovarian Carcinoma

“…These studies demonstrated that, although EOC typically colonized a wide variety of organs and tissues, there was not one single metastatic site that was always involved by metastasis in all studied cases. The main site of metastasis was the peritoneum, including the parietal and visceral peritoneum and omentum, which was involved in 77% of cases on average among several reports (ranging between 53% and 99%, Table 1 ) [ 25 , 26 , 27 , 29 , 30 , 31 ]. Other commonly colonized sites identified by autopsy studies included lymph nodes (38–77% of cases), large and small intestine (44–86% of cases), liver parenchyma (45–59% of cases), and lung (33–39% of cases).…”

The Role of Circulating Tumor Cells in Ovarian Cancer Dissemination

“…The most common and best known route of OC spread is the transcoelomic route. It is associated with metastasis within the peritoneal cavity and affects the surrounding peritoneal organs [ 4 , 5 ]. In this type of cancer, the dissemination of single cells, multicellular aggregates, and spheroids seed into the mesothelial layer and organs of the peritoneal cavity [ 6 ].…”

Reducing Ovarian Cancer Mortality Through Early Detection: Approaches Using Circulating Biomarkers

“…EOCs are diagnosed predominantly at an advanced stage with widespread metastases throughout the peritoneal cavity (4)(5)(6). Manifestations of the disease are typically vague and do not become apparent until the disease is advanced and difficult to treat.…”