This document discusses ovarian cancer prevention. It notes that ovarian cancer risk increases with age and factors like family history and endometriosis. Screening is not recommended for average risk women as trials found it did not reduce mortality and caused harm. Two main types of ovarian cancer have different origins - type II tumors often originate in the fallopian tubes. Prevention strategies discussed include risk-reducing salpingo-oophorectomies, oral contraceptives, metformin, NSAIDs, vitamins, and physical activity, which may reduce inflammation and hormones linked to cancer.

1. Ovarian cancer prevention
Zainab M. Al-Talal
Gyne.Oncologist
King abdulaziz,NGH,hasa

2. • Ovarian cancer is still the most frequent cause of
death by gynecological malignancy for women in
developed countries.
• The lifetime probability for developing ovarian
cancer is less than 2 percent .
• The incidence of ovarian cancer increases with age.

3. • One large-scale prospective clinical screening trial
found that screening did not reduce mortality from
ovarian cancer but did result in harm from
consequent follow-up.
• There is a consensus that women at average risk for
ovarian cancer should NOT undergo screening.

4. • Recently, a new classification of ovarian cancer in two
different types of cancer has been introduced, where
type II ovarian tumors are considered the most
frequently diagnosed, aggressive, genetically instable
and often advanced.
• One of the more important finding in last decade of
gynecologic oncology is the confirmed theory that
types II tumors derive from the epithelium of the
Fallopian tube, whereas clear cell and endometrioid
tumors derive from endometrial tissue that migrate to
the ovary by retrograde menstruation.

5. RISK FACTORS
• Age
• familial ovarian cancer syndrome/family
history of ovarian cancer
• Infertility
• Endometriosis
• Perimenopausal or postmenopausal hormone
therapy

6. RISKS AND BENEFITS OF SCREENING
• The potential benefit of screening is its ability to
identify ovarian cancer at a more localized and
curable stage, leading to reduced mortality from the
disease.
• Although ovarian cancer is an important cause of
cancer death, its incidence and prevalence in the
general population are relatively low. The problem of
false-positive screening tests becomes critically
important in diseases with low prevalence.

7. Can ovarian cancer be
prevented?

8. The incessant ovulation hypothesis
• The incessant ovulation hypothesis states that
tumors result from recurrent minor trauma at the
time ovulation .
proliferation repair

9. The pituitary gonadotropin hormone
hypothesis
• In contrast, the pituitary gonadotropin hormone
hypothesis states that high levels of circulating
gonadotropins result in the production of estrogen
or estrogen precursors, which stimulate ovarian
surface epithelial proliferate excessively
malignant transformation.

10. The inflammation hypothesis
• Ness and Cottreau have suggested that
inflammation may play a role in the
development of the disease. In support of this
hypothesis:
– talc
– tubal ligation and hysterectomy
– medical conditions associated with inflammation,
such as endometriosis and pelvic inflammatory
disease have also been linked to ovarian cancer.

11. Others..
• The androgen/progesterone hypothesis
• The ovarian stromal hyperactivity hypothesis

12. STIC
• The detection of premalignant cells in the
epithelium of the fallopian tube has resulted in
revolutionary theories regarding the origin of
epithelial ovarian cancer (EOC).
• Serous tubal intra-epithelial carcinomas (STIC ) have
been detected in patients with BRCA 1 or 2
mutations and are considered as the most likely
precursors of the high-grade serous ovarian cancer
(HGSOC), which is the most common histological
subtype.

13. • The incidence of STIC detection in fallopian tube
specimens after extensive histopathological
processing is as follows:
– 2–7 % in risk-reducing salpingo-
oophorectomies(BRCA1/2 positive or familial risk)
– up to 80 % in surgical specimens of BRCA1/2
patients with HGSOC
– 46 % in patients with sporadic ovarian cancer

14. SO..

15. BSO/Salpingectomy
• Preservation of the ovarian function is important
both in the pre-menopausal age and in the post-
menopause, due to the effective prevention of bone
resorption, guaranteed by the intact ovaries .
• Furthermore, surgical menopause increases long-
term risk of psychosexual, cognitive and
cardiovascular dysfunctions and incidence of fatal
and non-fatal coronary heart diseases.

16. BSO/salpingectomy
• According to the existing literature, however,
whether bilateral salpingectomy impairs ovarian
reserve is still a matter of debate.
• Bilateral salpingectomy with ovarian preservation
should be considered, as the best preventive strategy
for women with low risk of ovarian cancer (not
carrying BRCA mutations).

17. Chemoprevention

18. Oral contraceptives
• Women who used oral contraceptives for 5 or more
years have about a 50% lower risk of developing
ovarian cancer compared with women who never
used oral contraceptives.
• Further observation showed that progestin-only
formulations, which do not suppress ovulation, are
as protective as combined estrogen and progestin
formulations.

19. Metformin
• Has strong anti-neoplastic effects in several cancers
through activation of AMP-activated protein kinase
which is a critical energy sensing pathway in cells.
• Metformin has a favorable effect both in the context
of prevention and as an adjuvant treatment.

20. NSAIDs
• The COX-2 inhibitors are a class of NSAIDS where
activity against tumor development has been
suggested for cancers of the ovary, colon, breast,
lung, and cervix.
• Lower serum levels of VEGF were noted in some
patients after treatment.

21. Retinol and vitamin A
• Retinol and vitamin A derivatives influence cell
differentiation, proliferation, and apoptosis and play
an important physiologic role in a wide range of
biological processes.

22. Green tea
• n vitro/in vivo studies assessed the use of green tea
in EOC treatment, it showed promising properties
such as the capacity to decrease the expression
and/or activity of a large spectrum of cancer-related
proteins.

23. PA
• Relative to obesity, previous pooled analyses have
demonstrated a significant direct association
between BMI and EOC risk.
• Moderate-intensity PA may also decrease cancer risk
by blunting chronic inflammation and enhancing
immune surveillance .
• The most probable mechanisms linking with cancer
risk and survival include decreased body fat, altered
reproductive hormone levels, altered cytokine and
growth factor milieu, and changes in immune
function (including reduced inflammation and
enhanced anti-tumor immunity) .

24. Thank you