Pathogenetic concepts and treatment of serous ovarian cancer of the initial stages at the present time
Summary. There are two signaling pathways for the development of serous ovarian cancer. According to Kurman’s molecular-biological dualistic concept, low-grade serous ovarian cancer (type I) develops from borderline serous tumors, and high-grade serous ovarian cancer (type II) develops from the occult intraepithelial carcinoma of the fimbrial region of fallopian tube — «serous tubal intraepithelial carcinoma» with secondary involvement of the ovary in the tumor process, or from the ovarian cortical inclusion cyst, which is formed from a normal fimbrial epithelium implanted on the denuded ovarian surface at the site of rupture when ovulation occurs, that underwent malignant transformation. Most cases of serous ovarian cancer in the early stages are represented by type I tumors. Surgery with adequate staging is the main method of treating serous ovarian cancer in early stages. As a standard, surgical treatment includes complete abdominal hysterectomy, bilateral salpingo-oophorectomy, omenectomy, peritoneal washings, peritoneal biopsy, revision of abdominal cavity and retroperitoneal space for evaluation of pelvic and paraaortal lymph nodes. The conservative operation in the volume of unilateral adnexectomy with adequate staging on the basis of the consilium is possible for young patients with stage Іa of the disease. Surgical laparoscopy can be used in the treatment of serous ovarian cancer of the I–IIa stages with great caution, and with careful selection of patients at the diagnostic stage. Adjuvant chemotherapy using taxanes/carboplatin or carboplatin only for 3–6 courses is performed in patients with an intermediate or high risk of relapse or in case of inadequate staging.
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