Ovarian surface epithelial tumors

Definitions & Key takeaways

Surface epithelial-stromal tumors (SESTs), are tumors that arise from the ovarian surface epithelium, ectopic endometrial tissue, fallopian tube epithelium, or the endocervix. They can occur in many organs and tissues, including the ovaries, uterus, and other parts of the reproductive tract. These tumors can vary in size and type and can have variable clinical behaviors depending on the type. Treatment may include surgery, chemotherapy, radiation, and other therapies, depending on the type and severity of the tumor.

Chapters:

Watch video only

Introduction0:00–0:17

Epithelial refers to the surface lining, and ovarian refers to ovary, of which women have two that sit along either side of the uterus so epithelial ovarian cancer, is a cancer that forms along the surface of an ovary.

Pathology0:17–1:19

Now, each ovary contains multiple follicles. And, each follicle is made up of a germ cell, also known as an oocyte, which is the immature egg.
Between the follicles is the stromal or connective tissue cells, and lining the ovary is a layer of epithelial cells. Ovarian tumors are generally grouped based on these three types of cells in the ovaries, and the majority of ovarian cancers are epithelial kind.
Now, if an epithelial cell starts to divide uncontrollably, it can either be a benign tumor which means that it does not invade nearby tissue or spread to other parts of the body, or it can be a malignant tumor which means that it might invade or spread to other tissues.
Compared with benign tumor cells, a distinguishing feature of malignant tumor cells have slightly less organized nuclei.
A third class of tumors are called borderline tumors because they have features that are intermediate between the other benign and malignant tumors.

Serous and mucinous tumors1:19–3:09

Epithelial ovarian cancers can be subdivided into four types: serous, mucinous, endometrioid and transitional. Serous and mucinous tumors arise from epithelial cells that line the outside of ovaries, whereas even though the tumors are found in the epithelium, the endometrioid and transitional cell tumors arise from other cell types.
Serous tumors have fluid-filled cysts, typically a single cyst, and can be benign, malignant, or borderline. Benign serous tumors are called serous cystadenomas, and are the most common type, and often develop on both ovaries, and typically affect premenopausal women.
Mucinous tumors, on the other hand, have mucus-filled cysts that often involve large multiloculated cysts, but can also be benign, malignant, or borderline.
Benign mucinous tumors are called mucinous cystadenomas, and often develop on only one ovary. The malignant type of serous tumors are called serous cystadenocarcinomas, and malignant mucinous tumors are called mucinous cystadenocarcinomas.
Both serous and malignant cystadenocarcinomas are cysts with an inflamed and swollen lining, and they commonly arise in postmenopausal women.
An interesting feature of serous cystadenocarcinomas is that they often contain psammoma bodies which are plaques with calcium and cellular debris.
Next are endometrioid tumors which come from endometrium-like cells which is ectopic, meaning they’re out of place, because those sorts of cells are usually found in the endometrium.

Endometrioid tumors3:09–3:44

Benign endometrioid tumors often have cysts filled with dark blood, so although these are called endometriomas, they are sometimes referred to as chocolate cysts.
Endometrioid tumors can be malignant, and the endometrium-like cells can spread out to other areas including the fallopian tubes and the peritoneal cavity.

Transitional cell tumors3:44–4:04

Finally there are transitional cell tumors which are also called Brenner tumors, named after the german pathologist, Fritz Brenner who first discovered them.
These tumors are made of transitional cells which can usually found in the lining of the bladder. These guys are pretty rare and usually solid, as opposed to cystic like the others.

Causes and risk factors4:04–5:24

So, during ovulation, the follicle ruptures and releases the egg, which inadvertently leads to epithelial cell damage. To fix that damage the epithelial cells have to undergo cell division to replace and heal the tissue.
Each time cells divide there is a chance of a mutation and the possibility of tumor formation, and this means that with more ovulatory cycles, there’s increased risk of tumor formation.
So things that are associated with a decreased risk of ovarian cancer include things that reduce the number of ovulatory cycles like pregnancy, breastfeeding, and oral contraceptive use.
On the flip side, some things that are associated with an increased risk include certain medical conditions like endometriosis and polycystic ovarian syndrome.
There are also genetic risk factors like having the BRCA-1 or BRCA-2 mutation, which are both autosomal dominant mutations, which in addition to ovarian cancer, carry with them an increased risk of breast cancer.
There’s also hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome, which increases the risk of developing a number of cancers, including ovarian cancer.

Symptoms5:24–6:08

Generally speaking, symptoms of ovarian cancers can be subtle and non-specific. Common early symptoms can include abdominal distension, bloating, as well as abdominal or pelvic pain, which can come from an ovarian torsion - where the ovary gets twisted.
Occasionally, ovarian tumors can cause ascites, abdominal masses, bowel obstruction, or dyspareunia, which is pain during sexual intercourse.
A classic finding is a “sister mary joseph nodule”, which happens when it metastasizes to the umbilicus. This finding is often linked with a few types of cancer - one of which is ovarian cancer.

Diagnosis6:08–6:34

Diagnosis of ovarian cancer typically involves looking for specific tumor markers like B-hCG, as well as having a transvaginal ultrasound.
Tumor biopsies are done to figure out whether a growth is benign or malignant, and imaging with a CT or MRI scan can be done to look for evidence of metastasis.

Treatment6:34–7:06

Treatment of ovarian cancer typically involves chemotherapy, surgery, and sometimes radiotherapy. Surgery might be enough for malignant tumors confined to the ovary, whereas chemotherapy may be needed for disease that spread.
Carbohydrate antigen 125, called CA 125, is a protein made by various types of ovarian tumors, so tracking levels of this biomarker in the blood can help monitor response to therapy and potential relapse.

Review7:06–7:43

All right, as a quick recap: epithelial ovarian cancers include serous and mucinous tumors, which originate from normal epithelial cells that line the outside of the ovaries, as well as endometrioid tumors, or chocolate cysts, and transitional or Brenner tumors, both of which have ectopic cell origins.
Increased risk for developing ovarian cancers is associated with increased cumulative amount of time a woman spends in ovulation, and decreased risk is associated with pregnancy, breastfeeding, and oral contraceptive use.