Ovarian cancer: natural history and metastatic pattern.

Ovarian cancer begins at a molecular level, however to date, our knowledge of genetic changes and mechanisms of ovarian tumorigenesis is limited. The natural history of ovarian cancer may depend on different anatomo-clinical and biological factors. In the life history of ovarian cancers the stage, histology, tumor grade, age of the patient and gene abnormalities, both oncogenes (c-myc, H-ra, new) and oncosuppressor genes (p53, in particular), DNA ploidy and steroid receptor status have important prognostic significance. Residual disease, when less than 1 cm, is another important prognostic factor, being significantly associated to the survival and, progression free, improvement in the survival. In the low stage ovarian cancer (Stage IA, IB, IAII,IBII,IC,IIA,IIB,IIC), adjuvant treatment seems not to influence Disease Free Survival (DFS) or Overall Survival (OS) The exception to this rule is when cisplatin regimen is assessed, as it can highly reduce the relapse rate while the survival is not significantly influenced. Ovarian cancers disseminate, primarily by continuity. Lymphatic dissemination to the pelvic and para-aortic lymph nodes (40% of patients at stage III-IV disease) as well as to the peritoneum is common. At the time of diagnosis, bone or brain metastases are rarely present and their presence is not related to the histology or grading of the tumor.