Ovarian cancer is the 8^th most common cancer affecting women worldwide. It is also the 8^th most common cause of cancer deaths in women worldwide. In the first blog of this masterclass series, we discussed the symptoms and frequency of misdiagnosis of this cancer. If you missed it, please click here.

In 2022, 325,000 people were diagnosed with ovarian cancer and of these diagnoses 207,000 people died of it. According to Globocan’s projections made in 2022, worldwide diagnoses will increase over 55% by 2050. If nothing changes, Globocan has predicted that an estimated 8 million people will die of ovarian cancer yearly.

There are multiple different types of ovarian cancer including:

Epithelial ovarian cancer
This is the most common type of ovarian cancer, accounting for around 90% of cases diagnosed. The epithelium is the cells that line or cover the fallopian tubes and ovaries. Epithelial ovarian cancer is an umbrella term which covers several subtypes including:

• High-grade serous carcinoma – The most common type, usually affecting people ages 40-60 years
• Low-grade serous carcinoma – Usually affects younger people of 45 -55 years of age
• Endometrioid ovarian cancer – Affects people of all ages and can sometimes be linked to endometriosis
• Clear-cell carcinoma – Rarer type accounting for about 3-5% of epithelial ovarian cancers
• Mucinous ovarian cancer – Generally found in people over 50 and can be benign or malignant
• Unclassified or undifferentiated tumours – Cancers that don’t fit neatly into a category, accounting for around 15% of epithelial tumours
• Brenner tumours – Rare type accounting for only 2% of epithelial cancers, affecting people over 40 years of age
• Ovarian carcinosarcoma – This type displays a combination of epithelial and stromal characteristics and are usually found in the uterus

Germ cell ovarian cancer
These are rare accounting for around just 5% of ovarian cancer cases, usually affecting younger people up to their early 30s. It is often benign but there are malignant variations:

Benign

• Mature teratomas – The benign type, sometimes called a dermoid cyst. Often affects people anywhere between their teens to 40s.

Malignant

• Immature teratomas – Affects teenagers and people in their early 20s with usually quite good outcomes
• Dysgerminomas tumours – This is a rare type and mainly affects ovary owners of 15-45 years old
• Mixed germ cell tumours – Ovarian tumours made up of more than two types of germ cell tumours
• Ovarian yolk sac tumour – Sometimes known as an endodermal sinus tumour, usually occurring in children and young adults

Sex cord stromal tumours
These cancers are rare and can be benign or malignant. There are 3 main types, based on which cells make up the tumour:

• Pure stromal tumours – Made up only of stromal cells and are usually benign
• Pure sex cord tumours – Also usually benign with several subtypes including granulosa (malignant type), juvenile granulosa and adult granulosa cell tumours
• Mixed sex cord stromal tumours – Made up of a combination of both sex cord cells and stromal cells with multiple subtypes including androblastomas, gynandroblastomas and SCTAT (sex cord stromal tumour with annular tubules)

Primary peritoneal and fallopian tube cancer
These, although not ovarian cancer, are closely related and often grouped together because they are treated in the same way. Since the cancer cells can travel to the peritoneum or fallopian tubes, it is often difficult to determine whether fallopian tube cancer is just that or whether it is ovarian cancer that has spread to the fallopian tubes.

Borderline ovarian tumours
These are abnormal cells which are not yet cancerous and can be removed with relative ease through surgery.

As you can see, there are an incredibly wide range of types of ovarian cancers. Each type has differing survival rates but the most common, epithelial cancers and in particular the high-grade serous types, tend to be the most aggressive with the lowest survival rates. They spread easily, grow quickly and are often diagnosed at a later stage, making it more difficult to treat. Germ cell tumours often grow quickly leading to a rapid onset of pain, which can be more obvious than the insidious gastrointestinal symptoms of other types (e.g. bloating, indigestion, change in bowel habit etc). The rarer types, such as stromal cell ovarian cancers, which often involve a change in hormonal production, tend to have higher survival rates due to their more obvious symptoms at an earlier stage. Survival rates depend heavily on the stage the cancer is diagnosed at, how the cancer responds to the treatments and the patient’s overall health.

In our next instalment, we will discuss the current available treatments and treatments that are currently in development. Ovarian cancer kills more people with female reproductive organs each year than the other 4 gynae cancers combined. It is vital to maintain awareness of one’s body and pay attention to the messages it is sending you – prevention and early diagnosis can quite literally save your life. Click here to read the third and final instalment.