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Ovarian Cancer Diagnosis and Pathology

Why expert pathology matters

Diagnosing a disease may seem simple and straightforward. And sometimes it is. But, as the gynecologic pathologists at Johns Hopkins have discovered through years of research and diagnostic experience, ovarian cancer is neither simple nor is it straightforward. That's because we understand that ovarian cancer is not one disease; rather, there are many types.

Obtaining the correct diagnosis from your pathologist is critical to selecting the best treatment option.

Decades of experience gives our gynecologic pathology team the ability to expertly and accurately diagnose ovarian masses—from the generally suspicious to the rare and unusual. Our ability to swiftly diagnose ovarian cancer within minutes of obtaining a biopsy allows patients in whom a malignancy is diagnosed to undergo further surgery immediately.

Our reputation has led to a global consultation service whereby every year we receive thousands of requests from all over the world for second opinions and consultations.

Uncovering the origins of ovarian cancer

“Until five years ago, we knew nothing about ovarian cancer's carcinogenesis. As we begin to understand the molecular beginnings, it turns out that the earliest precursor lesions of ovarian cancer actually begin in the fallopian tube. Based on these new findings, there’s a very good chance we can come up with an early detection test. It could lead to an entirely new approach to prevention and management,”
– Robert J. Kurman, M.D., director of the Division of Gynecologic Pathology at The Johns Hopkins Hospital

The pioneering research of Johns Hopkins gynecologic pathologists and our collaborators has changed our ideas about the very nature and origin of ovarian cancer.

We now recognize that ovarian cancer is not just one disease but a constellation of diseases, and that not all ovarian tumors originate from the same place, follow the same trajectory, or respond to the same treatment protocol.

In the past five years, we've begun using molecular biology techniques in an effort to tease apart the basis, or pathogenesis, of ovarian cancer. These techniques have led to strong evidence to support the idea that tumors we once thought originated in the ovaries actually begin in the fallopian tubes, and involve the ovaries secondarily. This new evidence is some of the most promising research related to ovarian cancer in decades.

As a result, we now believe that ovarian cancer can be divided into two broad categories: 

  • Type I tumors generally present in stage 1 (which means they are confined to the ovary), are slow growing, relatively stable genetically, and characterized by specific mutations that target precise cell signaling pathways. 
  • Type II tumors are highly aggressive, present in advanced stage, possess different mutations than Type 1 tumors (specifically, over 95 percent harbor a mutation of the p53 gene), and are genetically highly unstable.

By continually enhancing our understanding of ovarian cancer, we will, in turn, develop more individualized and effective approaches to its screening, diagnosis, and management.

Already, our ability to distinguish between different types of ovarian cancer and their trajectories has enabled us to prevent aggressive surgical treatment and preserve fertility in some patients. Future findings will allow us to practice individualized medicine to an even greater extent.

 

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