Ovarian squamous cell carcinoma: Difference between revisions

Ovarian Squamous Cell Carcinoma
Ovarian Squamous Cell Carcinoma
	Squamous Ovarian Cell Carcinoma
Symptoms	Vaginal pain and discomfort, pain during sex, abdominal pain, post-menopausal bleeding,
Usual onset	Females older than 45 years old
Causes	Non-pre-existing ovarian lesions (primary) or pre-existing ovarian lesions (Mature Cystic Teratoma, endometriosis, Brenner tumor)
Diagnostic method	CT-scans, Ultrasound, biopsy
Prevention	PAP test, Preventive healthcare visits
Treatment	Surgery, Ionizing Radiation, Chemoradiotherapy, Immunotherapy, Platinum-based chemotherapy
Frequency	account 1% of ovarian cancer

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See also: Ovarian Cancer and Squamous Cell Carcinoma

Ovarian Squamous Cell Carcinoma (oSCC) or Squamous Ovarian Carcinoma (SOC) is a rare tumor that accounts for 1% of ovarian cancer^[1]. The World Health Organization has a way of classifying ovarian cancer, and it now includes a new kind called ovarian squamous cell carcinoma^[2]. This mainly affects elderly women (above 45 yrs old), and how well someone survives it depends on how advanced the disease is and how different the cancer cells are. The main subtypes of ovarian carcinoma include high-grade serous (68–71%), low-grade serous (3–4%), endometrioid (9–11%), clear cell (12–13%), and mucinous (3%)^[3]. Potentially, the earliest reported instance of pure primary SCC goes back to 1988 by Ben-Baruchet^[4]; oSSC emerging from pre-existing lesions, cases have been recorded since the early 1950s

As for 2023, "The Cancer Genome Atlas" (TCGA) is executing the TCGA-OV project^[5], involving 608 ovarian cancer cases. Within the TCGA-OV project, these cases have been sorted based on sample types, and 600 of these, fall under Cystic, Mucinous and/or Serous Neoplasms disease type. Squamous ovarian carcinoma is a recognized but uncommon diagnosis, often originating from a transformation of mature cystic teratoma (MCT). Unlike other squamous cell carcinomas, factors like UV exposure and direct tobacco use play a less significant role. Chronic inflammation in MCT and human papillomavirus (HPV) infection are linked to its development^[3]^[6]. The tumor emerges through metaplasia of the ovarian surface epithelium. While MCT is the primary source in most cases, others are associated with endometriosis or Brenner tumor, and rare metastasis from other organs can also lead to squamous ovarian carcinoma^[7].

Treatments for SCC involve surgery, chemotherapy, and radiotherapy, but health-professionals and researchers are not sure how well these extra treatments work. While there's no specific chemotherapy plan for ovarian SCCs, doctors often suggest using platinum-based chemotherapy^[8]. Some cases have done well with a combination of paclitaxel and cisplatin. Because ovarian SCC is so rare and connected to endometriosis, more research is needed, and we might want to try a mix of chemotherapy and radiation therapy after surgery because this cancer type seems to respond to radiation.

Pathology

Mature cystic teratoma (MCT):

See also: Teratoma

MCT, affecting women in 10-20% of cases during their lifetime, is characterized by benign mature cystic teratomas—an intriguing subject in gynecological pathology^[9]^[3]. These non-cancerous tumors, originating from at least two embryonic germ cell layers, exhibit a complex interplay of developmental pathways, stemming from singular germ cells or the complexities of meiosis I and II failure^[10]^[11]. Internally lined with squamous epithelium and externally connected to the ovarian stroma, mature cystic teratomas contain diverse fluids such as sebaceous, serous, or mucinous.

Although the majority of MCT cases are non-malignant, approximately 0.17-2% may undergo malignant transformation, with squamous cell carcinoma being the most prevalent, constituting 80% of such transformations^[12]. The clinical presentation of oSCC development within MCT lacks specificity, often resulting in the inadvertent discovery of early-stage tumors during routine examinations or postoperative assessments. In advanced cases, patients may exhibit palpable masses, abdominal swelling, and pain, potentially leading to acute abdominal complications due to tumor involvement^[11]^[13]^[6]. Diagnosing this condition remains challenging as preoperative imaging and laboratory tests lack specific indicators.

Brenner Tumor (BT):

See also: Brenner Tumor

Brenner Tumor (BT) are infrequent ovarian growths composed of specialized ovarian cells surrounded by dense fibrous tissue. Typically small (less than 2 cm), these tumors are often discovered incidentally in women without apparent symptoms^[2]. However, when a BT is borderline or malignant, indicating a potential for cancer, it may lead to symptoms such as an abdominal lump, abdominal pain, and post-menopausal bleeding. Less common signs include nausea, vomiting, back pain, bowel problems, reduced appetite, and weight loss.

Differentiating between benign (non-cancerous) and malignant (potentially cancerous) BTs poses a challenge as they appear similarly in medical images^[14]. The definitive diagnosis involves examining tissue under a microscope (histopathology). Benign BTs exhibit a consistent fibrous structure, a distinctive characteristic. They may also manifest as a cystic mass with multiple compartments, particularly associated with other ovarian growths^[15].

Endometriosis:

See also: Endometriosis

oSCC tumors from endometriosis are rare. There are criteria to figure out if oSCC comes from endometriosis, but they're kind of old and not easy to use. Individuals with this type of cancer are usually under 50, have a more severe form of the disease, and often feel abdominal pain^[3].

Conditions for verifying whether the SCC originated as Endometriosis or Not^[8]^[16]
Development from the Same Ovary	Growth Inside Endometriosis Tissue	Presence of Endometriosis Indicators	Microscopic Observation of Benign Epithelium
Both endometriosis and squamous epithelial cells must develop in the same ovary. The correlation between tissues from benign endometriosis and malignant SCC should show a pattern similar to a malignant tumor that originates from the endometrium.	The malignant tumor has to grow within the tissue of endometriosis. It should not be transferred from the outside of endometriosis to the inside.	Tissue characteristics indicative of endometriosis, such as endometrial stroma, evidence of old hemorrhage, hemosiderin pigmentation, etc., need to be present.	Microscopic examination should reveal a part changing to benign epithelium.

Screening and Diagnosis

Similar to other ovarian cancers patients can undergo a series of tests to identify characteristics and/or markers. This test includes a pelvic exam, Imaging (CT, MRI, ultrasound), blood test, and in some cases biopsy with histopathology.

Pelvic Examination

Main article: Pelvic examination

A pelvic examination is the physical examination of the external and internal female pelvic organs. The most commonly performed components of the exam are 1) the external exam, to evaluate the external genitalia 2) the internal exam with palpation (commonly called the bimanual exam) to examine the uterus, ovaries, and fallopian tubes, and 3) the internal exam using the speculum to visualize the vaginal walls and cervix^[17]. Nonetheless, routine screening test as Pap test or HPV are usually not effective for detecting ovarian cancer^[18].

Imaging

The diagnostic journey unfolds through imaging, with ultrasound taking the lead in evaluating symptoms in young females, portraying these tumors as predominantly cystic lesions adorned with echogenic elements. While ultrasound and computed tomography (CT) contribute significantly to the initial assessment, magnetic resonance imaging (MRI) emerges as a key player, excelling in soft tissue characterization and revealing hidden intricacies. In the exploration of metastatic potential, CT and MRI, coupled with diffusion-weighted imaging, offer crucial insights, particularly in detecting gliomatosis peritonei^[11].

Computed Tomography (CT)

Computed Tomography (CT) scans is a diagnostic x-ray procedure that generates detailed cross-sectional images of the body, facilitating the detection of potential ovarian cancer spread to other organs^[19]. While CT scans may not effectively visualize small ovarian tumors, they have the capability to detect larger tumors and evaluate their potential invasion into nearby structures. Additionally, CT scans can identify enlarged lymph nodes, signs of cancer spreading to the liver or other organs, and indications of an ovarian tumor impacting the kidneys or bladder. Although CT scans are not commonly used for biopsying ovarian tumors, they can be utilized in the biopsy of suspected metastases through a technique known as CT-guided needle biopsy^[19]. In this procedure, the patient remains on the CT scanning table as a radiologist guides a biopsy needle toward the mass, with repeated scans ensuring accurate placement.

The difficulty in screening for SCC revolves around the creation of effective strategies with a positive predictive value. The timing aspect is crucial due to the lack of a specific timeframe for the onset of invasive disease or the interval stage between stage I and stage III carcinomas^[20]. Ultrasound screening provides a detailed view of the ovaries, identifying morphologic changes as potential signs of malignancy. Key diagnostic factors include the presence of abnormalities, ovarian size, blood flow, and abdominal/pelvic fluid. The persistence of abnormalities after 4 to 6 weeks may decrease the occurrence of false positives. Screening protocols, often based on morphologic indices, utilize transvaginal ultrasound findings like cyst wall structure, septation, papillary projections, echogenicity, and ovarian volume to effectively detect malignancy^[20].

Magnetic resonance imaging (MRI):

Magnetic Resonance (MRI) scans use powerful magnets instead of x-rays to create detailed cross-sectional images of internal structures, and the injection of gadolinium into a vein enhances image details^[19]. Although MRI scans are not commonly employed for ovarian cancer detection, it is important to note that the majority of ultrasound-detected ovarian masses are usually benign. The combined approach of ultrasound with Doppler, along with the selective use of contrast-enhanced MRI, proves to be an efficient diagnostic method for identifying benign adnexal masses with distinctive features, including functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, hydrosalpinx, and peritoneal inclusion cysts^[22]. This integrated diagnostic strategy is effective in preventing unnecessary surgical intervention. Additionally, the use of MRI contributes to a decrease in false-positive diagnoses, ultimately reducing the overall number of unnecessary surgical procedures related to ovarian masses.

Advantages and Limitations of Using MRI to diagnose SCC^[23]:
Advantages:	Limitations
1. Higher soft-tissue contrast compared to computed tomography. 2. No radiation exposure, making it suitable for individuals with iodinated contrast agent contraindications, pregnant women, and those of childbearing age. 3. Characterization of tissues through DCE-MRI and DWI allows a move from morphologic assessment to tumor vascularity and cellularity. 4. Improved inter-observer agreement with the addition of DWI to the MRI protocol. 5. DWI and DCE-MRI quantitative parameters can potentially serve as biomarkers of prognosis and response.	1. Long examination time. 2. Technical difficulties covering a large field of view with adequate resolution. 3. Susceptibility to patient and bowel motion. 4. High cost and limited availability. 5. Expertise in interpreting abdominal MRI is usually available only in specialist centers. 6. Limitations based on the use of contrast agents or the technique itself, such as potential false-positive and false-negative results. 7. Need for patient preparation, including fasting and the use of antiperistaltic agents, to improve examination quality. 8. Gadolinium-based contrast agents should be used cautiously in women with renal insufficiency. 9. Limited sensitivity for lesions smaller than 1 cm, especially in areas with similar signal intensity. 10. Limited sensitivity and specificity for assessing lymph node metastasis based on size criteria alone.

Histopathology

Biopsy techniques, including excisional biopsy for complete lesion removal, are employed in suspected cancer cases. The examination of the specimen involves assessing surgical margins, where "clear margins" indicate no disease spread, while "positive margins" may require wider excision. In situations where intact removal is impractical, needle-based methods like core biopsy or fine needle aspiration may be utilized^[24].

Pathologic examination of biopsies helps distinguish between benign and malignant lesions, aiding in the identification of different cancer types. Larger excisional specimens, known as resections, provide comprehensive information about the cancer, its sub classification, histologic grading, and the extent of its spread, contributing to the pathologic staging. In cases where visible growth^[25] or malignant transformation is not apparent^[26], a precise grossing and thorough histopathological examination are essential for an accurate diagnosis. Additionally, conducting situ hybridization for HPV DNA is crucial to rule out the potential involvement of papillomavirus in this condition. To distinguish between primary ovarian serous carcinoma (OSC) and metastatic squamous cell carcinoma (SCC), various immunohistochemical markers such as PAX8, p16, WT1, ER, p53, and CK5/6 are utilized^[26]. The p53/p16 index was recognized as a valuable indicator for high-grade OSC, demonstrating diffuse p53 expression or complete absence (null type) along with diffuse p16 expression^[26].

Prognosis

Literature indicates that oSCC typically presents with a mean tumor size of 14.8 cm, and overall survival does not vary based on tumor size^[9]. Clinical manifestations include abdominal pain and a palpable abdominal mass. The research establishes a correlation between cancer stages and time of diagnosis, revealing that higher stages and delayed diagnoses are associated with a worse prognosis^[9]^[8]^[2]. Notably, hysterectomy reduces the risk of death, while lymphadenectomy does not demonstrate improved survival. Fertility-sparing surgery shows no difference in mortality compared to radical surgery in younger patients (under 45 years old)^[13]. Adjuvant chemotherapy enhances survival in advanced stages, with platinum-based chemotherapy ^[28] linked to a better prognosis. However, radiotherapy and chemoradiotherapy do not improve survival^[3]^[8].

oSCC exhibits locally invasive characteristics, with tumors demonstrating invasiveness or adherence to the adjacent uterus, pelvic structures, and colonic peritoneum, making surgery the crucial treatment. The standard approach for treating the malignant transformation of mature cystic teratoma of the ovary (MCTO) involves extensive surgery and subsequent chemotherapy, especially for advanced cases^[26]^[9]^[28]. Recommended for patients not seeking fertility, the surgical procedure includes bilateral salpingo-oophorectomy, hysterectomy, comprehensive surgical staging, and lymphadenectomy^[7]^[9]^[3]. Following surgery, advanced cases receive adjuvant chemotherapy with paclitaxel and carboplatin, although the overall prognosis is generally less favorable than that of common epithelial ovarian cancer. Poor prognostic factors include age over 45 or 55, advanced staging, larger tumors, high cancer grade, absence of hysterectomy, presence of residual tumor lesions, lack of adjuvant chemotherapy, and the use of non-platinum-based chemotherapy. In cases of recurrence, secondary cytoreductive surgery may be considered, revealing efficacy in selected cases with recurrent malignant transformation of MCTO^[22]^[8]^[3].

Additional treatment options suggest the use of targeted therapies for squamous cancers, particularly those with elevated Epidermal growth factor receptor (EGFR) levels, which remains somewhat limited^[9]^[10]. Elevated EGFR expression is identified in squamous cell carcinomas of the head and neck as well as the cervix, indicating potential benefits from EGFR inhibition regardless of HPV tumor status^[3]^[9]. Studies show improved overall survival in advanced head and neck cancers treated with a combination of cetuximab and radiotherapy. Promising outcomes are also observed in cervical cancer with a regimen involving erlotinib, radiotherapy, and cisplatin. Furthermore, the anti-VEGF monoclonal antibody bevacizumab demonstrates improved survival in recurrent or metastatic cervical cancer when combined with chemotherapy.

Management/Treatment

Surgery

Main Article: Ovarian Cancer

Treatment for ovarian cancer often involves surgical procedures to diagnose and remove affected tissues. The choice of surgery depends on the cancer's stage, type, and grade, offering options such as unilateral or bilateral oophorectomy, along with the removal of the Fallopian tubes, uterus, and omentum. In cases of low-grade cancers, fertility preservation may be possible, but the presence of microscopic metastases introduces the need for additional surgery. Unilateral surgery is typically employed for germ cell tumors. Achieving complete cytoreduction is essential for managing advanced epithelial ovarian cancer, while debulking surgery aims to remove as much tumor as possible, enhancing the effectiveness of chemotherapy.

An alternative approach involves interval debulking surgery, which combines neoadjuvant chemotherapy with post-debulking chemotherapy. While laparoscopic surgery is suitable for early-stage cancer, advanced cases require more extensive procedures like lymphadenectomy. Secondary surgery may be an option for recurrent cases, effectiveness depending on factors such as surgical technique and the extent of the disease. Oophorectomy's primary side effect, early menopause, can be alleviated with hormone replacement therapy. Hospitals with higher surgical volumes tend to have better surgery outcomes, and the choice between laparoscopy and laparotomy for stage I ovarian cancer remains uncertain. Aggressive surgeries are associated with improved outcomes in advanced stages, despite the presence of perioperative

Lymphadenectomy

Main Article: Lymphadenectomy

Lymphadenectomy, or the surgical removal of lymph nodes, is commonly undertaken in cancer management, with regional and radical dissections differing in the extent of node removal. A meta-analysis research of published randomized controlled trials comparing lymphadenectomy versus no lymphadenectomy in epithelial cancers of the ovary, suggest that overall survival did not demonstrate significance^[29]. However, the meta-analysis is unique for focusing on randomized trials, using hazard ratios, and treating ovarian carcinoma as a unified entity^[29]. In some cases, complications of lymphadenectomy include lymphedema, and the effectiveness of wound drainage in reducing complications after groin lymph node dissection remains uncertain.

Hysterectomy

Main Article: Hysterectomy

A systematic review and meta-analysis^[30] have uncovered a shift in the relationship between hysterectomy and ovarian cancer risk over time. Studies predominantly involving women diagnosed before 2000 suggested a reduced ovarian cancer risk with hysterectomy, whereas those with post-2000 diagnoses indicated a positive association^[30]. This shift appears unrelated to declining response rates or changes in hysterectomy frequency. The study's strengths lie in its thorough literature search and exploration of potential causes for this temporal change. However, limitations include reliance on published studies, potential publication bias, and a focus on predominantly U.S.-based recent studies^[30]. Clinically, the findings caution against advising women that hysterectomy alone reduces ovarian cancer risk, highlighting the need for further evidence on risk-reducing strategies like bilateral salpingectomy with ovarian

Oophorectomy

Main Article: Oophorectomy

Oophorectomy is performed to treat issues like removing risks that could lead to ovarian cancer, cysts, or to treat a twisted ovary.^[31]

Ionization therapy or Radiation therapy

Main Article: Radiation therapy

Typically, a combination of treatments, including surgery, external beam radiotherapy, brachytherapy, and/or chemotherapy, is frequently employed for these uncommon cancers. Specialized centers and networks have been created to streamline the care of these cancers, underscoring the importance of gaining a deeper understanding of the role of radiotherapy^[32]. This understanding could potentially enhance control over the local region, improve quality of life, and increase survival rates. Nevertheless, there is some indication, supported by certain case series, that radiation, particularly when paired with concurrent chemotherapy following aggressive cytoreduction, may be beneficial for certain cases of oSCC originating from teratomas, given the radiosensitive nature of this tumor^[7].

Chemotherapy

Main Article: Chemotherapy

Platinum-based chemotherapy

Main Article: Platinum-based chemotherapy

Addition of platinum-based chemotherapy drugs to chemoradiation in women with early cervical cancer seems to improve survival and reduce risk of recurrence^[33]. For patients diagnosed with oSSC, reports show that combination treatment most commonly with these platinum-based antineoplastic agents: Carboplatin, Bevacizumab, Cisplatin, Erlotinib^[7]^[10]. Nontheless, there are not the only ones and there are multiple prototyopes in devevelopment and or in clinical trials.

Immunotherapy

Main Article: Immunotherapy

Immunotherapy has gained significant traction in oncology, demonstrating safety and effectiveness in treating various solid tumors. However, its adoption in platinum-resistant ovarian cancer remains unsupported by studies, prompting a need for further investigation^[34]. Nonetheless, evidence indicates that combining chemotherapy with the humanized anti-VEGF monoclonal antibody, bevacizumab, in the treatment of recurrent, persistent, or metastatic cervical cancer results in a 3.7-month enhancement in overall survival^[3].

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^ Morcet-Delattre, R.; Espenel, S.; Tas, P.; Chargari, C.; Escande, A. (2023-12-01). "Role of radiotherapy in the management of rare gynaecological cancers". Cancer/Radiothérapie. 27 (8): 778–788. doi:10.1016/j.canrad.2023.08.006. ISSN 1278-3218. PMID 37925347. S2CID 264990398.
^ Falcetta, Frederico S; Medeiros, Lídia RF; Edelweiss, Maria I; Pohlmann, Paula R; Stein, Airton T; Rosa, Daniela D; Platt, Joanne (2016-11-22). Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group (ed.). "Adjuvant platinum-based chemotherapy for early stage cervical cancer". Cochrane Database of Systematic Reviews. 2022 (1): CD005342. doi:10.1002/14651858.CD005342.pub4. PMC 6473195. PMID 27873308.
^ Yang, Chang; Xia, Bai-Rong; Zhang, Zhao-Cong; Zhang, Yong-Jian; Lou, Ge; Jin, Wei-Lin (2020). "Immunotherapy for Ovarian Cancer: Adjuvant, Combination, and Neoadjuvant". Frontiers in Immunology. 11. doi:10.3389/fimmu.2020.577869. ISSN 1664-3224. PMC 7572849. PMID 33123161.

External links

www.example.com

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@@ Line 11: / Line 11: @@
 | frequency     = account 1% of [[ovarian cancer]]
 | treatment     = Surgery, [[Radiation therapy|Ionizing Radiation]], [[Chemoradiotherapy]], [[Immunotherapy]], [[Platinum-based chemotherapy]]
-}}'''Ovarian Squamous Cell Carcinoma (oSCC) or Squamous Ovarian Carcinoma''' '''(SOC)''' is a rare tumor that accounts for 1% of [[ovarian cancer]]<ref>{{Cite journal |last=Srivastava |first=Himsweta |last2=Shree |first2=Sneha |last3=Guleria |first3=Kiran |last4=Singh |first4=Usha R |date=2017-5 |title=Pure Primary Squamous Cell Carcinoma of Ovary – A Rare Case Report |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483757/ |journal=Journal of Clinical and Diagnostic Research : JCDR |volume=11 |issue=5 |pages=QD01–QD02 |doi=10.7860/JCDR/2017/16899.9771 |issn=2249-782X |pmc=5483757 |pmid=28658855}}</ref>. The [[World Health Organization]] has a way of classifying ovarian cancer, and it now includes a new kind called ovarian squamous cell carcinoma<ref name=":1" />. This mainly affects elderly women (above 45 yrs old), and how well someone survives it depends on how advanced the disease is and how different the [[Cancer cell|cancer cells]] are. The main subtypes of ovarian carcinoma include high-grade serous (68–71%), low-grade serous (3–4%), endometrioid (9–11%), clear cell (12–13%), and [[Mucinous neoplasm|mucinous]] (3%)<ref name=":2" />. Potentially, the earliest reported instance of pure primary SCC goes back to 1988 by Ben-Baruchet<ref>{{Cite journal |last=Ben-Baruch |first=Gilad |last2=Menashe |first2=Yehezkeal |last3=Herczeg |first3=Emil |last4=Menczer |first4=Joseph |date=1988-02 |title=Pure primary ovarian squamous cell carcinoma |url=https://doi.org/10.1016/0090-8258(88)90223-5 |journal=Gynecologic Oncology |volume=29 |issue=2 |pages=257–262 |doi=10.1016/0090-8258(88)90223-5 |issn=0090-8258}}</ref>; oSSC emerging from pre-existing lesions, cases have been recorded since the early 1950s
+}}'''Ovarian Squamous Cell Carcinoma (oSCC) or Squamous Ovarian Carcinoma''' '''(SOC)''' is a rare tumor that accounts for 1% of [[ovarian cancer]]<ref>{{Cite journal |last1=Srivastava |first1=Himsweta |last2=Shree |first2=Sneha |last3=Guleria |first3=Kiran |last4=Singh |first4=Usha R |date=2017-5 |title=Pure Primary Squamous Cell Carcinoma of Ovary – A Rare Case Report |journal=Journal of Clinical and Diagnostic Research : JCDR |volume=11 |issue=5 |pages=QD01–QD02 |doi=10.7860/JCDR/2017/16899.9771 |issn=2249-782X |pmc=5483757 |pmid=28658855}}</ref>. The [[World Health Organization]] has a way of classifying ovarian cancer, and it now includes a new kind called ovarian squamous cell carcinoma<ref name=":1" />. This mainly affects elderly women (above 45 yrs old), and how well someone survives it depends on how advanced the disease is and how different the [[Cancer cell|cancer cells]] are. The main subtypes of ovarian carcinoma include high-grade serous (68–71%), low-grade serous (3–4%), endometrioid (9–11%), clear cell (12–13%), and [[Mucinous neoplasm|mucinous]] (3%)<ref name=":2" />. Potentially, the earliest reported instance of pure primary SCC goes back to 1988 by Ben-Baruchet<ref>{{Cite journal |last1=Ben-Baruch |first1=Gilad |last2=Menashe |first2=Yehezkeal |last3=Herczeg |first3=Emil |last4=Menczer |first4=Joseph |date=February 1988 |title=Pure primary ovarian squamous cell carcinoma |url=https://doi.org/10.1016/0090-8258(88)90223-5 |journal=Gynecologic Oncology |volume=29 |issue=2 |pages=257–262 |doi=10.1016/0090-8258(88)90223-5 |issn=0090-8258}}</ref>; oSSC emerging from pre-existing lesions, cases have been recorded since the early 1950s
-As for 2023, [[The Cancer Genome Atlas|"''The Cancer Genome Atlas"'' (TCGA)]] is executing the TCGA-OV project<ref>{{Cite web |title=GDC |url=https://portal.gdc.cancer.gov/ |access-date=2023-12-07 |website=portal.gdc.cancer.gov}}</ref>, involving 608 ovarian cancer cases. Within the TCGA-OV project, these cases have been sorted based on sample types, and 600 of these, fall under Cystic, Mucinous and/or Serous Neoplasms disease type. Squamous ovarian [[carcinoma]] is a recognized but uncommon diagnosis, often originating from a transformation of [[Teratoma|mature cystic teratoma (MCT)]]. Unlike other [[Squamous-cell carcinoma|squamous cell carcinomas]], factors like UV exposure and direct tobacco use play a less significant role. Chronic inflammation in MCT and [[Human papillomavirus infection|human papillomavirus (HPV)]] infection are linked to its development<ref name=":2">{{Cite journal |last=Roxburgh |first=Patricia |last2=Glasspool |first2=Rosalind |date=2014-10-26 |title=Squamous Carcinoma of the Ovary |url=https://doi.org/10.1007/s11912-014-0413-1 |journal=Current Oncology Reports |language=en |volume=16 |issue=12 |pages=413 |doi=10.1007/s11912-014-0413-1 |issn=1534-6269}}</ref><ref name=":5">{{Cite journal |last=Koufopoulos |first=Nektarios |last2=Nasi |first2=Despoina |last3=Goudeli |first3=Christina |last4=Antoniadou |first4=Foteini |last5=Kokkali |first5=Stefania |last6=Pigadioti |first6=Eleni |last7=Provatas |first7=Ioannis |last8=Maggo |first8=Elpida |last9=Ardavanis |first9=Alexandros |last10=Terzakis |first10=Emmanouil |last11=Arkoumani |first11=Evdokia |last12=J Agnantis |first12=Niki |last13=Apostolikas |first13=Nikiforos |last14=Khaldi |first14=Lubna |date=2019 |title=Primary squamous cell carcinoma of the ovary. Review of the literature |url=https://pubmed.ncbi.nlm.nih.gov/31786837/ |journal=Journal of B.U.ON.: official journal of the Balkan Union of Oncology |volume=24 |issue=5 |pages=1776–1784 |issn=2241-6293 |pmid=31786837}}</ref>. The tumor emerges through metaplasia of the ovarian surface epithelium. While MCT is the primary source in most cases, others are associated with [[endometriosis]] or [[Brenner tumour|Brenner tumor]], and rare [[metastasis]] from other organs can also lead to squamous ovarian carcinoma<ref name=":0">{{Cite journal |last=Luo |first=Yan |last2=Bian |first2=Ce |date=2022 |title=Primary squamous cell carcinoma of the ovary. Review of the literature |url=https://www.frontiersin.org/articles/10.3389/fonc.2022.962613 |journal=Frontiers in Oncology |volume=12 |doi=10.3389/fonc.2022.962613 |issn=2234-943X |pmc=PMC9515541 |pmid=36185237}}</ref>.
+As for 2023, [[The Cancer Genome Atlas|"''The Cancer Genome Atlas"'' (TCGA)]] is executing the TCGA-OV project<ref>{{Cite web |title=GDC |url=https://portal.gdc.cancer.gov/ |access-date=2023-12-07 |website=portal.gdc.cancer.gov}}</ref>, involving 608 ovarian cancer cases. Within the TCGA-OV project, these cases have been sorted based on sample types, and 600 of these, fall under Cystic, Mucinous and/or Serous Neoplasms disease type. Squamous ovarian [[carcinoma]] is a recognized but uncommon diagnosis, often originating from a transformation of [[Teratoma|mature cystic teratoma (MCT)]]. Unlike other [[Squamous-cell carcinoma|squamous cell carcinomas]], factors like UV exposure and direct tobacco use play a less significant role. Chronic inflammation in MCT and [[Human papillomavirus infection|human papillomavirus (HPV)]] infection are linked to its development<ref name=":2">{{Cite journal |last1=Roxburgh |first1=Patricia |last2=Glasspool |first2=Rosalind |date=2014-10-26 |title=Squamous Carcinoma of the Ovary |url=https://doi.org/10.1007/s11912-014-0413-1 |journal=Current Oncology Reports |language=en |volume=16 |issue=12 |pages=413 |doi=10.1007/s11912-014-0413-1 |pmid=25344339 |s2cid=19909090 |issn=1534-6269}}</ref><ref name=":5">{{Cite journal |last1=Koufopoulos |first1=Nektarios |last2=Nasi |first2=Despoina |last3=Goudeli |first3=Christina |last4=Antoniadou |first4=Foteini |last5=Kokkali |first5=Stefania |last6=Pigadioti |first6=Eleni |last7=Provatas |first7=Ioannis |last8=Maggo |first8=Elpida |last9=Ardavanis |first9=Alexandros |last10=Terzakis |first10=Emmanouil |last11=Arkoumani |first11=Evdokia |last12=J Agnantis |first12=Niki |last13=Apostolikas |first13=Nikiforos |last14=Khaldi |first14=Lubna |date=2019 |title=Primary squamous cell carcinoma of the ovary. Review of the literature |url=https://pubmed.ncbi.nlm.nih.gov/31786837/ |journal=Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology |volume=24 |issue=5 |pages=1776–1784 |issn=2241-6293 |pmid=31786837}}</ref>. The tumor emerges through metaplasia of the ovarian surface epithelium. While MCT is the primary source in most cases, others are associated with [[endometriosis]] or [[Brenner tumour|Brenner tumor]], and rare [[metastasis]] from other organs can also lead to squamous ovarian carcinoma<ref name=":0">{{Cite journal |last1=Luo |first1=Yan |last2=Bian |first2=Ce |date=2022 |title=Primary squamous cell carcinoma of the ovary. Review of the literature |journal=Frontiers in Oncology |volume=12 |doi=10.3389/fonc.2022.962613 |issn=2234-943X |pmc=9515541 |pmid=36185237 |doi-access=free }}</ref>.
 Treatments for SCC involve surgery, [[chemotherapy]], and [[Radiation therapy|radiotherapy]], but health-professionals and researchers are not sure how well these extra treatments work. While there's no specific chemotherapy plan for ovarian SCCs, doctors often suggest using [[Platinum-based antineoplastic|platinum-based chemotherapy]]<ref name=":3" />. Some cases have done well with a combination of [[paclitaxel]] and [[cisplatin]]. Because ovarian SCC is so rare and connected to endometriosis, more research is needed, and we might want to try a mix of [[chemotherapy]] and [[radiation therapy]] after surgery because this cancer type seems to respond to radiation.
 == Pathology ==
 === Mature cystic teratoma (MCT): ===
-''See also'':  [[Teratoma]][[File:Meiosis Overview new.svg|thumb|215x215px|Ovarian Squamous Cell Carcinoma development from [[Teratoma|MCTO]] has been in linked to failure during [[meiosis]] I and II. ]][[Mature cystic teratoma|MCT]], affecting women in 10-20% of cases during their lifetime, is characterized by [[benign]] mature cystic teratomas—an intriguing subject in gynecological [[pathology]]<ref name=":10">{{Cite journal |last=Li |first=Congcong |last2=Zhang |first2=Qing |last3=Zhang |first3=Siying |last4=Dong |first4=Ruifen |last5=Sun |first5=Chenggong |last6=Qiu |first6=Chunping |last7=Zhang |first7=Zhiwei |last8=Yang |first8=Xingsheng |last9=Kong |first9=Beihua |date=2019-12 |title=Squamous cell carcinoma transformation in mature cystic teratoma of the ovary: a systematic review |url=https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5393-y |journal=BMC Cancer |language=en |volume=19 |issue=1 |doi=10.1186/s12885-019-5393-y |issn=1471-2407 |pmc=PMC6417039 |pmid=30866852}}</ref><ref name=":2" />. These non-cancerous tumors, originating from at least two embryonic [[germ cell]] layers, exhibit a complex interplay of developmental pathways, stemming from singular germ cells or the complexities of [[meiosis]] I and II failure<ref name=":12">{{Cite journal |last=Blackwell |first=William J. |last2=Dockerty |first2=Malcolm B. |last3=Masson |first3=James C. |last4=Mussey |first4=Robert D. |date=1946-02 |title=Dermoid Cysts of the Ovary: Their Clinical and Pathologic Significance**Abridgment of thesis submitted by Dr. Blackwell to the Faculty of the Graduate School of the University of Minnesota in partial fulfillment of the requirements for the degree of M.S. in Surgery. |url=https://linkinghub.elsevier.com/retrieve/pii/S0002937816398891 |journal=American Journal of Obstetrics and Gynecology |language=en |volume=51 |issue=2 |pages=151–172 |doi=10.1016/S0002-9378(16)39889-1}}</ref><ref name=":4">{{Cite journal |last=Laothamatas |first=Indira |last2=Fang |first2=Eric |last3=Lee |first3=Justine |last4=Abbas |first4=Syed Muhammad Hashim |last5=Ding |first5=Juan |last6=Kagen |first6=Alexander |last7=Zakashansky |first7=Konstantin |last8=Taouli |first8=Bachir |last9=Kamath |first9=Amita |last10=King |first10=Michael J. |date=November/December 2023 |title=Benign and Malignant Ovarian Teratomas: Multimodality Imaging Findings With Histopathologic Correlation |url=https://journals.lww.com/jcat/abstract/2023/11000/benign_and_malignant_ovarian_teratomas_.6.aspx |journal=Journal of Computer Assisted Tomography |language=en-US |volume=47 |issue=6 |pages=882 |doi=10.1097/RCT.0000000000001509 |issn=0363-8715}}</ref>. Internally lined with squamous epithelium and externally connected to the ovarian stroma, mature cystic teratomas contain diverse fluids such as [[Sebaceous cyst|sebaceous]], [[Serous fluid|serous]], or [[mucinous]].
+''See also'':  [[Teratoma]][[File:Meiosis Overview new.svg|thumb|215x215px|Ovarian Squamous Cell Carcinoma development from [[Teratoma|MCTO]] has been in linked to failure during [[meiosis]] I and II. ]][[Mature cystic teratoma|MCT]], affecting women in 10-20% of cases during their lifetime, is characterized by [[benign]] mature cystic teratomas—an intriguing subject in gynecological [[pathology]]<ref name=":10">{{Cite journal |last1=Li |first1=Congcong |last2=Zhang |first2=Qing |last3=Zhang |first3=Siying |last4=Dong |first4=Ruifen |last5=Sun |first5=Chenggong |last6=Qiu |first6=Chunping |last7=Zhang |first7=Zhiwei |last8=Yang |first8=Xingsheng |last9=Kong |first9=Beihua |date=December 2019 |title=Squamous cell carcinoma transformation in mature cystic teratoma of the ovary: a systematic review |journal=BMC Cancer |language=en |volume=19 |issue=1 |page=217 |doi=10.1186/s12885-019-5393-y |issn=1471-2407 |pmc=6417039 |pmid=30866852 |doi-access=free }}</ref><ref name=":2" />. These non-cancerous tumors, originating from at least two embryonic [[germ cell]] layers, exhibit a complex interplay of developmental pathways, stemming from singular germ cells or the complexities of [[meiosis]] I and II failure<ref name=":12">{{Cite journal |last1=Blackwell |first1=William J. |last2=Dockerty |first2=Malcolm B. |last3=Masson |first3=James C. |last4=Mussey |first4=Robert D. |date=February 1946 |title=Dermoid Cysts of the Ovary: Their Clinical and Pathologic Significance**Abridgment of thesis submitted by Dr. Blackwell to the Faculty of the Graduate School of the University of Minnesota in partial fulfillment of the requirements for the degree of M.S. in Surgery. |url=https://linkinghub.elsevier.com/retrieve/pii/S0002937816398891 |journal=American Journal of Obstetrics and Gynecology |language=en |volume=51 |issue=2 |pages=151–172 |doi=10.1016/S0002-9378(16)39889-1|pmid=21012750 }}</ref><ref name=":4">{{Cite journal |last1=Laothamatas |first1=Indira |last2=Fang |first2=Eric |last3=Lee |first3=Justine |last4=Abbas |first4=Syed Muhammad Hashim |last5=Ding |first5=Juan |last6=Kagen |first6=Alexander |last7=Zakashansky |first7=Konstantin |last8=Taouli |first8=Bachir |last9=Kamath |first9=Amita |last10=King |first10=Michael J. |date=November–December 2023 |title=Benign and Malignant Ovarian Teratomas: Multimodality Imaging Findings With Histopathologic Correlation |url=https://journals.lww.com/jcat/abstract/2023/11000/benign_and_malignant_ovarian_teratomas_.6.aspx |journal=Journal of Computer Assisted Tomography |language=en-US |volume=47 |issue=6 |pages=882–889 |doi=10.1097/RCT.0000000000001509 |pmid=37948362 |s2cid=259857697 |issn=0363-8715}}</ref>. Internally lined with squamous epithelium and externally connected to the ovarian stroma, mature cystic teratomas contain diverse fluids such as [[Sebaceous cyst|sebaceous]], [[Serous fluid|serous]], or [[mucinous]].
-Although the majority of MCT cases are non-malignant, approximately 0.17-2% may undergo malignant transformation, with [[Squamous-cell carcinoma|squamous cell carcinoma]] being the most prevalent, constituting 80% of such transformations<ref name=":11">{{Cite journal |last=Glasspool |first=Rosalind M. |last2=Martín |first2=Antonio González |last3=Millan |first3=David |last4=Lorusso |first4=Domenica |last5=Åvall-Lundqvist |first5=Elisabeth |last6=Hurteau |first6=Jean A. |last7=Davis |first7=Alison |last8=Hilpert |first8=Felix |last9=Kim |first9=Jae-Weon |last10=Alexandre |first10=Jérôme |last11=Ledermann |first11=Jonathan A. |date=2014-11 |title=Gynecologic Cancer InterGroup (GCIG) Consensus Review for Squamous Cell Carcinoma of the Ovary |url=https://ijgc.bmj.com/lookup/doi/10.1097/IGC.0000000000000209 |journal=International Journal of Gynecologic Cancer |language=en |volume=24 |issue=Supp 3 |pages=S26–S29 |doi=10.1097/IGC.0000000000000209 |issn=1048-891X}}</ref>. The clinical presentation of oSCC development within MCT lacks specificity, often resulting in the inadvertent discovery of early-stage tumors during routine examinations or postoperative assessments. In advanced cases, patients may exhibit palpable masses, abdominal swelling, and pain, potentially leading to acute abdominal complications due to tumor involvement<ref name=":4" /><ref name=":6">{{Cite journal |last=Luo |first=Yan |last2=Bian |first2=Ce |date=2022-09-14 |title=Primary squamous cell carcinoma of the ovary. Review of the literature |url=https://www.frontiersin.org/articles/10.3389/fonc.2022.962613/full |journal=Frontiers in Oncology |volume=12 |doi=10.3389/fonc.2022.962613 |issn=2234-943X |pmc=PMC9515541 |pmid=36185237}}</ref><ref name=":5" />. Diagnosing this condition remains challenging as preoperative imaging and laboratory tests lack specific indicators.
+Although the majority of MCT cases are non-malignant, approximately 0.17-2% may undergo malignant transformation, with [[Squamous-cell carcinoma|squamous cell carcinoma]] being the most prevalent, constituting 80% of such transformations<ref name=":11">{{Cite journal |last1=Glasspool |first1=Rosalind M. |last2=Martín |first2=Antonio González |last3=Millan |first3=David |last4=Lorusso |first4=Domenica |last5=Åvall-Lundqvist |first5=Elisabeth |last6=Hurteau |first6=Jean A. |last7=Davis |first7=Alison |last8=Hilpert |first8=Felix |last9=Kim |first9=Jae-Weon |last10=Alexandre |first10=Jérôme |last11=Ledermann |first11=Jonathan A. |date=November 2014 |title=Gynecologic Cancer InterGroup (GCIG) Consensus Review for Squamous Cell Carcinoma of the Ovary |url=https://ijgc.bmj.com/lookup/doi/10.1097/IGC.0000000000000209 |journal=International Journal of Gynecologic Cancer |language=en |volume=24 |issue=Supp 3 |pages=S26–S29 |doi=10.1097/IGC.0000000000000209 |pmid=25126954 |s2cid=205675510 |issn=1048-891X}}</ref>. The clinical presentation of oSCC development within MCT lacks specificity, often resulting in the inadvertent discovery of early-stage tumors during routine examinations or postoperative assessments. In advanced cases, patients may exhibit palpable masses, abdominal swelling, and pain, potentially leading to acute abdominal complications due to tumor involvement<ref name=":4" /><ref name=":6">{{Cite journal |last1=Luo |first1=Yan |last2=Bian |first2=Ce |date=2022-09-14 |title=Primary squamous cell carcinoma of the ovary. Review of the literature |journal=Frontiers in Oncology |volume=12 |doi=10.3389/fonc.2022.962613 |issn=2234-943X |pmc=9515541 |pmid=36185237 |doi-access=free }}</ref><ref name=":5" />. Diagnosing this condition remains challenging as preoperative imaging and laboratory tests lack specific indicators.
 === Brenner Tumor (BT): ===
 [[File:BT ultrasound.jpg|thumb|415x415px|'''Benign mixed Brenner tumor and mucinous cystadenoma of the right ovary.''' (a) Transvaginal ultrasound images show mixed cystic and solid components, with calcifications in the solid portion (arrow); (b) Macroscopic evaluation revealed an ovary partially replaced by a solid and cystic tumor<ref name=":1" />]]     ''See also'':  [[Brenner tumour|Brenner Tumor]]
-[[Brenner tumour|Brenner Tumor]] (BT) are infrequent ovarian growths composed of specialized ovarian cells surrounded by dense fibrous tissue. Typically small (less than 2 cm), these tumors are often discovered incidentally in women without apparent symptoms<ref name=":1">{{Cite journal |last=Costeira |first=Filipa de Sousa |last2=Félix |first2=Ana |last3=Cunha |first3=Teresa Margarida |date=2022-02-01 |title=Brenner tumors |url=https://www.birpublications.org/doi/10.1259/bjr.20210687 |journal=The British Journal of Radiology |language=en |volume=95 |issue=1130 |doi=10.1259/bjr.20210687 |issn=0007-1285 |pmc=PMC8822556 |pmid=34928171}}</ref>. However, when a BT is borderline or malignant, indicating a potential for cancer, it may lead to symptoms such as an abdominal lump, abdominal pain, and [[post-menopausal]] bleeding. Less common signs include nausea, vomiting, back pain, bowel problems, reduced appetite, and weight loss.
+[[Brenner tumour|Brenner Tumor]] (BT) are infrequent ovarian growths composed of specialized ovarian cells surrounded by dense fibrous tissue. Typically small (less than 2 cm), these tumors are often discovered incidentally in women without apparent symptoms<ref name=":1">{{Cite journal |last1=Costeira |first1=Filipa de Sousa |last2=Félix |first2=Ana |last3=Cunha |first3=Teresa Margarida |date=2022-02-01 |title=Brenner tumors |journal=The British Journal of Radiology |language=en |volume=95 |issue=1130 |doi=10.1259/bjr.20210687 |issn=0007-1285 |pmc=8822556 |pmid=34928171}}</ref>. However, when a BT is borderline or malignant, indicating a potential for cancer, it may lead to symptoms such as an abdominal lump, abdominal pain, and [[post-menopausal]] bleeding. Less common signs include nausea, vomiting, back pain, bowel problems, reduced appetite, and weight loss.
-Differentiating between benign (non-cancerous) and malignant (potentially cancerous) BTs poses a challenge as they appear similarly in medical images<ref>{{Cite journal |last=Miles |first=Philip A. |last2=Norris |first2=Henry J. |date=1972-07 |title=Proliferative and malignant brenner tumors of the ovary |url=https://onlinelibrary.wiley.com/doi/10.1002/1097-0142(197207)30:13.0.CO;2-D |journal=Cancer |language=en |volume=30 |issue=1 |pages=174–186 |doi=10.1002/1097-0142(197207)30:1<174::AID-CNCR2820300125>3.0.CO;2-D |issn=0008-543X}}</ref>. The definitive diagnosis involves examining tissue under a microscope ([[histopathology]]). Benign BTs exhibit a consistent fibrous structure, a distinctive characteristic. They may also manifest as a cystic mass with multiple compartments, particularly associated with other ovarian growths<ref>{{Cite journal |last=Lamping |first=J. Daniels |last2=Blythe |first2=James G. |date=1977-09-01 |title=Bilateral brenner tumors: A case report and review of the literature |url=https://www.sciencedirect.com/science/article/pii/S0046817777801172 |journal=Human Pathology |volume=8 |issue=5 |pages=583–585 |doi=10.1016/S0046-8177(77)80117-2 |issn=0046-8177}}</ref>.
+Differentiating between benign (non-cancerous) and malignant (potentially cancerous) BTs poses a challenge as they appear similarly in medical images<ref>{{Cite journal |last1=Miles |first1=Philip A. |last2=Norris |first2=Henry J. |date=July 1972 |title=Proliferative and malignant brenner tumors of the ovary |url=https://onlinelibrary.wiley.com/doi/10.1002/1097-0142(197207)30:13.0.CO;2-D |journal=Cancer |language=en |volume=30 |issue=1 |pages=174–186 |doi=10.1002/1097-0142(197207)30:1<174::AID-CNCR2820300125>3.0.CO;2-D |pmid=5040741 |s2cid=8818224 |issn=0008-543X}}</ref>. The definitive diagnosis involves examining tissue under a microscope ([[histopathology]]). Benign BTs exhibit a consistent fibrous structure, a distinctive characteristic. They may also manifest as a cystic mass with multiple compartments, particularly associated with other ovarian growths<ref>{{Cite journal |last1=Lamping |first1=J. Daniels |last2=Blythe |first2=James G. |date=1977-09-01 |title=Bilateral brenner tumors: A case report and review of the literature |url=https://www.sciencedirect.com/science/article/pii/S0046817777801172 |journal=Human Pathology |volume=8 |issue=5 |pages=583–585 |doi=10.1016/S0046-8177(77)80117-2 |pmid=903146 |issn=0046-8177}}</ref>.
 === Endometriosis: ===
@@ Line 34: / Line 34: @@
 oSCC tumors from endometriosis are rare. There are criteria to figure out if oSCC comes from [[endometriosis]], but they're kind of old and not easy to use. Individuals with this type of cancer are usually under 50, have a more severe form of the disease, and often feel abdominal pain<ref name=":2" />.
 {| class="wikitable"
-|+Conditions for verifying whether the SCC originated as Endometriosis or Not<ref name=":3">{{Cite journal |last=Jeon |first=Seob |date=2017-06-30 |title=Ovarian Squamous Cell Carcinoma Associated with Endometriosis: Poor Response to Chemotherapy |url=http://jsms.sch.ac.kr/journal/view.php?doi=10.15746/sms.17.013 |journal=Soonchunhyang Medical Science |language=English |volume=23 |issue=1 |pages=56–60 |doi=10.15746/sms.17.013 |issn=2233-4289}}</ref><ref>{{Cite journal |last=SAMPSON |first=JOHN A. |date=1925-01-01 |title=ENDOMETRIAL CARCINOMA OF THE OVARY, ARISING IN ENDOMETRIAL TISSUE IN THAT ORGAN |url=https://doi.org/10.1001/archsurg.1925.01120100007001 |journal=Archives of Surgery |volume=10 |issue=1 |pages=1–72 |doi=10.1001/archsurg.1925.01120100007001 |issn=0272-5533}}</ref>
+|+Conditions for verifying whether the SCC originated as Endometriosis or Not<ref name=":3">{{Cite journal |last=Jeon |first=Seob |date=2017-06-30 |title=Ovarian Squamous Cell Carcinoma Associated with Endometriosis: Poor Response to Chemotherapy |url=http://jsms.sch.ac.kr/journal/view.php?doi=10.15746/sms.17.013 |journal=Soonchunhyang Medical Science |language=English |volume=23 |issue=1 |pages=56–60 |doi=10.15746/sms.17.013 |s2cid=79889670 |issn=2233-4289}}</ref><ref>{{Cite journal |last=SAMPSON |first=JOHN A. |date=1925-01-01 |title=Endometrial Carcinoma of the Ovary, Arising in Endometrial Tissue in That Organ |url=https://doi.org/10.1001/archsurg.1925.01120100007001 |journal=Archives of Surgery |volume=10 |issue=1 |pages=1–72 |doi=10.1001/archsurg.1925.01120100007001 |issn=0272-5533}}</ref>
 !Development from the Same Ovary
 !Growth Inside Endometriosis Tissue
@@ Line 56: / Line 56: @@
 ''Main article: [[Pelvic examination]]''
-A [[pelvic examination]] is the physical examination of the external and internal female pelvic organs. The most commonly performed components of the exam are 1) the external exam, to evaluate the external genitalia 2) the internal exam with palpation (commonly called the bimanual exam) to examine the uterus, ovaries, and fallopian tubes, and 3) the internal exam using the speculum to visualize the vaginal walls and cervix<ref>{{Cite book |last=Bickley |first=Lynn S. |title=Bates' guide to physical examination and history taking |last2=Bates |first2=Barbara |last3=Szilagyi |first3=Peter G. |date=2013 |publisher=Wolters Kluwer Lippincott Williams & Wilkins |isbn=978-1-60913-762-5 |edition=11. ed., internat. ed |location=Philadelphia, Pa.}}</ref>. Nonetheless, routine screening test as [[Pap test]] or [[Human papillomavirus infection|HPV]] are usually not effective for detecting ovarian cancer<ref>{{Cite web |title=How to Check for Ovarian Cancer {{!}} Ovarian Cancer Screening |url=https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/detection.html |access-date=2023-12-07 |website=www.cancer.org |language=en}}</ref>.
+A [[pelvic examination]] is the physical examination of the external and internal female pelvic organs. The most commonly performed components of the exam are 1) the external exam, to evaluate the external genitalia 2) the internal exam with palpation (commonly called the bimanual exam) to examine the uterus, ovaries, and fallopian tubes, and 3) the internal exam using the speculum to visualize the vaginal walls and cervix<ref>{{Cite book |last1=Bickley |first1=Lynn S. |title=Bates' guide to physical examination and history taking |last2=Bates |first2=Barbara |last3=Szilagyi |first3=Peter G. |date=2013 |publisher=Wolters Kluwer Lippincott Williams & Wilkins |isbn=978-1-60913-762-5 |edition=11. ed., internat. |location=Philadelphia, Pa.}}</ref>. Nonetheless, routine screening test as [[Pap test]] or [[Human papillomavirus infection|HPV]] are usually not effective for detecting ovarian cancer<ref>{{Cite web |title=How to Check for Ovarian Cancer {{!}} Ovarian Cancer Screening |url=https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/detection.html |access-date=2023-12-07 |website=www.cancer.org |language=en}}</ref>.
 === Imaging ===
@@ Line 64: / Line 64: @@
 [[File:Ovarian Squamous Carcinoma Tumor.jpg|thumb|'''<big>Abdominal CT.</big>'''                                                           <small>''Cystic solid mass was detected on the left adnexal and the solid components were enhanced<ref name=":0" />''</small>.]][[CT scan|Computed Tomography]] (CT) scans is a diagnostic x-ray procedure that generates detailed cross-sectional images of the body, facilitating the detection of potential [[ovarian cancer]] spread to other organs<ref name=":7">{{Cite web |title=Tests for Ovarian Cancer {{!}} How Is Ovarian Cancer Diagnosed? |url=https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/how-diagnosed.html |access-date=2023-11-29 |website=www.cancer.org |language=en}}</ref>. While CT scans may not effectively visualize small ovarian tumors, they have the capability to detect larger tumors and evaluate their potential invasion into nearby structures. Additionally, CT scans can identify enlarged [[Lymph node|lymph nodes]], signs of cancer spreading to the liver or other organs, and indications of an ovarian tumor impacting the kidneys or bladder. Although CT scans are not commonly used for biopsying ovarian tumors, they can be utilized in the biopsy of suspected [[Metastasis|metastases]] through a technique known as CT-guided [[needle biopsy]]<ref name=":7" />. In this procedure, the patient remains on the CT scanning table as a radiologist guides a biopsy needle toward the mass, with repeated scans ensuring accurate placement.
-The difficulty in screening for SCC revolves around the creation of effective strategies with a positive predictive value. The timing aspect is crucial due to the lack of a specific timeframe for the onset of invasive disease or the interval stage between stage I and stage III [[Carcinoma|carcinomas]]<ref name=":8">{{Cite journal |last=Koutras |first=Antonios |last2=Perros |first2=Paraskevas |last3=Prokopakis |first3=Ioannis |last4=Ntounis |first4=Thomas |last5=Fasoulakis |first5=Zacharias |last6=Pittokopitou |first6=Savia |last7=Samara |first7=Athina A. |last8=Valsamaki |first8=Asimina |last9=Douligeris |first9=Athanasios |last10=Mortaki |first10=Anastasia |last11=Sapantzoglou |first11=Ioakeim |last12=Katrachouras |first12=Alexandros |last13=Pagkalos |first13=Athanasios |last14=Symeonidis |first14=Panagiotis |last15=Palios |first15=Vasileios-Chrysovalantis |date=2023-01 |title=Advantages and Limitations of Ultrasound as a Screening Test for Ovarian Cancer |url=https://www.mdpi.com/2075-4418/13/12/2078 |journal=Diagnostics |language=en |volume=13 |issue=12 |pages=2078 |doi=10.3390/diagnostics13122078 |issn=2075-4418 |pmc=PMC10297553 |pmid=37370973}}</ref>. Ultrasound screening provides a detailed view of the ovaries, identifying morphologic changes as potential signs of malignancy. Key diagnostic factors include the presence of abnormalities, ovarian size, blood flow, and abdominal/pelvic fluid. The persistence of abnormalities after 4 to 6 weeks may decrease the occurrence of false positives. Screening protocols, often based on morphologic indices, utilize [[transvaginal ultrasound]] findings like cyst wall structure, septation, papillary projections, echogenicity, and ovarian volume to effectively detect malignancy<ref name=":8" />.
+The difficulty in screening for SCC revolves around the creation of effective strategies with a positive predictive value. The timing aspect is crucial due to the lack of a specific timeframe for the onset of invasive disease or the interval stage between stage I and stage III [[Carcinoma|carcinomas]]<ref name=":8">{{Cite journal |last1=Koutras |first1=Antonios |last2=Perros |first2=Paraskevas |last3=Prokopakis |first3=Ioannis |last4=Ntounis |first4=Thomas |last5=Fasoulakis |first5=Zacharias |last6=Pittokopitou |first6=Savia |last7=Samara |first7=Athina A. |last8=Valsamaki |first8=Asimina |last9=Douligeris |first9=Athanasios |last10=Mortaki |first10=Anastasia |last11=Sapantzoglou |first11=Ioakeim |last12=Katrachouras |first12=Alexandros |last13=Pagkalos |first13=Athanasios |last14=Symeonidis |first14=Panagiotis |last15=Palios |first15=Vasileios-Chrysovalantis |date=January 2023 |title=Advantages and Limitations of Ultrasound as a Screening Test for Ovarian Cancer |journal=Diagnostics |language=en |volume=13 |issue=12 |pages=2078 |doi=10.3390/diagnostics13122078 |issn=2075-4418 |pmc=10297553 |pmid=37370973 |doi-access=free }}</ref>. Ultrasound screening provides a detailed view of the ovaries, identifying morphologic changes as potential signs of malignancy. Key diagnostic factors include the presence of abnormalities, ovarian size, blood flow, and abdominal/pelvic fluid. The persistence of abnormalities after 4 to 6 weeks may decrease the occurrence of false positives. Screening protocols, often based on morphologic indices, utilize [[transvaginal ultrasound]] findings like cyst wall structure, septation, papillary projections, echogenicity, and ovarian volume to effectively detect malignancy<ref name=":8" />.
 ==== Magnetic resonance imaging (MRI): ====
-[[File:SCC MRI.png|thumb|210x210px|'''Pelvic MRI images.''' ''<small>A: Axial T2-weighted image shows multicystic neoplastic masses (white arrows) with solid components in both ovaries. B: A peritoneal implant (blue arrow) with similar characteristics to the ovarian lesions is seen in the peritoneal cavity. C and D: T2-weighted images of the uterine cervix in the axial and sagittal plane reveal the bulky cervical tumor. The cervical stromal ring is well preserved (arrowhead)</small>''<ref>{{Cite journal |last=Yilmaz |first=Melek Tugce |last2=Gurlek |first2=Ezgi |last3=Gultekin |first3=Melis |last4=Kahraman |first4=Korhan |last5=Salman |first5=Mehmet C |last6=Usubutun |first6=Alp |last7=Akata |first7=Deniz |last8=Lay Ergun |first8=Eser |last9=Arik |first9=Zafer |last10=Yildiz |first10=Ferah |date=2022-01-06 |title=Ovarian Carcinoma Presenting With a Large Cervical Mass |url=https://www.cureus.com/articles/81571-ovarian-carcinoma-presenting-with-a-large-cervical-mass |journal=Cureus |language=en |doi=10.7759/cureus.20994 |issn=2168-8184 |pmc=PMC8820480 |pmid=35154969}}</ref>''<small>.</small>'']]
+[[File:SCC MRI.png|thumb|210x210px|'''Pelvic MRI images.''' ''<small>A: Axial T2-weighted image shows multicystic neoplastic masses (white arrows) with solid components in both ovaries. B: A peritoneal implant (blue arrow) with similar characteristics to the ovarian lesions is seen in the peritoneal cavity. C and D: T2-weighted images of the uterine cervix in the axial and sagittal plane reveal the bulky cervical tumor. The cervical stromal ring is well preserved (arrowhead)</small>''<ref>{{Cite journal |last1=Yilmaz |first1=Melek Tugce |last2=Gurlek |first2=Ezgi |last3=Gultekin |first3=Melis |last4=Kahraman |first4=Korhan |last5=Salman |first5=Mehmet C |last6=Usubutun |first6=Alp |last7=Akata |first7=Deniz |last8=Lay Ergun |first8=Eser |last9=Arik |first9=Zafer |last10=Yildiz |first10=Ferah |date=2022-01-06 |title=Ovarian Carcinoma Presenting With a Large Cervical Mass |url=https://www.cureus.com/articles/81571-ovarian-carcinoma-presenting-with-a-large-cervical-mass |journal=Cureus |volume=14 |issue=1 |pages=e20994 |language=en |doi=10.7759/cureus.20994 |issn=2168-8184 |pmc=8820480 |pmid=35154969}}</ref>''<small>.</small>'']]
-[[Magnetic resonance|Magnetic Resonance]] (MRI) scans use powerful magnets instead of x-rays to create detailed cross-sectional images of internal structures, and the injection of gadolinium into a vein enhances image details<ref name=":7" />. Although MRI scans are not commonly employed for ovarian cancer detection, it is important to note that the majority of ultrasound-detected ovarian masses are usually benign. The combined approach of ultrasound with [[Doppler ultrasonography|Doppler]], along with the selective use of contrast-enhanced MRI, proves to be an efficient diagnostic method for identifying benign [[Adnexal mass|adnexal]] masses with distinctive features, including functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, [[hydrosalpinx]], and peritoneal inclusion cysts<ref name=":13">{{Cite journal |last=Shetty |first=Mahesh |date=2023-12-01 |title=Imaging of a Pelvic Mass: Uterine |url=https://www.sciencedirect.com/science/article/pii/S0887217123000793 |journal=Seminars in Ultrasound, CT and MRI |series=Symptom based Imaging in the management of Gynecological Diseases |volume=44 |issue=6 |pages=528–540 |doi=10.1053/j.sult.2023.10.005 |issn=0887-2171}}</ref>. This integrated diagnostic strategy is effective in preventing unnecessary surgical intervention. Additionally, the use of MRI contributes to a decrease in false-positive diagnoses, ultimately reducing the overall number of unnecessary surgical procedures related to ovarian masses.
+[[Magnetic resonance|Magnetic Resonance]] (MRI) scans use powerful magnets instead of x-rays to create detailed cross-sectional images of internal structures, and the injection of gadolinium into a vein enhances image details<ref name=":7" />. Although MRI scans are not commonly employed for ovarian cancer detection, it is important to note that the majority of ultrasound-detected ovarian masses are usually benign. The combined approach of ultrasound with [[Doppler ultrasonography|Doppler]], along with the selective use of contrast-enhanced MRI, proves to be an efficient diagnostic method for identifying benign [[Adnexal mass|adnexal]] masses with distinctive features, including functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, [[hydrosalpinx]], and peritoneal inclusion cysts<ref name=":13">{{Cite journal |last=Shetty |first=Mahesh |date=2023-12-01 |title=Imaging of a Pelvic Mass: Uterine |url=https://www.sciencedirect.com/science/article/pii/S0887217123000793 |journal=Seminars in Ultrasound, CT and MRI |series=Symptom based Imaging in the management of Gynecological Diseases |volume=44 |issue=6 |pages=528–540 |doi=10.1053/j.sult.2023.10.005 |pmid=37839652 |s2cid=264109630 |issn=0887-2171}}</ref>. This integrated diagnostic strategy is effective in preventing unnecessary surgical intervention. Additionally, the use of MRI contributes to a decrease in false-positive diagnoses, ultimately reducing the overall number of unnecessary surgical procedures related to ovarian masses.
 {| class="wikitable"
-|+Advantages and Limitations of Using MRI to diagnose SCC<ref>{{Cite journal |last=Fischerova |first=Daniela |last2=Burgetova |first2=Andrea |date=2014-07-01 |title=Imaging techniques for the evaluation of ovarian cancer |url=https://www.sciencedirect.com/science/article/pii/S1521693414000637 |journal=Best Practice & Research Clinical Obstetrics & Gynaecology |series=Imaging in Gynaecology |volume=28 |issue=5 |pages=697–720 |doi=10.1016/j.bpobgyn.2014.04.006 |issn=1521-6934}}</ref>:
+|+Advantages and Limitations of Using MRI to diagnose SCC<ref>{{Cite journal |last1=Fischerova |first1=Daniela |last2=Burgetova |first2=Andrea |date=2014-07-01 |title=Imaging techniques for the evaluation of ovarian cancer |url=https://www.sciencedirect.com/science/article/pii/S1521693414000637 |journal=Best Practice & Research Clinical Obstetrics & Gynaecology |series=Imaging in Gynaecology |volume=28 |issue=5 |pages=697–720 |doi=10.1016/j.bpobgyn.2014.04.006 |pmid=24846098 |issn=1521-6934}}</ref>:
 !Advantages:
 !Limitations
@@ Line 104: / Line 104: @@
 === Histopathology ===
-[[Biopsy]] techniques, including excisional biopsy for complete lesion removal, are employed in suspected cancer cases. The examination of the specimen involves assessing surgical margins, where "clear margins" indicate no disease spread, while "positive margins" may require wider excision. In situations where intact removal is impractical, needle-based methods like core biopsy or fine needle aspiration may be utilized<ref>{{Citation |title=MRI-guided Core Needle Biopsy/Fine Needle Aspiration Biopsy |date=2010 |url=http://dx.doi.org/10.1055/b-0034-74238 |work=Interventional Breast Imaging |editor-last=Fischer |editor-first=Uwe |access-date=2023-12-07 |place=Stuttgart |publisher=Georg Thieme Verlag |isbn=978-3-13-146701-0 |editor2-last=Baum |editor2-first=Friedemann}}</ref>.
+[[Biopsy]] techniques, including excisional biopsy for complete lesion removal, are employed in suspected cancer cases. The examination of the specimen involves assessing surgical margins, where "clear margins" indicate no disease spread, while "positive margins" may require wider excision. In situations where intact removal is impractical, needle-based methods like core biopsy or fine needle aspiration may be utilized<ref>{{Citation |title=MRI-guided Core Needle Biopsy/Fine Needle Aspiration Biopsy |date=2010 |url=http://dx.doi.org/10.1055/b-0034-74238 |work=Interventional Breast Imaging |editor-last=Fischer |editor-first=Uwe |access-date=2023-12-07 |place=Stuttgart |publisher=Georg Thieme Verlag |doi=10.1055/b-0034-74238 |isbn=978-3-13-146701-0 |editor2-last=Baum |editor2-first=Friedemann}}</ref>.
-Pathologic examination of biopsies helps distinguish between benign and malignant lesions, aiding in the identification of different cancer types. Larger excisional specimens, known as resections, provide comprehensive information about the cancer, its sub classification, histologic grading, and the extent of its spread, contributing to the pathologic staging. In cases where visible growth<ref>{{Cite journal |last=Mishra |first=Pritinanda |last2=Sasmal |first2=PrakashK |last3=Jena |first3=SaubhagyaK |last4=Senapati |first4=Swagatika |last5=Patra |first5=Susama |date=2021 |title=Pure primary ovarian carcinoid tumor with carcinoid syndrome and cervical carcinoma: A rare concoction of dual primary malignancies |url=http://www.ijpmonline.org/text.asp?2021/64/3/563/322380 |journal=Indian Journal of Pathology and Microbiology |language=en |volume=64 |issue=3 |pages=563 |doi=10.4103/IJPM.IJPM_1379_20 |issn=0377-4929}}</ref> or malignant transformation is not apparent<ref name=":9">{{Cite journal |last=Sun |first=Yao |last2=Chen |first2=Yuezhou |last3=Zhang |first3=Xiaofei |last4=Chen |first4=Hao |last5=Zhou |first5=Feng |date=2021-05-08 |title=Primary ovarian serous carcinomas with extensive squamous differentiation: a case report and literature review |url=https://doi.org/10.1186/s12905-021-01336-y |journal=BMC Women's Health |volume=21 |issue=1 |pages=193 |doi=10.1186/s12905-021-01336-y |issn=1472-6874 |pmc=PMC8106833 |pmid=33964926}}</ref>, a precise grossing and thorough histopathological examination are essential for an accurate diagnosis. Additionally, conducting [[In situ hybridization|situ hybridization]] for [[HPV]] DNA is crucial to rule out the potential involvement of papillomavirus in this condition. To distinguish between primary ovarian serous carcinoma (OSC) and metastatic squamous cell carcinoma (SCC), various immunohistochemical markers such as [[PAX8]], [[p16]], [[WT1]], ER, [[p53]], and CK5/6 are utilized<ref name=":9" />. The [[P53 p63 p73 family|p53/p16]] index was recognized as a valuable indicator for high-grade OSC, demonstrating diffuse p53 expression or complete absence (null type) along with diffuse p16 expression<ref name=":9" />.[[File:Squamous Ovarian Cell Carcinoma.png|center|472x472px|thumb|<small>''('''a–c''') Seromucinous cystadenoma. A thin-walled paucilocular cyst filled with thin mucinous clear fluid. The cyst wall is lined by endocervical-type columnar mucinous cells admixed with scattered ciliated cells. ('''d–f''') Seromucinous adenofibroma. Mostly solid mass with scattered cystic spaces.<ref>{{Cite journal |last=Nagamine |first=Michiko |last2=Mikami |first2=Yoshiki |date=2020-02 |title=Ovarian Seromucinous Tumors: Pathogenesis, Morphologic Spectrum, and Clinical Issues |url=https://www.mdpi.com/2075-4418/10/2/77 |journal=Diagnostics |language=en |volume=10 |issue=2 |pages=77 |doi=10.3390/diagnostics10020077 |issn=2075-4418}}</ref>''</small>]]
+Pathologic examination of biopsies helps distinguish between benign and malignant lesions, aiding in the identification of different cancer types. Larger excisional specimens, known as resections, provide comprehensive information about the cancer, its sub classification, histologic grading, and the extent of its spread, contributing to the pathologic staging. In cases where visible growth<ref>{{Cite journal |last1=Mishra |first1=Pritinanda |last2=Sasmal |first2=PrakashK |last3=Jena |first3=SaubhagyaK |last4=Senapati |first4=Swagatika |last5=Patra |first5=Susama |date=2021 |title=Pure primary ovarian carcinoid tumor with carcinoid syndrome and cervical carcinoma: A rare concoction of dual primary malignancies |url=http://www.ijpmonline.org/text.asp?2021/64/3/563/322380 |journal=Indian Journal of Pathology and Microbiology |language=en |volume=64 |issue=3 |pages=563–567 |doi=10.4103/IJPM.IJPM_1379_20 |pmid=34341274 |issn=0377-4929 |doi-access=free }}</ref> or malignant transformation is not apparent<ref name=":9">{{Cite journal |last1=Sun |first1=Yao |last2=Chen |first2=Yuezhou |last3=Zhang |first3=Xiaofei |last4=Chen |first4=Hao |last5=Zhou |first5=Feng |date=2021-05-08 |title=Primary ovarian serous carcinomas with extensive squamous differentiation: a case report and literature review |journal=BMC Women's Health |volume=21 |issue=1 |pages=193 |doi=10.1186/s12905-021-01336-y |issn=1472-6874 |pmc=8106833 |pmid=33964926 |doi-access=free }}</ref>, a precise grossing and thorough histopathological examination are essential for an accurate diagnosis. Additionally, conducting [[In situ hybridization|situ hybridization]] for [[HPV]] DNA is crucial to rule out the potential involvement of papillomavirus in this condition. To distinguish between primary ovarian serous carcinoma (OSC) and metastatic squamous cell carcinoma (SCC), various immunohistochemical markers such as [[PAX8]], [[p16]], [[WT1]], ER, [[p53]], and CK5/6 are utilized<ref name=":9" />. The [[P53 p63 p73 family|p53/p16]] index was recognized as a valuable indicator for high-grade OSC, demonstrating diffuse p53 expression or complete absence (null type) along with diffuse p16 expression<ref name=":9" />.[[File:Squamous Ovarian Cell Carcinoma.png|center|472x472px|thumb|<small>''('''a–c''') Seromucinous cystadenoma. A thin-walled paucilocular cyst filled with thin mucinous clear fluid. The cyst wall is lined by endocervical-type columnar mucinous cells admixed with scattered ciliated cells. ('''d–f''') Seromucinous adenofibroma. Mostly solid mass with scattered cystic spaces.<ref>{{Cite journal |last1=Nagamine |first1=Michiko |last2=Mikami |first2=Yoshiki |date=February 2020 |title=Ovarian Seromucinous Tumors: Pathogenesis, Morphologic Spectrum, and Clinical Issues |journal=Diagnostics |language=en |volume=10 |issue=2 |pages=77 |doi=10.3390/diagnostics10020077 |pmid=32023964 |pmc=7168900 |issn=2075-4418 |doi-access=free }}</ref>''</small>]]
 == Prognosis ==
 [[File:Overall survival of treatments for Ovarian Squamous Cell Carcinoma.png|thumb|314x314px|'''Overall survival to different treatments of patients with oSCC''' <ref name=":10" />                                                                <small>a. [[International Federation of Gynaecology and Obstetrics|International Federation of Gynecology and Obstetrics]] (FIGO) stage and overall survival. b. [[Hysterectomy]] and overall survival. c. [[Chemotherapy]] and overall survival for stage II, III, IV. d. chemotherapy with platinum and overall survival for stage II, III, IV.</small>]]
-Literature indicates that oSCC typically presents with a mean tumor size of 14.8 cm, and overall survival does not vary based on tumor size<ref name=":10" />. Clinical manifestations include [[abdominal pain]] and a palpable abdominal mass. The research establishes a correlation between [[cancer stages]] and time of diagnosis, revealing that higher stages and delayed diagnoses are associated with a worse [[prognosis]]<ref name=":10" /><ref name=":3" /><ref name=":1" />. Notably, [[hysterectomy]] reduces the risk of death, while [[lymphadenectomy]] does not demonstrate improved survival. Fertility-sparing surgery shows no difference in mortality compared to radical surgery in younger patients (under 45 years old)<ref name=":6" />. [[Adjuvant chemotherapy]] enhances survival in advanced stages, with [[platinum-based chemotherapy]] <ref name=":14">{{Cite journal |last=Yang |first=Szu-Ting |last2=Chang |first2=Wen-Hsun |last3=Chou |first3=Fang-Wei |last4=Liu |first4=Hung-Hsien |last5=Lee |first5=Wen-Ling |last6=Wang |first6=Peng-Hui |date=2023-11 |title=Front-line chemo-immunotherapy for treating epithelial ovarian cancer: Part I CA125 and anti-CA125 |url=https://linkinghub.elsevier.com/retrieve/pii/S1028455923002668 |journal=Taiwanese Journal of Obstetrics and Gynecology |language=en |volume=62 |issue=6 |pages=802–808 |doi=10.1016/j.tjog.2023.09.017}}</ref> linked to a better prognosis. However, [[radiotherapy]] and [[chemoradiotherapy]] do not improve survival<ref name=":2" /><ref name=":3" />.
+Literature indicates that oSCC typically presents with a mean tumor size of 14.8 cm, and overall survival does not vary based on tumor size<ref name=":10" />. Clinical manifestations include [[abdominal pain]] and a palpable abdominal mass. The research establishes a correlation between [[cancer stages]] and time of diagnosis, revealing that higher stages and delayed diagnoses are associated with a worse [[prognosis]]<ref name=":10" /><ref name=":3" /><ref name=":1" />. Notably, [[hysterectomy]] reduces the risk of death, while [[lymphadenectomy]] does not demonstrate improved survival. Fertility-sparing surgery shows no difference in mortality compared to radical surgery in younger patients (under 45 years old)<ref name=":6" />. [[Adjuvant chemotherapy]] enhances survival in advanced stages, with [[platinum-based chemotherapy]] <ref name=":14">{{Cite journal |last1=Yang |first1=Szu-Ting |last2=Chang |first2=Wen-Hsun |last3=Chou |first3=Fang-Wei |last4=Liu |first4=Hung-Hsien |last5=Lee |first5=Wen-Ling |last6=Wang |first6=Peng-Hui |date=November 2023 |title=Front-line chemo-immunotherapy for treating epithelial ovarian cancer: Part I CA125 and anti-CA125 |url=https://linkinghub.elsevier.com/retrieve/pii/S1028455923002668 |journal=Taiwanese Journal of Obstetrics and Gynecology |language=en |volume=62 |issue=6 |pages=802–808 |doi=10.1016/j.tjog.2023.09.017|pmid=38008497 |s2cid=265450805 }}</ref> linked to a better prognosis. However, [[radiotherapy]] and [[chemoradiotherapy]] do not improve survival<ref name=":2" /><ref name=":3" />.
 oSCC exhibits locally invasive characteristics, with tumors demonstrating invasiveness or adherence to the adjacent [[uterus]], [[Pelvic structure|pelvic structures]], and colonic [[Peritoneum urogenitale|peritoneum]], making surgery the crucial treatment. The standard approach for treating the malignant transformation of mature cystic teratoma of the ovary (MCTO) involves extensive surgery and subsequent chemotherapy, especially for advanced cases<ref name=":9" /><ref name=":10" /><ref name=":14" />. Recommended for patients not seeking fertility, the surgical procedure includes bilateral [[salpingo-oophorectomy]], hysterectomy, comprehensive surgical staging, and lymphadenectomy<ref name=":0" /><ref name=":10" /><ref name=":2" />. Following surgery, advanced cases receive adjuvant chemotherapy with [[paclitaxel]] and [[carboplatin]], although the overall prognosis is generally less favorable than that of common epithelial ovarian cancer. Poor prognostic factors include age over 45 or 55, advanced staging, larger tumors, high cancer grade, absence of hysterectomy, presence of residual tumor lesions, lack of adjuvant chemotherapy, and the use of non-platinum-based chemotherapy. In cases of recurrence, secondary [[Cytoreductive surgery|cytoreductive]] surgery may be considered, revealing efficacy in selected cases with recurrent malignant transformation of MCTO<ref name=":13" /><ref name=":3" /><ref name=":2" />.
@@ Line 127: / Line 127: @@
 ''Main Article:'' [[Lymphadenectomy]]
-[[Lymphadenectomy]], or the surgical removal of [[Lymph node|lymph nodes]], is commonly undertaken in cancer management, with regional and radical dissections differing in the extent of node removal. A [[meta-analysis]] research of published [[Randomized controlled trial|randomized controlled trials]] comparing lymphadenectomy versus no lymphadenectomy in epithelial cancers of the ovary, suggest that overall survival did not demonstrate significance<ref name=":18">{{Cite journal |last=Purwar |first=Roli |last2=Ranjan |first2=Rakesh |last3=Soni |first3=Kishan |last4=Pandey |first4=Manoj |last5=Upadhyay |first5=Satyanshu K. |last6=Pai |first6=Esha |last7=Kumar |first7=Tarun |date=2022-11-22 |title=Lymphadenectomy in ovarian cancers: a meta-analysis of hazard ratios from randomized clinical trials |url=https://doi.org/10.1186/s12957-022-02835-4 |journal=World Journal of Surgical Oncology |volume=20 |issue=1 |pages=367 |doi=10.1186/s12957-022-02835-4 |issn=1477-7819}}</ref>. However, the meta-analysis is unique for focusing on randomized trials, using hazard ratios, and treating ovarian carcinoma as a unified entity<ref name=":18" />. In some cases, complications of lymphadenectomy include lymphedema, and the effectiveness of wound drainage in reducing complications after groin lymph node dissection remains uncertain.
+[[Lymphadenectomy]], or the surgical removal of [[Lymph node|lymph nodes]], is commonly undertaken in cancer management, with regional and radical dissections differing in the extent of node removal. A [[meta-analysis]] research of published [[Randomized controlled trial|randomized controlled trials]] comparing lymphadenectomy versus no lymphadenectomy in epithelial cancers of the ovary, suggest that overall survival did not demonstrate significance<ref name=":18">{{Cite journal |last1=Purwar |first1=Roli |last2=Ranjan |first2=Rakesh |last3=Soni |first3=Kishan |last4=Pandey |first4=Manoj |last5=Upadhyay |first5=Satyanshu K. |last6=Pai |first6=Esha |last7=Kumar |first7=Tarun |date=2022-11-22 |title=Lymphadenectomy in ovarian cancers: a meta-analysis of hazard ratios from randomized clinical trials |journal=World Journal of Surgical Oncology |volume=20 |issue=1 |pages=367 |doi=10.1186/s12957-022-02835-4 |pmid=36419077 |pmc=9682714 |issn=1477-7819 |doi-access=free }}</ref>. However, the meta-analysis is unique for focusing on randomized trials, using hazard ratios, and treating ovarian carcinoma as a unified entity<ref name=":18" />. In some cases, complications of lymphadenectomy include lymphedema, and the effectiveness of wound drainage in reducing complications after groin lymph node dissection remains uncertain.
 ==== '''Hysterectomy''' ====
 ''Main Article:'' [[Hysterectomy]]
-A systematic review and meta-analysis<ref name=":19">{{Cite journal |last=Jordan |first=Susan J. |last2=Nagle |first2=Christina M. |last3=Coory |first3=Michael D. |last4=Maresco |first4=Diane |last5=Protani |first5=Melinda M. |last6=Pandeya |first6=Neha A. |last7=Balasubramaniam |first7=Kanchana D. |last8=Webb |first8=Penelope M. |date=2013-11 |title=Has the association between hysterectomy and ovarian cancer changed over time? A systematic review and meta-analysis |url=https://doi.org/10.1016/j.ejca.2013.07.005 |journal=European Journal of Cancer |volume=49 |issue=17 |pages=3638–3647 |doi=10.1016/j.ejca.2013.07.005 |issn=0959-8049}}</ref> have uncovered a shift in the relationship between hysterectomy and ovarian cancer risk over time. Studies predominantly involving women diagnosed before 2000 suggested a reduced ovarian cancer risk with hysterectomy, whereas those with post-2000 diagnoses indicated a positive association<ref name=":19" />. This shift appears unrelated to declining response rates or changes in hysterectomy frequency. The study's strengths lie in its thorough literature search and exploration of potential causes for this temporal change. However, limitations include reliance on published studies, potential publication bias, and a focus on predominantly U.S.-based recent studies<ref name=":19" />. Clinically, the findings caution against advising women that hysterectomy alone reduces ovarian cancer risk, highlighting the need for further evidence on risk-reducing strategies like bilateral salpingectomy with ovarian
+A systematic review and meta-analysis<ref name=":19">{{Cite journal |last1=Jordan |first1=Susan J. |last2=Nagle |first2=Christina M. |last3=Coory |first3=Michael D. |last4=Maresco |first4=Diane |last5=Protani |first5=Melinda M. |last6=Pandeya |first6=Neha A. |last7=Balasubramaniam |first7=Kanchana D. |last8=Webb |first8=Penelope M. |date=November 2013 |title=Has the association between hysterectomy and ovarian cancer changed over time? A systematic review and meta-analysis |url=https://doi.org/10.1016/j.ejca.2013.07.005 |journal=European Journal of Cancer |volume=49 |issue=17 |pages=3638–3647 |doi=10.1016/j.ejca.2013.07.005 |pmid=23890943 |issn=0959-8049}}</ref> have uncovered a shift in the relationship between hysterectomy and ovarian cancer risk over time. Studies predominantly involving women diagnosed before 2000 suggested a reduced ovarian cancer risk with hysterectomy, whereas those with post-2000 diagnoses indicated a positive association<ref name=":19" />. This shift appears unrelated to declining response rates or changes in hysterectomy frequency. The study's strengths lie in its thorough literature search and exploration of potential causes for this temporal change. However, limitations include reliance on published studies, potential publication bias, and a focus on predominantly U.S.-based recent studies<ref name=":19" />. Clinically, the findings caution against advising women that hysterectomy alone reduces ovarian cancer risk, highlighting the need for further evidence on risk-reducing strategies like bilateral salpingectomy with ovarian
 ==== '''Oophorectomy''' ====
@@ Line 142: / Line 142: @@
 Main Article: [[Radiation therapy]]
-Typically, a combination of treatments, including surgery, external beam radiotherapy, brachytherapy, and/or chemotherapy, is frequently employed for these uncommon cancers. Specialized centers and networks have been created to streamline the care of these cancers, underscoring the importance of gaining a deeper understanding of the role of radiotherapy<ref>{{Cite journal |last=Morcet-Delattre |first=R. |last2=Espenel |first2=S. |last3=Tas |first3=P. |last4=Chargari |first4=C. |last5=Escande |first5=A. |date=2023-12-01 |title=Role of radiotherapy in the management of rare gynaecological cancers |url=https://www.sciencedirect.com/science/article/pii/S1278321823002159 |journal=Cancer/Radiothérapie |volume=27 |issue=8 |pages=778–788 |doi=10.1016/j.canrad.2023.08.006 |issn=1278-3218}}</ref>. This understanding could potentially enhance control over the local region, improve quality of life, and increase survival rates. Nevertheless, there is some indication, supported by certain case series, that radiation, particularly when paired with concurrent chemotherapy following aggressive cytoreduction, may be beneficial for certain cases of oSCC originating from teratomas, given the radiosensitive nature of this tumor<ref name=":0" />.
+Typically, a combination of treatments, including surgery, external beam radiotherapy, brachytherapy, and/or chemotherapy, is frequently employed for these uncommon cancers. Specialized centers and networks have been created to streamline the care of these cancers, underscoring the importance of gaining a deeper understanding of the role of radiotherapy<ref>{{Cite journal |last1=Morcet-Delattre |first1=R. |last2=Espenel |first2=S. |last3=Tas |first3=P. |last4=Chargari |first4=C. |last5=Escande |first5=A. |date=2023-12-01 |title=Role of radiotherapy in the management of rare gynaecological cancers |url=https://www.sciencedirect.com/science/article/pii/S1278321823002159 |journal=Cancer/Radiothérapie |volume=27 |issue=8 |pages=778–788 |doi=10.1016/j.canrad.2023.08.006 |pmid=37925347 |s2cid=264990398 |issn=1278-3218}}</ref>. This understanding could potentially enhance control over the local region, improve quality of life, and increase survival rates. Nevertheless, there is some indication, supported by certain case series, that radiation, particularly when paired with concurrent chemotherapy following aggressive cytoreduction, may be beneficial for certain cases of oSCC originating from teratomas, given the radiosensitive nature of this tumor<ref name=":0" />.
 === Chemotherapy ===
@@ Line 150: / Line 150: @@
 Main Article: [[Platinum-based chemotherapy]]
-Addition of platinum-based chemotherapy drugs to chemoradiation in women with early [[cervical cancer]] seems to improve survival and reduce risk of recurrence<ref>{{Cite journal |last=Falcetta |first=Frederico S |last2=Medeiros |first2=Lídia RF |last3=Edelweiss |first3=Maria I |last4=Pohlmann |first4=Paula R |last5=Stein |first5=Airton T |last6=Rosa |first6=Daniela D |last7=Platt |first7=Joanne |date=2016-11-22 |editor-last=Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group |title=Adjuvant platinum-based chemotherapy for early stage cervical cancer |url=http://doi.wiley.com/10.1002/14651858.CD005342.pub4 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=1 |doi=10.1002/14651858.CD005342.pub4 |pmc=PMC6473195 |pmid=27873308}}</ref>.  For patients diagnosed with oSSC, reports show that combination treatment most commonly with these [[platinum-based antineoplastic]] agents: [[Carboplatin]], [[Bevacizumab]], [[Cisplatin]], [[Erlotinib]]<ref name=":0" /><ref name=":12" />. Nontheless, there are not the only ones and there are multiple prototyopes in devevelopment and or in clinical trials.
+Addition of platinum-based chemotherapy drugs to chemoradiation in women with early [[cervical cancer]] seems to improve survival and reduce risk of recurrence<ref>{{Cite journal |last1=Falcetta |first1=Frederico S |last2=Medeiros |first2=Lídia RF |last3=Edelweiss |first3=Maria I |last4=Pohlmann |first4=Paula R |last5=Stein |first5=Airton T |last6=Rosa |first6=Daniela D |last7=Platt |first7=Joanne |date=2016-11-22 |editor-last=Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group |title=Adjuvant platinum-based chemotherapy for early stage cervical cancer |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=1 |pages=CD005342 |doi=10.1002/14651858.CD005342.pub4 |pmc=6473195 |pmid=27873308}}</ref>.  For patients diagnosed with oSSC, reports show that combination treatment most commonly with these [[platinum-based antineoplastic]] agents: [[Carboplatin]], [[Bevacizumab]], [[Cisplatin]], [[Erlotinib]]<ref name=":0" /><ref name=":12" />. Nontheless, there are not the only ones and there are multiple prototyopes in devevelopment and or in clinical trials.
 ==== Immunotherapy ====
 Main Article: [[Immunotherapy]]
-[[Immunotherapy]] has gained significant traction in [[oncology]], demonstrating safety and effectiveness in treating various solid tumors. However, its adoption in platinum-resistant ovarian cancer remains unsupported by studies, prompting a need for further investigation<ref>{{Cite journal |last=Yang |first=Chang |last2=Xia |first2=Bai-Rong |last3=Zhang |first3=Zhao-Cong |last4=Zhang |first4=Yong-Jian |last5=Lou |first5=Ge |last6=Jin |first6=Wei-Lin |date=2020 |title=Immunotherapy for Ovarian Cancer: Adjuvant, Combination, and Neoadjuvant |url=https://www.frontiersin.org/articles/10.3389/fimmu.2020.577869 |journal=Frontiers in Immunology |volume=11 |doi=10.3389/fimmu.2020.577869 |issn=1664-3224 |pmc=PMC7572849 |pmid=33123161}}</ref>. Nonetheless, evidence indicates that combining chemotherapy with the humanized anti-[[VEGF]] monoclonal antibody, bevacizumab, in the treatment of recurrent, persistent, or metastatic cervical cancer results in a 3.7-month enhancement in overall survival<ref name=":2" />.
+[[Immunotherapy]] has gained significant traction in [[oncology]], demonstrating safety and effectiveness in treating various solid tumors. However, its adoption in platinum-resistant ovarian cancer remains unsupported by studies, prompting a need for further investigation<ref>{{Cite journal |last1=Yang |first1=Chang |last2=Xia |first2=Bai-Rong |last3=Zhang |first3=Zhao-Cong |last4=Zhang |first4=Yong-Jian |last5=Lou |first5=Ge |last6=Jin |first6=Wei-Lin |date=2020 |title=Immunotherapy for Ovarian Cancer: Adjuvant, Combination, and Neoadjuvant |journal=Frontiers in Immunology |volume=11 |doi=10.3389/fimmu.2020.577869 |issn=1664-3224 |pmc=7572849 |pmid=33123161 |doi-access=free }}</ref>. Nonetheless, evidence indicates that combining chemotherapy with the humanized anti-[[VEGF]] monoclonal antibody, bevacizumab, in the treatment of recurrent, persistent, or metastatic cervical cancer results in a 3.7-month enhancement in overall survival<ref name=":2" />.
 == References ==