Um novo modelo de carcinogénese para cancro do ovário: implicações clínicas da salpingectomia profiláctica

• Autor(a) principal: Ferreira,Ana Filipa Rodrigues
• Data de Publicação: 2016
• Outros Autores: Carvalho,Maria João, Rebelo,Teresa, Falcão,Francisco, Torgal,Isabel
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000100008
• topic: Carcinogenesis; Ovarian Neoplasms; Salpingectomy

Ovarian cancer is the most lethal gynaecological malignancy. There is limited knowledge regarding this cancer and we are witnessing a paradigm shift, in which the Fallopian tube is considered the primary site of most high-grade serous carcinoma (HGSC). The aim of this article is to review the current body of knowledge of the origin and pathogenesis of ovarian cancer and the clinical implications of the new model of carcinogenesis. During more than 30 years, the prevailing view on the origin of HGSC was that it derived from the ovary, since the ovarian surface epithelium is exposed to inflammation and oxidative stress induced by ovulation. The incessant ovulation hypothesis was proposed by Fathalla in 1971. At the beginning of this century, many studies were published demonstrating the presence of invasive and non-invasive carcinoma in the fallopian tubes of prophylactic salpingo-oophorectomies performed in carriers of BRCA mutation, which led some authors to suggest the fallopian tube as the origin of these tumors. This theory was published in 2007, by Kindelberger, who described the precursor lesion - serous tubal intraepithelial carcinoma (STIC). The advances in cellular and molecular biology and in genetics added support for this new concept, indicating that the HGSC develops from an occult intraephitelial carcinoma in the fimbria of the fallopian tube and involves the ovary secondarily. Observational epidemiologic evidence strongly supports that tubal ligation and hysterectomy are associated with a decrease in the risk of ovarian cancer, by approximately 26-34%. The additional bilateral salpingectomy to hysterectomy does not affect ovarian function, and has no significant differences in rate of complications and operative time. Considering the new insights into the origin of HGSC, in which the majority is of tubal origin, there is a significant preventive potential by performing prophylactic salpingectomy.