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In the Name of God the Merciful

L.D. NO.ISBN :

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Prologue ……………………………...........................................................…………………………………

Dedication ……………………………………………………………..................................................………..

Preface ……………………………...........................................................………………………………………

1. Brief introduction to the female reproductive system …….....................................……………

2. The Female ovary ………………………………………................................................…………………

3. Ovarian follicles……………………………...............................................……………………………….

3.1 Classification of ovarian follicles ……................................………………………………………...

3.2 Follicular development ……………....................................……………………………………….......

4. The pituitary and hypothalamus role in ovarian functions …....................................…………

5. The ovarian surface epithelium ……………………….............................................................………

6. Cancer cells and their formation ………..........................................................……………………….

7. Cancer of the ovaries ……………….............................................………………………………………

7.1 Epidemiology and risk factors of ovarian cancer….........................…………………………....

7.2 Role of genetic factors in ovarian cancer……………….............................………………………

7.3 Ovarian cancer symptoms……………………………..................................…………………............

7.4 Ovarian cancer diagnosis……………………………....................................…………………………

7.5 Ovarian cancer staging…………………………......................................……………………………...

7.6 Treatment methods……………………………......................................………………………………..

7.7 Types of ovarian cancer……………………………....................................…………………………...

7.8 Histopathological evidence for origin of EOC………..........................…………………………

7.9 Cancer stem cells constitute a small proportion of OSE stem cells…..................…………

7.10 CSC tumorigenesis whether a genetic or an epigenetic phenomenon?............................

7.11 Ongoing research on ovarian cancer………………………….......................................…………

8. References………………………………………………....................................................…………………

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Contents Pge No.

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Prologue

Several types of malignancy arising from the ovary with approximately 90% originate from the ovarian surface epithelium. Ovarian epithelial carcinoma is the fifth most common cancer in female around the world. It results in the highest mortality rate among female malignancy with 50% of cases reported in women aged over 65 years. The lifetime risk of ovarian cancer is 1.48% with an annual incidence approaching 57.3 per 100,000 women aged 75 to 79 years.

Internationally, ovarian cancer represents about 4% of all types of cancers among women. Latest statistics, in 2008, indicate that 225,000 cases were reported internationally. Developed nations account for the highest incidence rates as their figures stands at 9 per 100,000. Conversely developing or under developed nations only have incidence rates of 5 in every 100,000 females. Asia and Africa represent the regions with the lowest prevalence rates while Europe and North America account for the highest rates. It is not surprising that this is the case because certain risk factors are higher among affluent groups than deprived ones

Incidence rates, but not mortality rates, have been decreasing since 1987. In Saudi Arabia, ovarian cancer represents 3.1% of all types of female cancers; there were around 149 cases reported in 2007. It ranks seventh among female population. The age-standardized incidence rate (ASR) was 2.2100,000/ for females. Low awareness regarding early symptoms of ovarian cancer among women in general population of Saudi Arabia is a major obstacle in the early detection challenges and research. In addition, deficiency in screening methods and Lack of knowledge about the nature of ovarian cancer among primary care physician decrease the survival rate of patients.

To the best of my knowledge, this is the first booklet in Middle East that offers a valuable but brief discussion about most of the aspects of the ovary

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including basic anatomy, physiology, genetics, tumorigenesis, early detection and treatment.

This book is written for scientists and students who are interested either scientifically or medically in knowing about the female ovary, also researcher in the field of ovarian tumors may benefit from reading it. All images used in this booklet has been taken with maintain all the requirements for copy right with permission from 123RF digital media library online.

Author/ Dr Salina Saddick

Assistant professor / Faculty of science, Department of Biological studies

King Abdulaziz University

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Dedication

I would like to dedicate this book to my family for allowing me the time to write it and to every woman who have been diagnosed with ovarian cancer and their loved ones who are also affected.

First and foremost, I would like to thank my husband Khalid for standing beside me throughout my study, career and writing this book. Even endless thanks cannot express my gratitude to him. He has been my inspiration and motivation for continuing to improve my knowledge and move my career forward.

Special thanks go to my wonderful parents Dad Yahya and Mum Dalal for their kind blessings and encouragement that enlightened and instilled in me the belief that I can do. My heart goes out for my three kids, Ghaliah, Yazeed and Dalal, their smiles and hugs spirited me to dare into the hard research ventures.

Last but not least King Abdulaziz University and all the members of Professor Hussain Basalamh’s scientific chair for Gynecological cancer deserve special mention and thankful acknowledgement, thanks for being part of their family.

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Preface

Believe it or not, cancer has afflicted people for several centuries. It is not a new disease. It is because of the early research that we hold a greater knowledge of cancer today. The word cancer came from the father of medicine, Hippocrates, a Greek physician. Hippocrates used the Greek words, carcinos and carcinoma to describe tumors, thus calling cancer «karkinos». The Greek terms actually were words to describe a crab, which Hippocrates thought a tumor resembled. Although Hippocrates may have named «Cancer», he was certainly not the first to discover the disease. The history of cancer actually begins much earlier.

The worlds oldest documented case of cancer hails from ancient Egypt, in 1500 b.c. The details were recorded on a papyrus, documenting 8 cases of tumors occurring on the breast. It was treated by cauterization, a method to destroy tissue with a hot instrument called «the fire drill». It was also recorded that there was no treatment for the disease, only palliative treatment. There is evidence that the ancient Egyptians were able to tell the difference between malignant and benign tumors. According to inscriptions, surface tumors were surgically removed in a similar manner as they are removed today. Although the person who discovered ovarian cancer is unknown ovarian cancer was discovered as a benign tumor during a C section in 1968

This is awareness book has simply the basic knowledge of ovarian pathogenesis allow early detection and screening. Data in Saudi Arabia ovarian cancer research is lacking. There is great opportunity to learn from this book and for ovarian cancer. I hope you will find it beneficial….

Khalid Hussain SaitConsultant Obstetrics and Gynecology, Professor, Faculty of Medicine, KingAbdulaziz University, Jeddah, Saudi ArabiaDirector of Gynecology Oncology UnitChairman of Scientific Chair of Prof. Abdullah Hussain Basalamah forGynecological Cancer

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15 μm 15 μm 24 μm

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BRCA2

BRCA1

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elongation factor 1-alpha 2 (eEF1A-2), collagen alpha 1(III) chain precursor (COL3A1) the aldehyde dehydrogenase family 1 member A1 (ALDH1A1)

transcriptional activity, cellular metabolism, cell adhesion or motility and cytoskeleton organization.

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