Theories regarding the origin and carcinogenesis of high-grade epithelial ovarian carcinoma and their clinical implications

Ovarian cancer is a heterogeneous pathology, with diverse clinical presentation, pathogenesis and histology, and it remains one of the leading mortality causes through gynecological cancer. Despite surgical and therapeutic advances, the prognosis of ovarian cancer is reserved, with a five-year survival rate lower than 45%. This is due to the lack of a screening test that could detect this disease in preinvasive stages, to nonspecific symptoms, late diagnosis, aggressive tumor types and to the tendency to develop resistance to currently available treatments. Regarding the origin and etiology of ovarian cancer, several recent studies, based on immunohistochemical, molecular and genetic findings, support the non-ovarian origin of the cells responsible for the initiation of ovarian cancer. In this review article, we round up the existing theories regarding the non-ovarian origin of high-grade serous ovarian cancer, respectively the tubal origin. This article also highlights the impact this theory has on the prophylactic measures taken in cases of patients at high risk of developing ovarian cancer.