Precancerous Lesions of Ovarian Cancer—A US Perspective

A major challenge to realizing the goals of early detection and prevention of ovarian cancer is a lack of comprehensive knowledge of the natural history of precancerous lesions. Precancerous lesions are abnormal tissues that often precede the development of invasive carcinoma, which could be a risk factor, a true precursor, or an in situ component of the carcinoma. Unlike cancers arising in the endometrium, cervix, colon, breast, and prostate, where the early events of carcinogenesis can be studied because their precursor lesions have been well established, this is not the case for ovarian high-grade serous carcinoma (HGSC), the most common and lethal type of ovarian cancer. In recent years, technology has enabled the generation of molecular evidence that suggests that serous tubal intraepithelial carcinoma (STIC) of the fallopian tube is likely the precancerous lesion of most HGSCs (1–5). While molecular and epidemiologic data are emerging to support this paradigm, the clinical utility of a STIC diagnosis remains to be determined. A STIC comprises contiguous atypical epithelial cells with morphological and molecular features resembling an invasive HGSC. STICs reside in the fimbriated ends of fallopian tubes, from which some STIC cells may be by exported to ovaries and peritoneal tissues, where they progress to HGSCs. As such, HGSCs are often advanced diseases at the time of diagnosis (Figure 1). The prevalence of STICs is reported to be as high as 10% in BRCA1/2 mutation carriers (6), but little is known about the incidence of STICs in the general population.

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