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lüll Microenvironment and pathogenesis of epithelial ovarian cancer Saad AF; Hu W; Sood AKHorm Cancer 2010[Dec]; 1 (6): 277-90Multiple genetic alterations play a role in the pathogenesis of ovarian cancer. Although many key proteins and pathways involved in ovarian carcinogenesis and metastasis have been discovered, knowledge of the early steps leading to malignancy remains poorly understood. This poor understanding stems from lack of data from early-stage cancers and absence of a well-established premalignant state universal to all ovarian cancer subtypes. Existing evidence suggests that ovarian cancers develop either through a stepwise mutation process (low-grade pathway), through genetic instability resulting in hastened metastasis (high-grade pathway), or more recently through what has been described as the "'fimbrial-ovarian' serous neoplasia theory." In this latter model, ovarian serous cancers evolve from premalignant lesions in the distal fallopian tube called tubal intraepithelial carcinoma. In this manuscript, we review key genetic and molecular changes that occur in cancer cell progression and suggest a model of ovarian cancer pathogenesis involving both tumor cell mutations and microenvironmental factors.|*Carcinoma in Situ/genetics/metabolism/pathology[MESH]|*Cell Transformation, Neoplastic/genetics/metabolism/pathology[MESH]|*Neoplasms, Glandular and Epithelial/genetics/metabolism/pathology[MESH]|*Ovarian Neoplasms/genetics/metabolism/pathology[MESH]|*Precancerous Conditions/genetics/metabolism/pathology[MESH]|*Tumor Microenvironment[MESH]|Animals[MESH]|Carcinoma, Ovarian Epithelial[MESH]|Disease Progression[MESH]|Female[MESH]|Humans[MESH] |