ABSTRACT
Ovarian carcinoma and the closely linked serous carcinomas of the fallopian tube and peritoneum (together with the rare diffuse peritoneal mesothelioma) exhibit a unique pattern of invasion and metastasis, with widespread dissemination within the serosal (peritoneal and pleural) cavities and a far lower degree of distant metastasis to parenchymal organs. The ability of more than two-thirds of ovarian carcinomas to metastasize prior to detection is primarily related to the late appearance of symptoms. However, this aggressive clinical behavior also depends on the presence of highly efficient cellular mechanisms that mediate profound changes in the expression of key molecules in cancer biology as functions of anatomic site and the changing microenvironment. These molecular differences are exemplified in the alterations undergone by cancer cells in effusions compared with primary tumors and solid metastases – differences that are also relevant in terms of predictive and prognostic value. Chemotherapy produces further molecular changes in ovarian carcinoma cells, requiring further stratification of tumor samples obtained at various stages of the clinical course. The dynamic molecular profile of ovarian cancer cells is complemented by their ability to cross-talk
with stromal and endothelial cells in solid tumors and with mesothelial cells in effusions. This chapter will detail current data related to the expression, diagnostic role, and predictive/ prognostic value of adhesion molecules and proteolytic enzymes in primary and metastatic ovarian carcinoma.
