Expression of Cancer-associated Fibroblasts Markers in Epithelial Ovarian Neoplasms and Its Correlation with Tumour Progression, Angiogenesis and Lymphangiogenesis: An Immunohistochemical Study

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Epithelial ovarian carcinoma (EOC) is the most common type of ovarian cancer representing 80-90% of all malignant ovarian tumors and it is the most lethal gynecological malignancy in the world. The high mortality rate of ovarian carcinoma primarily stems from the late diagnosis of this tumor. Approximately 70% of patients are diagnosed with stage III or IV ovarian cancer, which is characterized by peritoneal or distant metastases, respectively. Despite advances in cytotoxic therapies, only 30% of patients with advanced-stage ovarian cancer survive 5 years after initial diagnosis. So there is a continuous need for better understanding of the mechanisms involved in the spread of ovarian carcinoma. Cancer tissue is considered a sophisticated construct of both malignant tumor cells and non-malignant host stromal cells. However, in the past decades, the major focus of ovarian cancer researches has been the transformed tumor cell itself with a rapid progression of knowledge pertaining to the genetic and epigenetic changes they undergo and eluciding their signaling pathways in tumor cells. Till now existing therapies remain relatively ineffective for most types of cancer, and the role of tumor stroma in tumor genesis, especially the fibroblasts which are the main component in the stroma, has not been widely explored.