Oncogenesis in ovarian cancer

Tumorigenesis is a multistep process involving mutations of dominantly acting proto‐oncogenes and mutations and loss‐of‐function mutations of tumor suppressor genes. Some of these mutations may be inherited, but most of them are acquired. Models for the sequential steps of the genetic changes involved in tumor development have been proposed for certain cancers, such as colon cancer. In the case of ovarian cancer, relatively little is known about the genetic events associated with the initiation or subsequent progression and metastases of the tumor. Cytogenetic analysis has revealed a high incidence of both structural and numerical chromosome changes, and the extent of these changes seems to increase with tumor progression. Oncogene activations of the proto‐oncogenes K‐ras, c‐myc and c‐erbB‐2 have been found more frequently in aggressive ovarian tumors and may be associated with poor survival. Tumor‐specific allele loss involving putative tumor suppressor genes has been observed for loci at chromosomes 11p, 17p, and 17q, ‐ loci commonly deleted in other cancers too. A relatively high incidence of allelic loss on chromosome 6q appears to be specific to ovarian carcinoma. Familial breast/ovarian cancer has been suggested to map to chromosome 8q. Recently we have found a germ‐line mutation in the tumor suppressor gene p53 in a family with breast‐ and ovarian cancers, indicating that this is the predisposing gene in this family. Genetic changes important for the etiology of ovarian cancers seem to involve both somatic mutations of oncogenes and somatic or germ‐line inactivation of tumor suppressor genes.