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PubMed This is a summary of 12 peer-reviewed journal articles Updated
Oncology

Understanding Your Pathology and Molecular Profile

At a Glance

Your ovarian cancer pathology report contains essential details like your FIGO stage, genetic mutations (BRCA), and HRD status. Understanding these test results helps you and your care team choose the most effective, personalized targeted therapies like PARP inhibitors.

Your pathology report is the “blueprint” for your cancer care. It provides the essential details about the type, stage, and genetic makeup of your tumor. Today, this report goes far beyond looking at cells under a microscope; it now includes deep molecular testing that is an absolute standard of care to help select tailored therapy [1].

Understanding Your FIGO Stage

Ovarian cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) system [2]. This is fundamentally a surgical and pathological stage, meaning it is determined by what the surgeon sees during an operation and what the pathologist finds in the tissue samples [3][4].

  • Stage I: The cancer is limited to one or both ovaries or fallopian tubes [2].
  • Stage II: The cancer has spread to other organs within the pelvis.
  • Stage III: The cancer has spread to the lining of the abdomen outside the pelvis and/or to the lymph nodes.
  • Stage IV: The cancer has spread to distant organs, and is further subdivided into IVA and IVB based on prognostic implications [5].

Comprehensive Multi-Gene Testing: Germline vs. Somatic

While early testing focused only on BRCA1 and BRCA2, current clinical guidelines mandate comprehensive multi-gene panel testing for patients with high-grade serous ovarian cancer [6][1]. This tests for a wider array of genes involved in cancer risk and DNA repair.

  • Germline Testing: This is done via a blood or saliva sample. It looks for inherited mutations you were born with. If a mutation is found here, it means your relatives (children, siblings) may also carry the risk and should be offered genetic counseling [6].
  • Somatic (Tumor) Testing: This is done on the tumor tissue itself. It looks for mutations that occurred only within the cancer cells. These are not inherited, but they are crucial for unlocking specific targeted treatments [1].

Homologous Recombination Deficiency (HRD)

Homologous Recombination Deficiency (HRD) is a specific “scar” in the cancer’s DNA [6]. It means the cancer cells have lost their ability to accurately repair double-strand DNA breaks.

HRD testing is a critical strategy for optimizing management [7]. Tumors that are HRD-positive (which includes all BRCA-mutated tumors and some others) are significantly more sensitive to maintenance therapies called PARP inhibitors [8].

Your Pathology “Completeness Checklist”

When you review your report, ensure these key elements are present to guide modern treatment:

Category What to Look For Why It Matters
Histology High-grade serous, Endometrioid, etc. Determines the “personality” and behavior of the cancer [9].
FIGO Stage Stages I–IV Guides the intensity of treatment and prognosis [10].
Comprehensive Panel BRCA1/2 + other genes (Germline/Somatic) Essential for PARP inhibitor eligibility and family planning [11].
HRD Status Positive or Negative Identifies more patients who may benefit from maintenance therapy [6].
MMR/PD-L1 Mismatch Repair / PD-L1 expression Helps screen for immunotherapy options [12].
FRα Folate Receptor alpha Emerging marker for targeted therapies (Antibody-Drug Conjugates).

If any of these are missing, it is a valid reason to ask your doctor for an addendum. Knowing these details empowers you to participate fully in your treatment decisions.

Common questions in this guide

What is the difference between germline and somatic genetic testing?
Germline testing uses blood or saliva to find inherited mutations you were born with, which can also affect your family members. Somatic testing analyzes the tumor tissue itself to find mutations that only exist in the cancer cells to help doctors select targeted treatments.
What does an HRD-positive result mean for ovarian cancer?
Homologous Recombination Deficiency (HRD) positive means your cancer cells have lost their ability to accurately repair double-strand DNA breaks. This indicates that your tumor is highly likely to respond to targeted maintenance therapies called PARP inhibitors.
How is the FIGO stage for ovarian cancer determined?
The FIGO stage is a surgical and pathological stage. It is determined by what your surgeon observes during your operation and what the pathologist finds when examining the removed tissue and lymph nodes under a microscope.
Why is comprehensive multi-gene panel testing important?
While older tests only looked at BRCA1 and BRCA2, a comprehensive panel checks for a wider array of genes linked to cancer. This is now the standard of care because it uncovers more options for targeted therapies and helps assess potential cancer risks for your family members.
What essential markers should be included on my complete pathology report?
A complete report should detail your cancer's histology, FIGO stage, comprehensive gene panel results, HRD status, and specialized markers like Mismatch Repair (MMR) or Folate Receptor alpha (FRα). If any of these are missing, you should ask your doctor for an addendum.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What was my final FIGO stage after surgery, and were any lymph nodes involved?
  2. 2.Have I received 'comprehensive multi-gene panel testing' (both germline and somatic) rather than just BRCA1/2 testing alone?
  3. 3.What is my HRD (Homologous Recombination Deficiency) status, and does it make me a candidate for PARP inhibitor maintenance?
  4. 4.Has my tumor been tested for Folate Receptor alpha (FRα) or Mismatch Repair (MMR) status?
  5. 5.Were my tumor's immunohistochemistry (IHC) markers clearly reported to confirm my exact subtype?

Questions For You

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Related questions

Does Fallopian Tube Removal Prevent Ovarian Cancer?Is Fallopian Tube Removal Safe? Risks & RecoveryWhat Are the Risks of Fallopian Tube Removal?What is HRD Status in Ovarian Cancer?Somatic vs Germline BRCA Mutations: What's the Difference?

References

References (12)
  1. 1

    Homologous recombination deficiency in newly diagnosed FIGO stage III/IV high-grade epithelial ovarian cancer: a multi-national observational study.

    Morgan RD, Clamp AR, Barnes BM, et al.

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2023; (33(8)):1253-1259 doi:10.1136/ijgc-2022-004211.

    PMID: 37072323
  2. 2

    Ovarian Cancer, the Revised FIGO Staging System, and the Role of Imaging.

    Javadi S, Ganeshan DM, Qayyum A, et al.

    AJR. American journal of roentgenology 2016; (206(6)):1351-60 doi:10.2214/AJR.15.15199.

    PMID: 27042752
  3. 3

    Stage III disease of ovarian, tubal and peritoneal cancers can be accurately diagnosed with pre-operative CT. Japan Clinical Oncology Group Study JCOG0602.

    Onda T, Tanaka YO, Kitai S, et al.

    Japanese journal of clinical oncology 2021; (51(2)):205-212 doi:10.1093/jjco/hyaa145.

    PMID: 33556170
  4. 4

    Mucinous Neoplasms of the Ovary: Radiologic-Pathologic Correlation.

    Marko J, Marko KI, Pachigolla SL, et al.

    Radiographics : a review publication of the Radiological Society of North America, Inc 2019; (39(4)):982-997 doi:10.1148/rg.2019180221.

    PMID: 31283462
  5. 5

    The revised 2014 FIGO staging system for epithelial ovarian cancer: Is a subclassification into FIGO stage IVA and IVB justified?

    Ataseven B, Harter P, Grimm C, et al.

    Gynecologic oncology 2016; (142(2)):243-7.

    PMID: 27208538
  6. 6

    Mutation landscape of germline and somatic BRCA1/2 in patients with high-grade serous ovarian cancer.

    Eoh KJ, Kim HM, Lee JY, et al.

    BMC cancer 2020; (20(1)):204 doi:10.1186/s12885-020-6693-y.

    PMID: 32164585
  7. 7

    Cost-Effectiveness Analysis of Biomarker Testing to Guide First-Line PARP Inhibitor Maintenance for Patients with Advanced Ovarian Cancer After Response to First-Line Platinum Chemotherapy in the USA.

    Elsea D, Muston D, Fan L, et al.

    Targeted oncology 2023; (18(4)):531-541 doi:10.1007/s11523-023-00966-6.

    PMID: 37233868
  8. 8

    Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer.

    Ray-Coquard I, Pautier P, Pignata S, et al.

    The New England journal of medicine 2019; (381(25)):2416-2428 doi:10.1056/NEJMoa1911361.

    PMID: 31851799
  9. 9

    Invasive Epithelial Ovarian Cancer Survival by Histotype and Disease Stage.

    Peres LC, Cushing-Haugen KL, Köbel M, et al.

    Journal of the National Cancer Institute 2019; (111(1)):60-68 doi:10.1093/jnci/djy071.

    PMID: 29718305
  10. 10

    Stage migration and survival outcomes in patients with cervical cancer at Stage IIIC according to the 2018 FIGO staging system: a systematic review and meta-analysis.

    Han L, Chen Y, Zheng A, et al.

    Frontiers in oncology 2024; (14()):1460543 doi:10.3389/fonc.2024.1460543.

    PMID: 39411135
  11. 11

    How BRCA and homologous recombination deficiency change therapeutic strategies in ovarian cancer: a review of literature.

    Arcieri M, Tius V, Andreetta C, et al.

    Frontiers in oncology 2024; (14()):1335196 doi:10.3389/fonc.2024.1335196.

    PMID: 38525421
  12. 12

    Expression of Programmed Cell Death Ligand 1 and Mismatch Repair Status in Ovarian Carcinomas.

    Hariprasad M, Rao M, Elhence PA, et al.

    Journal of mid-life health 2025; (16(3)):309-314 doi:10.4103/jmh.jmh_102_25.

    PMID: 40951848

This page explains ovarian cancer pathology terms for educational purposes. Always consult your gynecologic oncologist and pathologist to interpret your specific report and genetic test results.

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