Female Reproductive System and Ovarian Cancer

by Robert Tallitsch, PhD | April 28, 2022

3D anatomy video showing real visualizations of the female reproductive anatomy and ovarian cancer patient case example!

Written by: Robert Tallitsch, PhD

Ovarian cancer is the second most common gynecologic cancer, causing more deaths than any other cancer of the female reproductive system. The incidence of ovarian cancer increases with age, with over 50% of the women diagnosed being 63 years-of-age or older.

This Brain Builder will concentrate on the gross and microscopic anatomy of the ovaries of the female reproductive system, and will also discuss ovarian cancer.

Organs and Functions of the Female Reproductive System

The female reproductive system is composed of the external genitalia and the internal pelvic structures.

The external genitalia are:

Labia majora
Labia minora
Clitoris

The internal pelvic structures are:

Ovaries
Uterine (Fallopian) tubes
Uterus
Vagina

The functions of the female reproductive system are:

Production of gametes called ova
Provide a site for fertilization
Support the implantation of the fertilized gamete
Provide nourishment to support the developing fetus
Delivery of a human fetus
Production and release of female sex hormones
Nourishment of the baby following delivery

Gross Anatomy of the Ovaries

The ovaries, which are the female gonads, function to produce ova and the female hormones estrogen and progesterone. These hormones:

Influence the cyclic production and maturation of the ova
Influence the development and maintenance of the secondary female reproductive organs
Establish the microscopic requirements for implantation of the ova within the uterus
Maintain the uterine characteristics required for retention of the embryo and fetus within the uterine cavity until expulsion at birth

Each ovary, which is approximately 2 cm wide, 3 cm long, and 1 cm thick, lies between the uterus and the lateral pelvic walls. However, the position of the ovaries may vary slightly within the pelvic cavity, depending on the individual’s body position.

The ovaries lie within the ovarian fossa, which are shallow depressions of the parietal peritoneum. Each ovary is suspended from the posterior aspect of the broad ligament by a ligament termed the mesovarium. Each broad ligament, which encloses the uterine (Fallopian) tube, is a fold of the peritoneum that runs from the lateral pelvic wall to the uterus, passing in the coronal plane.

Microscopic Anatomy of the Ovary

The surface of the ovary is covered with a simple squamous epithelium. Deep to this epithelium is a piece of dense, fibrous connective tissue termed the tunica albuginea.

When viewed in cross section the ovary is composed of two layers: an inner medulla and an outer cortex. The medulla is composed of loose connective tissue rich in lymphatic vessels, capillaries, and nerves. In contrast, the cortex is composed of a compact bed of connective tissue containing numerous ovarian follicles. In a premenopausal female these follicles will be in various stages of development and degeneration. The size and complexity of each follicle will depend on its developmental stage. Each follicle contains an ova surrounded by epithelial tissue. The follicles are divided into the following stages of development: primordial, primary, secondary (also termed antral follicles), and mature (also termed Graafian, tertiary, or ovulatory).

Primordial follicles are the most numerous ovarian follicles. They are the most superficial follicles, and are in a stage of resting meiotic prophase. Primordial follicles have been in this resting state since the fifth or sixth month of fetal development.

The next developmental stage is the primary follicle. In this stage the follicle has begun to grow. The oocyte has started to enlarge, and the surrounding epithelial cells and adjacent connective tissue have undergone considerable histological changes.

Secondary follicles move deeper within the cortex of the ovary. The follicle continues to grow in size, as does the enclosed oocyte. A fluid-filled cavity, termed an antrum, develops within the secondary follicle.

The final stage of development is termed the mature follicle. Here the follicle has reached its maximum size and forms a noticeable bump in the surface of the ovary. This developmental stage contains a very large oocyte with a noticeable nucleus and nucleolus. The antrum now occupies most of the follicle, and the follicle is preparing for ovulation.

Not all follicles progress through all of the developmental stages and ultimately ovulate. Indeed, most developing follicles stop in one of the developmental stages and undergo a degeneration process termed follicular atresia. Upon completion of follicular atresia a small scar, which represents what remains of the once developing follicle, is visible within the cortex of the ovary.

Ovarian Cancer

Ovarian cancer is the result of abnormal and uncontrollable cellular growth within one or both of the ovaries. In the early stages of development most individuals exhibit no signs or symptoms of the disease or, if they do, the signs and symptoms are often blamed on other common conditions. Some of the more common symptoms associated with the early stages of ovarian cancer are indigestion, constipation, acid reflux, bloating, pelvic pain, abnormal vaginal bleeding, and/or nausea.

There are three types of ovarian tumors:

Stromal cell tumors develop from the cells of the follicle that are responsible for the production of two female hormones: estrogen and progesterone.
Epithelial cells tumors develop from the surface epithelial tissue of the ovary.
Germ cell tumors develop from the ova contained within the follicle of the ovary. Although this type of tumor may become malignant, most remain benign (non-cancerous).

Ovarian cancer is most commonly diagnosed as a result of one or more of the following procedures:

Pelvic exam
Ultrasound or other imaging procedures
Biopsy
Blood tests to assay for one or more blood markers typically present in a patient with ovarian cancer.

The cause of ovarian cancer is unknown, although it is believed to be the result of one or more genetic mutations within cells in or near the ovaries.

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Key Terms:

Primordial oocyte - Primordial follicles are the most numerous ovarian follicles. They are the most superficial follicles, and are in a stage of resting meiotic prophase.

Germ cell tumor - A type of ovarian tumor that develops from the ova contained within the follicle of the ovary.

Mature follicle - The final stage of follicular development.

Follicular atresia - The process by which an ovarian follicle degenerates and dies.

Mesovarium - A piece of connective tissue that suspends each ovary from the posterior aspect of the broad ligament.

Tunica albuginea - A tough piece of connective tissue found immediately deep to the surface epithelium of the ovary.

Broad ligament - A fold of the peritoneum that runs from the lateral pelvic wall to the uterus, passing in the coronal plane. This piece of connective tissue encloses the uterine tubes.

Malignant - Cancerous

Benign - Non-cancerous

Questions:

True or False? All developing follicles ultimately undergo ovulation.
A: False
List the developmental stages of follicular development, beginning with the initial phase and ending with the phase where the follicle is preparing for ovulation.
A: Primordial follicle, primary follicle, secondary follicle, mature follicle.
True or False? An individual in the early stages of ovarian cancer will always develop the same symptoms, and these symptoms will alert the patient to the cancer developing within them.
A: False
True or False? Germ cell tumors are always malignant.
A: False
True or False? Each ovary is in contact with the posterior wall of the pelvic cavity.
A: False
True or False? An ovarian follicle that is in the mature stage will produce a visible bump on the surface of the ovary.
A: True
True or False? When viewed in cross section an ovary is composed of two layers: an outer cortex and an inner medulla.
A: True
What is the name of the process by which a follicle degenerates?
A: Follicular atresia
List the four most common examination procedures that detect ovarian cancer.
A: Pelvic exam, ultrasound or other imaging procedures, biopsy, and blood tests to assay for one or more blook markers typically present in a patient with ovarian cancer.
Give an anatomical definition of the tunica albuginea of the female ovary.
A: A tough piece of connective tissue found immediately deep to the surface epithelium of the ovary.

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