Observations indicate three different tissues of origin for ovarian carcinoma. The ovarian surface epithelium, oviduct epithelium (TSE), and derivates of the Müllerian duct. This chapter discusses the TSE-related ovarian carcinogenesis (exfoliation theory). Recent evidence from prophylactic removed ovaries and Fallopian tubes shows (pre)neoplastic lesions primarily within the tubes and not in the ovaries, putting another light on the malignant potential of the tubal epithelium and possibly ovarian carcinogenesis.