Transcript Ovarian tumors

Rahimullah Khattak
Final Year MBBS
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Anatomy of the Ovary
Classification
Incidence
Risk Factors
Spread and Screening
Signs and Symptoms
Investigations
Staging
Differential Diagnosis
Treatment and Management
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Cancer that arises in the epithelium, the tissue
that lines the skin and internal organs of the
body, and has a malignant potential as well.
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Surface Epithelial Tumors
Serous Tumor
Mucinous Tumor
Endometrioid Tumor
Clear-cell Tumor
Brenner Tumor
Cystadenofibroma
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Germ-cell Tumors
Teratoma
 Dysgerminoma
 Yolk sac Tumor
 Choriocarcinoma
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Sex Cord Stromal Tumors
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Fibroma
Granulosa-theca cell Tumor
Sertoli-Leydig cell Tumor
Metastasis to Ovaries
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In general ovarian malignancy accounts for
25% of gynaecological cancers.
Among ovarian tumors only 10% are
malignant.
1. Nulliparity
2. Family history
There is a higher incidence of carcinoma in
unmarried women and married women with
low parity. Interestingly, prolonged use of oral
contraceptives reduces the risk somewhat.
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. Direct spread.
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Lymphatic spread.
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Neighbouring organs like fallopian tube, uterus,
bladder and pelvic peritonium.
Via lymphatic channel to the diaphragm, omentum,
peritonial surfaces of small and large bowel , liver
and parietal peritonium throughout the abdominal
cavity.
Blood metastasis.
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to the liver, lungs, bones and brain but occurs late in
the course of the disease
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Limited by two factors;
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Ovary is not an accessible organ.
A premalignant stage of ovarian cancr has not yet
been recognized.
Screening includes, bimanual pelvic
examination, ultrasonography and tumour
markers.
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Abdominal Pain or discomfort
Distention or feeling a lump
Indigestion
Urinary frequency
Abnormal menses
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Ultrasound.
Radiological Investigations.
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Chest x-ray
Barium studies to assess bowel involvement.
Imaging techniques.
CT scan
 MRI
 Lymphangio-graphy
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Cytology.
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Tumor markers.
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Fine needle aspiration done in clinically suspicious
lymph nodes in the groin and neck.
CA-125 (<35 IU/mL)
Haematological investigations.
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Full blood count, urea , creatinine, electrolytes and
liver function tests.
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The Federation Internationale de
Gynecologie et d'Obstetrique (FIGO) and the
American Joint Committee on Cancer (AJCC)
have designated staging.
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Limited to the ovaries.
 Stage IA: tumour limited to 1 ovary, the capsule is
intact, no tumour on ovarian surface and no
malignant cells in ascites or peritoneal washings.
 Stage IB: tumour limited to both ovaries, capsules
intact, no tumour on ovarian surface and no
malignant cells in ascites or peritoneal washings.
 Stage IC: tumour is limited to 1 or both ovaries
with any of the following: capsule ruptured,
tumour on ovarian surface, malignant cells in
ascites or peritoneal washings.
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Tumors involving 1 or both ovaries with pelvic
extension and/or implants.
 Stage IIA: extension and/or implants on the uterus
and/or fallopian tubes. No malignant cells in
ascites or peritoneal washings.
 Stage IIB: extension to and/or implants on other
pelvic tissues. No malignant cells in ascites or
peritoneal washings.
 Stage IIC: Pelvic extension and/or implants (stage
IIA or stage IIB) with malignant cells in ascites or
peritoneal washings.
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Tumours involving 1 or both ovaries with
microscopically confirmed peritoneal implants
outside the pelvis. Superficial liver metastasis equals
stage III.
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Stage IIIA: microscopic peritoneal metastasis
beyond pelvis (no macroscopic tumour).
Stage IIIB: macroscopic peritoneal metastasis
beyond pelvis less than 2 cm in greatest dimension.
Stage IIIC: peritoneal metastasis beyond pelvis
greater than 2 cm in greatest dimension and/or
regional lymph node metastasis.
Tumours involving 1 or both ovaries with distant
metastasis. Parenchymal liver metastasis equals stage
IV.
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Distended urinary bladder
Pregnancy
Uterine swelling and displacements
Fallopian tube swelling
Pelvic abscess
Endometriosis, adenomycosis
Ascites
Broad ligament cyst
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History
GPE
Per Abdominal Examination
Per Vaginal Examination
Surgery is main stay for treatment and
diagnosis.
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Hormone therapy is the use of hormones or
drugs that block hormones to fight cancer.
Hormone therapy is rarely used to treat
epithelial ovarian cancer. It is more often used
to treat ovarian stromal tumors.
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BENIGN TUMOURS
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Cystectomy
Unilateral oopherectomy
Salpingo-oopherectomy
In post-menopausal…TAH
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BORDERLINE TUMOURS
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Young patients: conservative treatment and follow up
Older patients: TAH
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MALIGNANT TUMOURS
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Depends upon staging and grading
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Stage IA and IB/Grade I
TAH
No need for further treatment
Close follow up
In young patients who wish to preserve fertility, conservative surgery of
preserving uterus and contralateral ovary can be performed.
Stage IA and IB with Grade 2 and 3/and stage IC
TAH and BSO followed by chemotherapy and radiotherapy
Stage II,III and IV
Same as above. Has to be modified according to:
General health
Extent of disease and residual disease after surgery
If growth cannot be removed completely:
Debulking
Cytoreduction
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Radiation to whole abdomen is given after
removal of most disease by operation.
Restricted to those who are most likely to get
benefit.
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Prolongs remission and survival
Also used for palliative treatment in advanced and
recurrent disease.
Administered in all cases beyond stage Ia.
Earlier single agents were used, nowadays
combination therapy is favoured.
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The drugs used are;
Alkylating agents.
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Anti-metabolites.
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Cisplatin, carboplatin
Toxoid compounds
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5-florouracil, methotrexate
Platinum compounds.
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Cyclophosphamide, chlorambucil
Paclitaxil (taxol)
Anti tumour antibiotics.
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Combination therapy is most beneficial.
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Drugs are given at 3 weeks intervals
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Intraperitoneal chemotherapy is also done but is very
effective.
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Overall 5-year survival in ovarian epithelial carcinoma
is low because of the preponderance of late-stage
disease at diagnosis.
 Stage I and II: 80-100%
 Stage III: 15-20%
 Stage IV: 5%
Patients under 50 in all stages have considerably better
5-year survival than older patients (40% compared to
15%)