OB gyn – MED32
Ovarian CancerGeneral Notes Most common cause of death among gyn cancersAdnexal mass + Ascites = ovarian cancer till proven otherwiseMost ovarian tumors are benignAny ovarian tumor must be removed surgically even if it is small and symptomlessRisk factors- ?Postmenopausal (above 40 years old )- ?Fx Hx - ? (BRCA1) mutation ?- ?Abnormal ovarian development as in Turner’s syndrome ?- ?Nulliparity ?- ?Ovulatory stimulant drugs ?TypesEpithelial ctumorsGerm cell tumorsSex cord stromal tumorsGonandoblastomaLipoid cell tumorsMetastatic ovarian neoplasmSoft tissue tumorsUnclassified tumorsTumor like conditionsStages SpreadDiagnosisSigns and Symptoms :- Most are asymptomatic?- Lower abdominal pain?- Pelvic mass?- Gastro intestinal signs – painless usually – cachexia (large tumors) - Menstrual disturbances (rare)- Pressure symptoms (Dyspareunia, urinary frequency, constipation) - Ascites and any other signs related to metastasis?Note: 70 -80 % are diagnosed at an advanced stage Investigations :- Abdominal ultrasound?- Intravenous urogram?- Ascitic tap for cytology?- Laparotomy/laparoscopy for biopsy and histology (+small tumors) - CT-scan and/or MRI - Barium meal- CA-125?- Chest x-ray, FBC, liver function, renal function Benign vs Malignant : Complications - ?Spread of the cancer to other organs (metastases) ?- ?Severe loss of weight ?- ?Ascites ?- ?Intestinal occlusion ?- ?DeathManagement Surgery is the principal treatment Chemotherapy + RadiotherapyRecommendation- ?Manage pelvic pain and/or abdomno-pelvic mass especially associated with vaginal bleeding ?- ?Perform annual pelvic examination and pelvic ultrasound in reproductive and advanced age - ?Encourage oral contraceptive for high risk women of cancer of the ovary ?- ?Consider prophylactic bilateral laparoscopic oophorectomy in women that don’t desire fertility with a risk of cancer of the ovary. ?- CA 125 is good test for follow up of patients with cancer of ovary but its not good for screening ?Epiththelial tumorsMost common typeSubtypes : Serous cystadenomaMucinous cystadenomaEndometroid tumorClear cell tumor (Mesonephric)Brenner`s tumorMixed epithelial tumorUndifferentiated carcinomaGerm cell tumorsfrom the primitive germ cellssubtypes :DysgerminomaEndodermal sinus tumorTeratomaSex cord stromal tumorsSubtypes :Granulosa stromal neoplasm: Sertoli-lydig cell tumorMixedGonandoblastomaPure or Mixed with dysgerminoma or other forms of germ cell tumors.Lipoid cell tumorsAdrenal rests tumors: It is formed of cells resembling those of the adrenal cortex, luteinized cells, or lydig cells.Metastatic ovarian neoplasmTypical: Histologically similar to primary tumor.Atypical: Krukenberg`s tumorTumor like conditionsNon-neoplastic ovarian cysts (pregnancy lutoma, follicular cysts, endometriotic cyst, and inflammatory cyst).Epiththelial tumorsGerm cell tumorsSex cord stromal tumorsGonandoblastomaLipoid cell tumorsMetastatic ovarian neoplasmTumor like conditions ................
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