Ovarian CancerGeneral Notes - Most common cause of death among gyn cancers

- Adnexal mass + Ascites = ovarian cancer till proven otherwise- Most ovarian tumors are benign- Any ovarian tumor must be removed surgically even if it is small and symptomless

Risk factors - Postmenopausal (above 40 years old )- Fx Hx - (BRCA1) mutation - Abnormal ovarian development as in Turner’s syndrome - Nulliparity - Ovulatory stimulant drugs

Types 1) Epithelial ctumors2) Germ cell tumors3) Sex cord stromal tumors4) Gonandoblastoma5) Lipoid cell tumors6) Metastatic ovarian neoplasm7) Soft tissue tumors8) Unclassified tumors9) Tumor like conditions

Stages

Spread

Diagnosis Signs 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 metastasisNote: 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 - Death

Management Surgery is the principal treatment Chemotherapy + Radiotherapy

Recommendation - 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 Most common type Subtypes :

tumors - Serous cystadenoma- Mucinous cystadenoma- Endometroid tumor- Clear cell tumor (Mesonephric)- Brenner`s tumor- Mixed epithelial tumor- Undifferentiated carcinoma

Germ cell tumors from the primitive germ cells subtypes :- Dysgerminoma- Endodermal sinus tumor- Teratoma

Sex cord stromal tumors

Subtypes :- Granulosa stromal neoplasm: - Sertoli-lydig cell tumor- Mixed

Gonandoblastoma Pure or Mixed with dysgerminoma or other forms of germ cell tumors.

Lipoid cell tumors Adrenal rests tumors: It is formed of cells resembling those of the adrenal cortex, luteinized cells, or lydig cells.

Metastatic ovarian neoplasm

Typical: Histologically similar to primary tumor.Atypical: Krukenberg`s tumor

Tumor like conditions

Non-neoplastic ovarian cysts (pregnancy lutoma, follicular cysts, endometriotic cyst, and inflammatory cyst).

Epiththelial

tumors

Germ cell tumors

Sex cord stromal tumors

Gonandoblastoma

Lipoid cell tumors

Metastatic ovarian neoplasmTumor like conditions