Power Point of Poster

7/24/2019 Power Point of Poster

1/28

INTRODUCTION

Ovarian malignancy is not uncommon in young

women

Initiation of childbearing is delayed to later in life

Stage I borderline or invasive ovarian tumors are

more freuent in childbearing age

These women may benefit from conservative

a!!roach" !reserving their fertility withoutcom!romising long#term survival


2/28

INTRODUCTION

Conservative management of $OT is

becoming a necessity because

Ovarian malignancy is not uncommon in

young women

Delayed childbearing is becoming more

common

Stage I borderline % early invasive ovarian

tumors are more freuent in this age grou!


3/28

The standard treatment for early stage

$OC is radical and includes hysterectomy

with bilateral sal!ingo#oo!horectomy

Conservative treatment denotes surgery

that !reserves the re!roductive !otential

without com!romising long term survival

& staging !rocedure is necessary to

confirm the early stage and to guide

chemothera!y decisions


4/28

'I(O Staging for early ovarian

cancer

Stage ) growth limited to ovaries

Stage )a growth limited to one ovary only

Stage )b growth limited to both ovaries

Stage )c tumor either stage )a or )b

tumor on surface of one or both ovary

ascites containing malignant cells

ca!sule ru!tured


5/28

Criteria for conservative surgical

management of epithelial ovarian cancer

*oung !atient desirous of future childbearing

+atient and family consent and agreement to

close follow u!

&ny unilateral borderline tumor" stage )ae!ithelial tumor

,ultidisci!linary a!!roach with close

collaboration of gynecologist#oncologist"re!roductive endocrinologist and !erinatologist


6/28

Com!rehensive surgical staging

techniue

)- ,idline vertical incision

.- +eritoneal cytology

/- Systematic abdominal e0!loration1- Unilateral sal!hingo#oo!horectomy with

intact ca!sule

2- Random and directed !eritoneal bio!sy3- Omentectomy

4- +elvic and !ara#aortic lym!hadenectomy


7/28

+eritoneal cytology

+eritoneal washing

with )55#)25 ml of

saline solution from

+elvis

+aracolic s!aces

6evel of each

hemidia!hragm


8/28

Systematic abdominal e0!lorationIns!ect and !al!ate

Right !aracolic s!ace

Rt 7idney

Su!ra he!atic s!ace

Rt dia!hragm Rt he!atic lobe

(allbladder

,orison8s !ouch

6t hemidia!hragm

6t he!atic lobe

S!leen

Stomach

Transeverse colon

6t 7idny

6t !aracolic s!ace

6esser sac

!ancreas

Small bowel

Colon ,esentry both surfaces

Retro!eritonial areas along

vascular structure


9/28

,anagement of !rimary tumor

$valuate tumor si9e"

e0ternal e0crescence"

ca!sule ru!ture"

adhesions

Unilateral sal!ingo#

oo!horectomy

'ro9en section

Contralateral ovary if

grossly normal" leave it

undisturbed


10/28

Random and directed !eritoneal

bio!sies

+osterior cul#de#sac

:ladder reflection

:oth !elvic side walls

:oth !aracolic s!aces

&dhesions

&bnormal a!!earing

areas

Undersurface of

dia!hragm


11/28

Omentectomy

Infracolic omentectomyis indicated in theabsence of grossomental disease

In early stage ovariancancer omentaldisease is detected inabout ; 2uvant chemothera!y

Stage I& = I:" grade)

Stage IC" grade/" Stage II

Stage I& = I:" grade .

(ood !rognosis

Surgery only

&d>uvant thera!y not

reuired /5#15< recurrence in 2

years

&d>uvant thera!y reuired

Role of ad>uvant thera!y

not clearly 7nown


16/28

Integration of !rognostic factors

Low risk group :orderline tumors

(rade ) mucinous andendometroid tumors

Di!loid grade ) tumor ofserous" mi0ed andundifferentiated histologicalty!es

'I(O stage )a

Normal !ost o!erative serumC&).2

No ad>uvant chemothera!yafter com!rehensive surgicalstaging

High risk group :orderline aneu!loid tumor

&neu!loid" grade )"of serous"mi0ed and undifferentiated

histological ty!es (rade . and grade / tumors

Clear cell adenocarcinoma

+ersistent elevation of !osto!erative serum C&).2level

'I(O stage )b")c Reuire ad>uvant

chemothera!y


17/28

'ertility !reservation o!tions

'ertility !reserving surgery

Ovarian trans!osition

$mbryo cryo!reservation

Oocyte cryo!reservation

Ovarian cryo!reservation

(nR? analog cotreatment


18/28

Case re!ort@ (overnment ?os!ital"

Udu!i

& .A year old

unmarried lady

,ass abdomen since

. months,enstrual cycles

regular

&bdominal

e0amination@ )2 B )2

cm mobile cystic mass


19/28

Investigations

&bdominal ultrasound@

)2 B )2 cm multi#

loculated cyst with se!tal

thic7ness of /#2 mm No ascites

Uterus normal in si9e

Routine investigationswere normal

C&).2 level # .4-3 U%ml


20/28

Staging la!arotomy

Right ovarian cyst with intact

smooth ca!sule

&scites absent" !eritoneal

cytology done Random !eritoneal and

omental bio!sy ta7en

Right sal!ingo#

oo!horectomy with intactca!sule


21/28


22/28

+atient was referred to oncologist

She received !latinum based

chemothera!y

She was advised to marry and conceive

as early as !ossible

Not to conceive within one year ofchemothera!y


23/28


24/28

hat was wrong in this case

SU(($STION&s !reo!erative evaluation EUS(F is !resent in

govt hos!i" we should have referred to gyn

oncologist

Com!rehensive surgical staging should be done

by gynonco only


25/28


26/28


27/28

conclusion

?igh inde0 of sus!icion of ovarian !athology when a

woman !resents with nons!ecific sym!toms

Referral to gynec#oncologist for !rimary surgery

Com!rehensive surgical staging by a gynec#oncologist

'ertility !reservation o!tions should be considered

Surgeon should have


28/28

'ertility !reservation = ovarian

malignancy in young women

Im!rovement in survival rates due to

!rogress in cancer treatment

+artial or com!lete removal of

re!roductive organ" or cytoto0ic treatment"

affects fertility

$arly loss of ovarian function

Documents

Power Point of Poster