1 / 66

Ovarian Cancer

Ovarian Cancer. DI WEN M.D., Ph.D., Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine. General Introduction.

jordane
Download Presentation

Ovarian Cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ovarian Cancer DI WEN M.D., Ph.D., Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine

  2. General Introduction • Ovarian tumors are commonest between 30 and 60. • They are particularly liable to be or to become malignant. • In their early stages, they are asymptomatic and painless. • They may grow to a large size. • 1.4% lifetime risk of ovarian cancer Ovarian Cancer

  3. Risk Factors • Family history • Ovarian cancer • Breast cancer • Colon cancer • Genetic factors • Older age • Caucasian • More menstrual circles during lifetime (Ovulation induction) Ovarian Cancer

  4. Incidence • Nearly 25% of all ovarian neoplasm are malignant. • Approximately 80％ of them are primary growths of the ovary. • The remainder being secondary，usually carcinomata. Ovarian Cancer

  5. symptoms • Lack of any specific symptoms, ovarian tumors are often large by the time the doctor is consulted. • Menstrual function is seldom upset, and any irregularity is attributed to the patient’s ‘time of life’. Ovarian Cancer

  6. symptoms • Increased abdominal size Ovarian Cancer

  7. symptoms Pressure symptoms • Gastro-intestinal symptoms (Bloating) • Urge to urinate • plevic pain (a dull pain in the lower abdomen) • Very large tumors may cause respiratory embarrassment and edema or varicosities in the legs, and a characteristic ‘ ovarian cachexia’ develops. Ovarian Cancer

  8. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  9. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  10. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  11. DIFFERENTIAL DIAGNOSIS General Rule An experienced examiner will recognize an ovarian tumor mainly because ovarian tumor is, in the circumstances, the most likely diagnosis. All abdominal swellings should be subjected to ultrasound and X-ray examination. Ovarian Cancer

  12. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  13. DIFFERENTIAL DIAGNOSIS ASCITES A fluid thrill may be elicited from an ovarian cyst, and ascites and tumor may coexist; but as a rule the distinction should be easily made. Ovarian Cancer

  14. DIFFERENTIAL DIAGNOSIS Uterine Fibroids A large midline intramural fibroid may be impossible to distinguish from a solid ovarian tumor until the abdomen is opened and an entirely different surgical problem encountered. Ovarian Cancer

  15. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  16. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  17. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  18. Histological Classification Most tumors arise from the ovarian stroma and germinal epithelium. The embryonic coelom from which that epithelium develops also gives rise to the Mullerian duct from which develop the structures of the genital tract, and it is this common origin which explains the great variety of epithelial patterns which are met with. Ovarian Cancer

  19. Primary Epithelial Tumor • Mucinous cystadenoma or cystadencarcinoma (of. Cervical epithelium). • Serous cystadenoma or cystadenocarcinoma (of . tubal epithelium). • Endometrioma or Endometrioid carcinoma (of. Endometrium). • Clear cell carcinoma. • Brenner tumour. Ovarian Cancer

  20. Ovarian Germ Cell Tumor • Fibroma or sarcoma. • .Dysgerminoma. • .Teratoma. • .Gonadoblastoma. • .Yolk sac tumour. • .Carcinoid • .Thyroid tumour Choriocarcinoma Ovarian Cancer

  21. Gonadal Sex Cord Stromal Tumor • Estrogen-producing: • Granulosa cell tumour. • Thecoma. • Androgen-prodicing: • Sertoli-Leydig cell tumor (Arrhenoblastoma). • Hilar cell tumour. • Lipoid cell tumour. Ovarian Cancer

  22. Krukenberg Tumor There is one well-known secondary tumour of the ovary, the krukenberg tumour, a secondary of a stomach carcinoma. Ovarian Cancer

  23. Mucinous cystadenoma A unilocular or multilocular cyst of ovary lined by tall columnar epithelium resembling that of the cervix or large intestine. It is usually large and may reach immense proportions, occupying the whole peritoneal cavity and compressing other organs. It may occur at any age. Ovarian Cancer

  24. OVARIAN TUMOURS --MUCINOUS CYSTADENOMA Ovarian Cancer

  25. SEROUS CYSTADENOMA A unilocular or multilocular cyst lined by epithelium similar to the fallopian tube. They are the most common benign epithelial tumors and form 20% of all ovarian neoplasm. In 10% of cases they are bilateral. It is uncommon to find them large than a fetal head. Ovarian Cancer

  26. OVARIAN TUMORS --SEROUS CYSTADENOMA Ovarian Cancer

  27. Serous cystadenocarcinoma This is by far the commonest primary carcinoma, accounting for 60% of all cases, and in over half the cases it is bilateral. The cysts are always of papillary type and the epithelium burrowing through the capsule produces papillary processes on the serous surface. Extension of the growth to the pelvis and adjacent organs fixes the tumor. Ascites is always present. Ovarian Cancer

  28. Endometrioid Carcinoma of the Ovary It is now recognized that carcinoma of the ovary may be of endometrial type, sometimes arising in endometrioma. Attacks of pain, unusual with ovarian cancer, are common. Sometimes there is uterine bleeding in post-menopausal cases. Ovarian Cancer

  29. Endometrioid Carcinoma of the Ovary Usually the lesion is cystic and chocolate brown in color. If such a cyst ruptures spontaneously, malignancy should be suspected. The histology varies as in uterine carcinoma. It may be a well-differentiated adenocarcinoma, an adeno-acanthoma, mucinous adenocarcinoma or clear-celled carcinoma. Ovarian Cancer

  30. Fibroma • This is composed of fibrous tissue and resembles fibromata found elsewhere. It is most common in the elderly and accounts for 4-5% of all ovarian neoplasm. • The fibroma is believed by many to be a thecoma which has undergone fibrous transformation. It is sometimes associated with Meig’s syndrome. Ovarian Cancer

  31. Dysgerminoma This is the only solid ovarian tumor of characteristic appearance. Usually ovoid with a smooth capsule, it is of rubbery consistency and greyish colour. It is commonest in younger age groups, under 30 years as a rule, and is often bilateral. Sometimes it is found in cases of intersex. Ovarian Cancer

  32. Teratoma • Cystic teratoma or dermoid • Solid teratoma Ovarian Cancer

  33. Yolk Sac Tumor • rare • Children and young adults • highly malignant • alphafetoprotein Ovarian Cancer

  34. Estrogen-producing Tumors These belong to the granulosa-theca cell group and are found at all ages. They account for 3% of all solid tumors of the ovary. Ovarian Cancer

  35. Estrogen-producing Tumors In childhood there is accelerated skeletal growth and appearance of sex hair. • 5% occur in children precocious puberty. • 60% occur in child-bearing years irregular menstruation. • 30% occur in post-menopausal women post-menopausal bleeding. Ovarian Cancer

  36. Andorogen-producing Tumours Three distinct types of masculinising ovarian tumor are recognised: a) Sertoli-Leydig cell tumor (Arrhenoblastoma), b) Hilar cell tumor, c) Lipoid cell tumor. All three cause amenorrhoea. Ovarian Cancer

  37. Spread -Direct The first spread is directly into neighbouring structures – peritoneum, uterus, bladder, bowel and omentum. Ovarian Cancer

  38. Spread -Lymphatics Ovarian drainage is to the para-aortic glands, but sometimes to the pelvic and even inguinal groups. Cells seeded on to the peritoneum are drained via the lymphatic channels on the underside of the diaphragm into the subpleural glands and thence to the pleura. Ovarian Cancer

  39. Spread -Blood Stream Blood spread is usually late, to the liver and lungs. Ovarian Cancer

  40. Staging of ovarian cancer • STAGE I Growth limited to ovaries • Ia Limited to one ovary. No ascites. • Ib Limited to both ovaries. No ascites. • Ic Ascites or positive peritoneal washings also present or tumour on surface of one or both ovaries or capsule ruptured. Ovarian Cancer

  41. Staging of ovarian cancer • STAGE II Pelvic extension • IIa Spread to uterus/tubes • IIb Spread to other pelvic tissues • IIc IIb with ascites or positive peritoneal washings or tumour on surface of one or both ovaries or capsule ruptured. Ovarian Cancer

  42. Staging of ovarian cancer • Stage III Extrapelvic intraperitoneal spread and/or retroperitoneal or inguinal positive nodes, or superficial lover metastases. • IIIa Apparent limitation to true pelvis • IIIb Histologically proven abdominal peritoneal superficial implants<2cm diameter. • IIIc Abdominal implants>2cm diameter or positive retroperitoneal or inguinal nodes. Ovarian Cancer

  43. Staging of ovarian cancer • Stage IV Distant metastases or pleural effusion with positive cyotlogy or parenchymal liver metastases. Ovarian Cancer

  44. Diagnosis • Pelvic exam • Ultrasound • CT scan • CA125 blood test • SURGERY Ovarian Cancer

  45. TORSION of the PEDICLE • The commonest complication • Occur with any tumor • Except those with adhesions Ovarian Cancer

  46. TORSION of the PEDICLE Clinical Features-Subacute The patient complains of recurrent abdominal pain which passes off as the pedicle untwists. There is a rise in pulse and temperature during the bleeding; And over a period anemia develops. Ovarian Cancer

  47. TORSION of the PEDICLE Clinical Features-acute The signs and symptoms are those of an acute abdominal condition. The problem becomes one of differential diagnosis to exclude those conditions in which laparotomy is not needed and laparoscopy may be useful. Pain tends to be intense and continuous. Ovarian Cancer

  48. TORSION of thePEDICLE Ruptured Cyst This may occur alone or in conjunction with torsion. Rupture is not particularly upsetting to the patient unless the contents are irritant. Ovarian Cancer

  49. Suggestive of Malignancy • Age. If the patient is over 50 the chance of malignancy is over 50% as opposed to less than 15% in premenopausal women. Tumors in childhood are usually malignant. • Rapid growth. • Ascites. Ovarian Cancer

  50. Suggestive of Malignancy • Solid tumours, especially when bilateral. • Multilocular cysts with solid areas. (At least 10% of cysts are malignant). • Pain. Pressure pain can occur with any tumor; But referred pain suggests malignant involvement of nerve roots. • Tumor markers, such as CA125, may be measured in the blood, but a normal level does not exclude malignancy. Ovarian Cancer

More Related