1 / 57

Ovarian neoplasms.

Ovarian neoplasms. Ovarian neoplasms. Anita Chudecka - Głaz.

aglaia
Download Presentation

Ovarian neoplasms.

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 neoplasms. Ovarian neoplasms. Anita Chudecka - Głaz

  2. Human ovarian neoplasms (especially epithelial ovarian cancer) presents a major challenge to oncological research , because they are frequently diagnosed late and show poor prognosis and low survival despite the apparent success of chemotherapy in achieving remission with no evidence of disease. Ovarian neoplasms. Anita Chudecka - Głaz

  3. Epithelial ovarian cancer is the fourth most common cause of death from cancer in women and the most lethal of gynaecologic neoplasms. Epithelial ovarian cancer is the fourth most common cause of death from cancer in women and the most lethal of gynaecologic neoplasms. Ovarian neoplasms. Anita Chudecka - Głaz

  4. The most important positive prognostic feature continues to be diagnosis at an early stage. • BUT EARLY STAGE OVARIAN CANCERS DON’T PRODUCE SYMPTOMS !!! Ovarian neoplasms. Anita Chudecka - Głaz

  5. The incidence of ovarian cancer is relatively high in Scandinavian (15/100000) countries , lower in western Europe and North America ( 10/100000 ) and low in Japan (3/100000). Ovarian neoplasms. Anita Chudecka - Głaz

  6. ETIOLOGY • Two hypotheses have been proposed to explain the biological mechanisms that increase the risk of ovarian cancer : • genetics • gonadotropin hypothesis Ovarian neoplasms. Anita Chudecka - Głaz

  7. ETIOLOGY The involvement of gonadotropins in human ovarian carcinoma is backed by a number of epidemiological and experimental studies showing: • increase occurrence of disease with exposure to high levels of LH , FSH during menopause , after ovariectomy or during fertility treatment Ovarian neoplasms. Anita Chudecka - Głaz

  8. ETIOLOGY • reduced risk of cancer associated with multiple pregnancies, oral contraceptives , breast - feeding • LH and hCG receptors are expressed in 40% of epithelial ovarian cancer • LHRH receptors are expressed in almost 80% of EOC Ovarian neoplasms. Anita Chudecka - Głaz

  9. ETIOLOGY • deficit of cases of ovarian cancer among women with diagnosis of alcoholism in • animals ovarian cancer may be induced by gonadal radiation or chemical toxins that cause premature oocyte death , but hypophysectomized animals do not develop ovarian tumours after oocyte depletion which suggests a specific role of gonadotropins Ovarian neoplasms. Anita Chudecka - Głaz

  10. ETIOLOGY other risk factors: • diet • talc • pelvic irradiation • viruses • age Ovarian neoplasms. Anita Chudecka - Głaz

  11. ETIOLOGY other risk factors: • PID • endometriosis • blood group • legal status • education Ovarian neoplasms. Anita Chudecka - Głaz

  12. SYMPTOMS EOC oftenest are asymptomatic until advanced stage , when the prognosis is poor and 5 year survival less then 40%. EOC oftenest are asymptomatic until advanced stage , when the prognosis is poor and 5 year survival less then 40%. Ovarian neoplasms. Anita Chudecka - Głaz

  13. SYMPTOMS Irrespective of histology , most ovarian neoplasms when they have large size in advanced stage cause symptoms by exerting pressure on contiguous structures (urinary frequency, pelvic discomfort and constipation). Ovarian neoplasms. Anita Chudecka - Głaz

  14. SYMPTOMS The most common : • abdominal swelling • fatigue • abdominal pain Ovarian neoplasms. Anita Chudecka - Głaz

  15. SYMPTOMS Upper abdominal metastases or ascites cause nausea, heart burn , bloating , weight loss and anorexia. Acute abdominal pain secondary to haemorrhage , rupture or torsion can all result from tumour growth. Ovarian neoplasms. Anita Chudecka - Głaz

  16. SYMPTOMS Biologically active hormones , including estrogen, progesterone, testosterone , corticosteroids and hCG can be produce by a variety of ovarian neoplasms and cause the predicted symptoms associated with each compound. Ovarian neoplasms. Anita Chudecka - Głaz

  17. DIAGNOSIS 1. Physical examination-bimanual rectovaginal pelvic examination 2. Ultrasound investigation 3. Tumour markers 4. Ascites puncture 5. Biopsy the tumour 6. Laparoscopy 7. CT 8. NMR 9. Chest X ray Ovarian neoplasms. Anita Chudecka - Głaz

  18. ULTRASONOGRAPHY ULTRASONOGRAPHY • abdominal • transvaginal TVS • colour Doppler CDI Ovarian neoplasms. Anita Chudecka - Głaz

  19. TUMOR MARKERS CA 125 CA 19-9 CEA epithelial ovarian cancer Ovarian neoplasms. Anita Chudecka - Głaz

  20. TUMOR MARKERS AFP endodermal sinus tumors embryonal carcinomas mixed germ cell tumors rarely immature teratoma and polyembryoma Ovarian neoplasms. Anita Chudecka - Głaz

  21. TUMOR MARKERS hCG chorioncarcinoma embryonal carcinoma mixed germ cell tumors polyembryoma Ovarian neoplasms. Anita Chudecka - Głaz

  22. TUMOR MARKERS ESTRADIOL adult granulosa cell tumors thecomas Ovarian neoplasms. Anita Chudecka - Głaz

  23. TUMOR MARKERS INHIBIN adult granulosa cell tumors Ovarian neoplasms. Anita Chudecka - Głaz

  24. PREMENOPAUSAL OVARIAN MASS EXCLUDE NON-GYNAECOLOGICAL PROBLEM Solid or complex on US OR > 6 cm OR Elevated AFP/hCG/LDH OR Elevated CA 125 Simple on US AND < 6 cm AND Normal CA 125 Observation for 6-8 weeks and Gonadotrpopin suppression Surgical evaluation Peristent on US

  25. POSTMENOPAUSAL OVARIAN MASS EXCLUDE NON-GYNAECOLOGICAL PROBLEM Asymptomatic AND Simple on US AND < 3 cm AND Normal CA 125 Symptomatic OR Complex on US OR > 3 cm OR Elevated CA 125 Observe with Follow up US Surgical Evaluation

  26. DIFFERENTIAL DIAGNOSIS • gynaecologic • tuboovarian abscess • ectopic pregnancy • leiomyoma • fallopian tube neoplasia • luteal or follicular cysts Ovarian neoplasms. Anita Chudecka - Głaz

  27. DIFFERENTIAL DIAGNOSIS • gynaecologic • ovarian hyperthecosis • pregnancy luteoma • theca-lutein cysts • endometrioma • simple cysts Ovarian neoplasms. Anita Chudecka - Głaz

  28. DIFFERENTIAL DIAGNOSIS • nongynaecologic • diverticular disease • appendiceal abscess • Crohn’s disease • primary nongynaecological malignancy • pelvic kidney Ovarian neoplasms. Anita Chudecka - Głaz

  29. CLASSIFICATION 1. Epithelial ovarian tumours - 70% of all ovarian neoplasms 2. Sex cord stromal tumours 5-10% 3. Germ cell tumours 15-20% 4. Metastatic 5 % 5. Other Ovarian neoplasms. Anita Chudecka - Głaz

  30. Ovarian neoplasms. Anita Chudecka - Głaz

  31. Ovarian neoplasms. Anita Chudecka - Głaz

  32. SEX CORD STROMAL TUMOURS 1. Granulosa stromal cell • granulosa cell • thecoma-fibroma 2. Sertoli stromal cell 3. Lipid cell tumours 4. Gynanandroblastoma Ovarian neoplasms. Anita Chudecka - Głaz

  33. GERM CELL TUMOURS 1. Dysgerminoma 2. Endodermal sinus tumour 3. Embryonal carcinoma 4. Polyembryoma 5. Chorioncarcinoma 6. Teratomas 7. Mixed forms 8. Gonadoblastoma Ovarian neoplasms. Anita Chudecka - Głaz

  34. STAGE I Growth limited to the ovaries Ovarian neoplasms. Anita Chudecka - Głaz

  35. STAGE II Growth involving one or both ovaries with pelvic extension Ovarian neoplasms. Anita Chudecka - Głaz

  36. STAGE III Tumour involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperotoneal or inguinal nodes; superficial liver metastasis ; tumour is limited to the true pelvis but with histologically proven malignant extension to small bowel or omentum Ovarian neoplasms. Anita Chudecka - Głaz

  37. STAGE IV Tumour involving one or both ovaries with distant metastases; if pleural effusion is present , there must be positive cytology to allot a case to stage IV Ovarian neoplasms. Anita Chudecka - Głaz

  38. Five - year survival rates for epithelial ovarian cancer Stage IA 82,3% IB 74,9% IC 67,7% IIA 60,6% IIB&IIC 53,8% III 22,7% IV 8 % Ovarian neoplasms. Anita Chudecka - Głaz

  39. PREDICTORS OF SURVIVAL • stage • grade • age • residual disease • max. cytoreductive surgery • histopathology • others ( protein p53, CA 125, EGF-R) Ovarian neoplasms. Anita Chudecka - Głaz

  40. TREATMENT • surgical • chemotherapy • radiotherapy • hormonal treatment postoperative procedures Ovarian neoplasms. Anita Chudecka - Głaz

  41. SURGICAL TREATMENT cytoreductive operation: • hysterectomy • bilateral oophorectomy • omentectomy • appendectomy • lypmphadenectomy ?? Nowotwory jajnika. Anita Chudecka - Głaz

  42. CHEMOTHERAPY • CT • PC • PAC • Vepesid or Ifosfamid with CDDP as II LINE CHT. • Hycamptin or Gemzar asIII LINE CHT. I LINE CHEMOTHERAPY Ovarian neoplasms. Anita Chudecka - Głaz

  43. SURGICAL TREATMENT - EOC • benign In young women conservative surgery usually including cystectomy or oophorectomy. In postmenopausal women TAH/BSO should be considered to avoid the risk of cancer in the future. • borderline In young women conservative surgery oophorectomy or USO can be performed. In women who have completed their child bearing a TAH/BSO/Omentectomy is appropriate always with very precise surgical staging. Ovarian neoplasms. Anita Chudecka - Głaz

  44. SURGICAL TREATMENT - EOC • malignant In all cases we have to carry out cytoreductive surgery. It includes TAH/BSO complete omentectomy with resection of any metastatic lesions. In some cases bowel resection and retroperitoneal lymphadenectomy are necessary in order to obtain optimum cytoreduction. Optimum cytoreduction is achieved when the largest residual tumour mass measures less then 1,5 cm. Ovarian neoplasms. Anita Chudecka - Głaz

  45. POSTOPERATIVE TREATMENT - EOC • chemotherapy Platinum-based combination with paclitaxel chemotherapy is now the standard postoperative treatment for patient with ovarian cancer • radiation therapy It is useful method especially in patient who have positive second-look laparoscopy or laparotomy after chemotherapy treatment but the residual mass are less than 2 cm. • hormonal treatment Ovarian neoplasms. Anita Chudecka - Głaz

  46. FOLLOW - UP • second-look laparoscopy every year during first 5 year to detect early microscopic relapse • CA 125 every 3 to 4 month • complete medical history • physical examination • rectovaginal pelvic examination Ovarian neoplasms. Anita Chudecka - Głaz

  47. SCREENING Screening is recommended in women with HOCS and HBOCS and include: • rectovaginal pelvic examination • CA 125 determination • TVS • prophylactic TAH/BSO Ovarian neoplasms. Anita Chudecka - Głaz

  48. MALIGNANT GERM CELL TUMOURS • Dysgerminomamost common germ cell malignancy , in 10-15% is bilateral , survival rate for early stage is 95% and even in advanced stage grater then 80% when appropriate adjuvant therapy is given. LDH is useful tumour marker.hCG levels is elevated in small number of patients. In young women and stage I unilateral oophorectomy is recommended with inspection and biopsy of opposite ovary and staging with retroperitoneal lymphadenectomy. In other women TAH/BSO. Adjuvant therapy should be given in all patients radiotherapy and/or chemotherpy. Ovarian neoplasms. Anita Chudecka - Głaz

  49. MALIGNANT GERM CELL TUMOUR • Embryonal carcinoma is quite rare, rarely bilateral and trends to spread intraperitoneally , survival is slightly better then with EST using the same platinum based chemotherapy regiments . Both AFP and hCG can serve as tumour markers. Surgical treatment depend on age and stage . Adjuvant therapy ( chemotherapy) is recommended in all cases. Ovarian neoplasms. Anita Chudecka - Głaz

  50. MALIGNANT GERM CELL TUMOURS • Immature teratomarepresents approximately 20% of all malignant germ cell tumours and 25 % in girls under 10. After grade surgicopathologic stage is the most prognostic factors. Fortunately most patient are diagnosed with early stage. Occasionally immature carcinoma produce AFP as tumour marker but hCG is never produced. Surgical treatment depend on age and stage. Chemotherapy is kind of adjuvant therapy but only in immature teratoma of all malignant germ cell tumours chemotherapy in stage IA grade I does not benefit. Ovarian neoplasms. Anita Chudecka - Głaz

More Related