Ovarian Cancer   www.freelivedoctor.com
Differential Diagnosis of Adnexal Mass Mature cystic teratoma www.freelivedoctor.com
Differential Diagnosis <ul><li>Young women </li></ul><ul><ul><li>Usually gynecologic </li></ul></ul><ul><ul><li>Often func...
Ovarian Cancer <ul><li>Incidence/Morbidity/Mortality </li></ul><ul><ul><li>Lifetime risk: approx 1/70 </li></ul></ul>www.f...
Types of Ovarian Cancer <ul><li>Epithelial </li></ul><ul><li>Germ Cell </li></ul><ul><ul><li>Dysgerminoma </li></ul></ul><...
Ovarian Cancer Staging www.freelivedoctor.com
Ovarian Cancer Staging www.freelivedoctor.com
Ovarian Cancer Staging www.freelivedoctor.com
Ovarian Cancer Staging www.freelivedoctor.com
Ovarian Cancer Risks <ul><li>Increase Risk </li></ul><ul><ul><li>Age most important independent risk factor </li></ul></ul...
Exam <ul><li>Physical </li></ul><ul><ul><li>Malignancy: irregular, solid consistency, is fixed, nodular, or bilateral, is ...
Exam <ul><li>Ultrasound </li></ul><ul><ul><li>Low positive predictive value for cancer </li></ul></ul><ul><ul><li>Cancer: ...
Labs <ul><li>Tumor markers </li></ul><ul><ul><li>Epithelial: CA 125, elevated in 80%  </li></ul></ul><ul><ul><ul><li>35 U/...
Work-up <ul><li>Premenopausal </li></ul><ul><ul><li>Symptomatic : evaluate as appropriate for tuboovarian abcess, ectopic,...
Work-up <ul><li>Postmenopausal </li></ul><ul><ul><li>Exclude common diagnoses: endometriosis, cyst, abcess </li></ul></ul>...
Treatment of Epithelial Ovarian Cancer <ul><li>Chemotherapy </li></ul><ul><li>Cytoreductive surgery (debulking) </li></ul>...
Treatment of Epithelial Ovarian Cancer <ul><li>Debulking </li></ul>Removal of: uterus, tubes, ovaries, omentum, pelvic and...
Treatment of Epithelial Ovarian Cancer <ul><li>Carboplatin and Paclitaxel </li></ul><ul><ul><li>First line </li></ul></ul>...
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Ovariancancer

  1. 1. Ovarian Cancer www.freelivedoctor.com
  2. 2. Differential Diagnosis of Adnexal Mass Mature cystic teratoma www.freelivedoctor.com
  3. 3. Differential Diagnosis <ul><li>Young women </li></ul><ul><ul><li>Usually gynecologic </li></ul></ul><ul><ul><li>Often functional cysts </li></ul></ul><ul><li>Postmenopausal </li></ul><ul><ul><li>Benign neoplasms </li></ul></ul><ul><ul><ul><li>Cystadenomas </li></ul></ul></ul><ul><ul><li>Higher risk of malignancy than premenopausal </li></ul></ul><ul><li>Metastatic cancers may first present as adnexal masses </li></ul>www.freelivedoctor.com
  4. 4. Ovarian Cancer <ul><li>Incidence/Morbidity/Mortality </li></ul><ul><ul><li>Lifetime risk: approx 1/70 </li></ul></ul>www.freelivedoctor.com
  5. 5. Types of Ovarian Cancer <ul><li>Epithelial </li></ul><ul><li>Germ Cell </li></ul><ul><ul><li>Dysgerminoma </li></ul></ul><ul><ul><li>Immature teratoma </li></ul></ul><ul><ul><li>Endodermal sinus tumor </li></ul></ul><ul><ul><li>Embryonal carcinoma </li></ul></ul><ul><ul><li>Polyembryonal </li></ul></ul><ul><ul><li>Choriocarcinoma </li></ul></ul><ul><ul><li>Mixed </li></ul></ul><ul><li>Sex Cord Stromal </li></ul><ul><ul><li>Granulosa cell </li></ul></ul><ul><ul><li>Sertoli-Leydig </li></ul></ul><ul><ul><li>Gynandroblastoma </li></ul></ul><ul><ul><li>Unclassified </li></ul></ul><ul><li>Metastatic </li></ul><ul><ul><li>Breast </li></ul></ul><ul><ul><li>Kruckenberg- Primary usually stomach, signet ring cells on pathology </li></ul></ul>www.freelivedoctor.com
  6. 6. Ovarian Cancer Staging www.freelivedoctor.com
  7. 7. Ovarian Cancer Staging www.freelivedoctor.com
  8. 8. Ovarian Cancer Staging www.freelivedoctor.com
  9. 9. Ovarian Cancer Staging www.freelivedoctor.com
  10. 10. Ovarian Cancer Risks <ul><li>Increase Risk </li></ul><ul><ul><li>Age most important independent risk factor </li></ul></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>BRCA1 (60x increased risk), BRCA2 (30x), HNPCC (13x) </li></ul></ul><ul><ul><li>Nulliparity, infertility, endometriosis </li></ul></ul><ul><li>Decrease Risk </li></ul><ul><ul><li>Prophylactic oophorectomy </li></ul></ul><ul><ul><li>Oral contraceptive pills </li></ul></ul>www.freelivedoctor.com
  11. 11. Exam <ul><li>Physical </li></ul><ul><ul><li>Malignancy: irregular, solid consistency, is fixed, nodular, or bilateral, is associated with ascites </li></ul></ul>www.freelivedoctor.com
  12. 12. Exam <ul><li>Ultrasound </li></ul><ul><ul><li>Low positive predictive value for cancer </li></ul></ul><ul><ul><li>Cancer: excrescences, ascites, and mural nodules </li></ul></ul><ul><ul><li>Benign: unilocular, thin-walled sonolucent cysts with smooth, regular borders, regardless of menopausal status or cyst size </li></ul></ul>Ovarian cancer Benign cyst www.freelivedoctor.com
  13. 13. Labs <ul><li>Tumor markers </li></ul><ul><ul><li>Epithelial: CA 125, elevated in 80% </li></ul></ul><ul><ul><ul><li>35 U/mL is upper limit of normal </li></ul></ul></ul><ul><ul><ul><li>Also elevated in many benign conditions </li></ul></ul></ul><ul><ul><li>Malignant germ cell tumors: b-hCG, LDH, AFP </li></ul></ul><ul><ul><li>Embryonal carcinoma: AFP, BhCG </li></ul></ul><ul><ul><li>Endodermal Sinus tumor: AFP </li></ul></ul><ul><ul><li>Granulosa cell tumors: inhibin </li></ul></ul>www.freelivedoctor.com
  14. 14. Work-up <ul><li>Premenopausal </li></ul><ul><ul><li>Symptomatic : evaluate as appropriate for tuboovarian abcess, ectopic, torsion, ruptured ovarian cyst </li></ul></ul><ul><ul><li>B-HCG, CBC, transvaginal USN, cervical cultures </li></ul></ul>Tuboovarian abcess Ectopic pregnancy www.freelivedoctor.com
  15. 15. Work-up <ul><li>Postmenopausal </li></ul><ul><ul><li>Exclude common diagnoses: endometriosis, cyst, abcess </li></ul></ul><ul><ul><li>Higher index for suspicion: transvaginal USN, CA 125 </li></ul></ul><ul><ul><li>Unless simple cysts, most likely will need surgery </li></ul></ul><ul><ul><li>Need breast exam, digital rectal, mammography </li></ul></ul>Ovarian Cancer Ovarian Cancer www.freelivedoctor.com
  16. 16. Treatment of Epithelial Ovarian Cancer <ul><li>Chemotherapy </li></ul><ul><li>Cytoreductive surgery (debulking) </li></ul>CT of ovarian mass www.freelivedoctor.com
  17. 17. Treatment of Epithelial Ovarian Cancer <ul><li>Debulking </li></ul>Removal of: uterus, tubes, ovaries, omentum, pelvic and paraaortic nodes, all visible tumor Peritoneal washings Diaphragm biopsies www.freelivedoctor.com
  18. 18. Treatment of Epithelial Ovarian Cancer <ul><li>Carboplatin and Paclitaxel </li></ul><ul><ul><li>First line </li></ul></ul><ul><ul><li>Mechanism of action </li></ul></ul><ul><ul><ul><li>Carbo: binds and crosslinks DNA </li></ul></ul></ul><ul><ul><ul><li>Taxol: promotes formation and inhibits disassembly of stable microtubules, inhibiting mitosis </li></ul></ul></ul><ul><ul><li>Side effects </li></ul></ul><ul><ul><ul><li>Carbo: thrombocytopenia, leukopenia, anemia, vomiting, hair loss </li></ul></ul></ul><ul><ul><ul><li>Taxol: neutropenia, leukopenia, anemia, </li></ul></ul></ul><ul><ul><ul><ul><li>hair loss, muscle pain, vomiting, diarrhea </li></ul></ul></ul></ul>www.freelivedoctor.com
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