Ovarian Carcinoma
Khalid Sait
Professor of Obstetrics and
Gynecology and Gynecological
oncology
Faculty of Medicine
King A...
QUESTIONS
•  DIFFERNTIAL DIAGNOSIS OF ADNEXIAL MASS
•  CLASSIFICATION OF OVARIAN MASS
•  TUMOUR MARKER IN EACH CANCER
•  P...
Pelvic mass before puberty
•  Newborn
Functional ovarian cyst
•  Children
Ovarian germ cell tumour
Wilm’s tumor
neuroblast...
Pelvic mass in the young women
•  Congenital anomalies such as imporferated
hymen and blind uterine horn to be considered
...
Pelvic mass in the peri/post
menopausal women
•  Neoplasm ( benign and malignant )
Ovarian Mass
•  Pathologic behavior :
Non neoplastic
Neoplastic
–  (benign,malign, borderline).
•  Morphology(cystic,solid...
Ovarian Mass
Neoplastic
Epithelial T
Germ cell T.
Sex cord T.
Stromal T.
Others( Metastatic….)
Non neoplastic
Physiologica...
Evaluation of Ovarian Mass
•  Preoperative assessment:
History
Physical Examination
Tumour markers
Ultrasound
•  Intra-ope...
Lab evaluation
•  Young patients with large complex or solid
masses: CA 125-LDH-AFP-HCG
•  Peri/post menpousal women: CA 1...
CA 125
•  Correlates with stage of disease
Increase 90 % - Stage II,III,IV
Increase 50 % - Stage I
CA-125
Malignant conditions
•  Cervical CA
•  Fallopian tube CA
•  Endometrial CA
•  Pancreatic CA
•  Colon CA
•  Breast C...
Sonographic parameters
Risk of
malignancy
Lower Higher
Tumour size <10cm >=10 cm
Septae Absent or thin
(1-2 mm)
Thick
Numb...
ROMA and RMI
Risk of Ovarian Malignancy Algorithm
CA 125 + HE4+Menopausal status
Risk of Malignancy Index
CA 125 + US+ Men...
Evaluation of Ovarian Mass
•  Preoperative assessment:
History
Physical Examination
Tumour markers
Ultrasound
•  Intra-ope...
AIDA Storz
complications of benign ov Tumours
•  torsion
•  hemorrhage
•  rupture
•  infection
•  incarceration
•  malignant change
•...
Clinical picture cancer ovary
Benign ovarian Tumours + The following suggest
malignancy
•  age:mostly postmenopausal
•  pa...
Epidemiology
•  23,000 cases annually
•  15,900 deaths annually
•  4th common cause of cancer mortality
•  Most (70%) diag...
TEN LEADING CANCER SITES IN
WOMEN
Patterns of spread
•  Direct extension
•  Exfoliation of clonogenic cells
•  Lymphatic spread
Risk Factors
•  Any age ( common >40ys) .
•  Nulliparous.
•  Late age 1st preg
•  History of breast or colon cancer.
•  Go...
Risk Factors
•  M.H:
– Early menarche.
–  Late menopause
–  prolonged use of fertility drugs without achieving
pregnancy
–...
Protective factors
•  Multiparity: First pregnancy before age 30
•  Oral contraceptives.
•  Hysterectomy
•  Lactation
•  B...
•  Screening
( Early diagnosis)
•  GENETIC TESTING
Treatment
•  Depends on
– Staging
– Tumor type
–  Age
–  Desire for future fertility
•  Include surgery, chemotherapy
Approach
When approaching an adnexal mass, there
are 2 important questions:
•  Does this mass need to be
removed or can it...
Principle of surgical management
•  Prepare the patient for the appropriate
surgery ( GI preparation …..)
•  Avoid intraop...
Guideline
EORTIC, NCCN, NIH, SGO
•  The more localized the disease appear ,
the more extensive the assessment should
be( S...
Ovarian Ca - advanced disease
Optimal Residual Disease
better prognosis
no
residual
tumor
<0.5 cm
0.5 - 1.5 cm
CORRELATES
Ovarian Cancer Staging
•  Stage 1
– 1A: One ovary
– 1B: Both ovaries
– 1C: with malignant
ascites, rupture surface
tumor
Ovarian Cancer Staging
•  Stage 2
– 2A: Reproductive organs
– 2B: Other pelvic organs
– 2C: with malignant ascites or wash...
Ovarian Cancer Staging
•  Stage 3
– 3A: microscopic upper abdominal disease
– 3B: upper abdominal metastasis less than 2
c...
Ovarian Cancer Staging
•  Stage 4 is disease outside the peritoneal
cavity
– Liver parenchymal metastasis.
– Pleural effus...
Rationale of debulking
•  Goldie-Coldman hypothesis
Adjuvant chemotherapy
•  Carboplatin (Calvert AUC =
6-7)
•  Taxol (175 mg/m2)
•  x6 courses q3 weeks
Serous Tumors
•  Bilateral (30-66%).
§  The commenst
cystic benign
ovarian tumor is
cystadenoma.
§  The commenst
ovarian carcinoma
is papillary serous
cystoa...
Mucinous Tumors:
•  very large.
•  Pseudomyxoma
peritonei.
Germ cell tumour
Germ cell tumors
classification:
–  benign: Teratoma ( mature),
–  malignant: Dysgerminoma, endodermal sinus t. immature
t...
( Tumor marker)
•  LDH: dysgerminoma
•  AFP : endodermal sinus tumor
•  HCG : choriocarcinoma, embryonal
carcinoma
Cystic Teratoma
Dysgerminoma
•  The most-common
malignant germ cell tumor
•  5% dysgenetic gonad
•  Significant rate of
bilaterality
•  Ra...
Immature Teratoma
•  The second most common GCT
•  Contains elements that resemble tissues
derived from the embryo.
Endodermal sinus tumor
•  Secrete AFP
•  Hobnail bodies
Chemotherapy. BEP
•  Cisplatin : 100mg/m i.v d1
•  Bleomycin : 10-15mg d1-3(24h inf)
•  Etoposide : 100mg/m i.v d1-3
SEX CORD-STROMAL
TUMORS( SCTS)
Granulosa Cell Tumor:
Sertoli lydig cell tumour
•  Testestrone secreted
Metastatic Tumors of Ovary
Krukenberg
Tumor:
Thanks
•  www.jcsp.sa.com
•  www.cabwt.kau.edu.sa
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Ovarian cancer
Upcoming SlideShare
Loading in...5
×

Ovarian cancer

1,925

Published on

Published in: Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,925
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

Ovarian cancer

  1. 1. Ovarian Carcinoma Khalid Sait Professor of Obstetrics and Gynecology and Gynecological oncology Faculty of Medicine King Abdulaziz University
  2. 2. QUESTIONS •  DIFFERNTIAL DIAGNOSIS OF ADNEXIAL MASS •  CLASSIFICATION OF OVARIAN MASS •  TUMOUR MARKER IN EACH CANCER •  PATHOGNOMIC FEATURE OF EACH TUMOUR •  INVESTIGATION AND MANAGEMENT OF OVARIAN MASS •  OVARIAN CANCER ACCORDING TO AGE GROUP •  RISK FACTOR AND PREVENTION AND SCREENING •  STAGING •  TYPE OF CHEMOTHERAPY USE IN DIFF. OVARIAN CANCER
  3. 3. Pelvic mass before puberty •  Newborn Functional ovarian cyst •  Children Ovarian germ cell tumour Wilm’s tumor neuroblastoma lymphoma other ( GI, musculoskeletal)
  4. 4. Pelvic mass in the young women •  Congenital anomalies such as imporferated hymen and blind uterine horn to be considered in adolescents •  Common causes of adnexial mass functional cyst PID(toa …) choclet cyst •  Germ cell tumors
  5. 5. Pelvic mass in the peri/post menopausal women •  Neoplasm ( benign and malignant )
  6. 6. Ovarian Mass •  Pathologic behavior : Non neoplastic Neoplastic –  (benign,malign, borderline). •  Morphology(cystic,solid). •  Histogenesis.
  7. 7. Ovarian Mass Neoplastic Epithelial T Germ cell T. Sex cord T. Stromal T. Others( Metastatic….) Non neoplastic Physiological: Lutein cysts. Follicular cysts. Endometrial cysts: endometriosis Inflammatory
  8. 8. Evaluation of Ovarian Mass •  Preoperative assessment: History Physical Examination Tumour markers Ultrasound •  Intra-operative assessment
  9. 9. Lab evaluation •  Young patients with large complex or solid masses: CA 125-LDH-AFP-HCG •  Peri/post menpousal women: CA 125 – CEA •  Other marker : testosterone, estriol and inhibin A
  10. 10. CA 125 •  Correlates with stage of disease Increase 90 % - Stage II,III,IV Increase 50 % - Stage I
  11. 11. CA-125 Malignant conditions •  Cervical CA •  Fallopian tube CA •  Endometrial CA •  Pancreatic CA •  Colon CA •  Breast CA •  Lymphoma •  Mesothelioma Benign conditions •  Endometriosis/ Menses •  Uterine fibroids •  PID •  Pregnancy •  Diverticulitis •  Pancreatitis •  Liver disease •  Renal failure •  Appendicitis
  12. 12. Sonographic parameters Risk of malignancy Lower Higher Tumour size <10cm >=10 cm Septae Absent or thin (1-2 mm) Thick Number of loculi unilocular Multilocular Over all echo density* Hypo-echogenic homogenous Increased and / or mixed and / or solid component Papillary excrescences absent present * Excludes dermoid cyst/endometrioma
  13. 13. ROMA and RMI Risk of Ovarian Malignancy Algorithm CA 125 + HE4+Menopausal status Risk of Malignancy Index CA 125 + US+ Menopausal status
  14. 14. Evaluation of Ovarian Mass •  Preoperative assessment: History Physical Examination Tumour markers Ultrasound •  Intra-operative assessment
  15. 15. AIDA Storz
  16. 16. complications of benign ov Tumours •  torsion •  hemorrhage •  rupture •  infection •  incarceration •  malignant change •  complications during pregnancy
  17. 17. Clinical picture cancer ovary Benign ovarian Tumours + The following suggest malignancy •  age:mostly postmenopausal •  pain: chronic and persistent •  rapid course •  bilaterality •  Solidity ( variegated consistency ) •  fixity •  metastases :nodules in DP, lymph nodes •  ascitis •  edema LL •  cachexia
  18. 18. Epidemiology •  23,000 cases annually •  15,900 deaths annually •  4th common cause of cancer mortality •  Most (70%) diagnosed at advanced stage where cure is uncommon.
  19. 19. TEN LEADING CANCER SITES IN WOMEN
  20. 20. Patterns of spread •  Direct extension •  Exfoliation of clonogenic cells •  Lymphatic spread
  21. 21. Risk Factors •  Any age ( common >40ys) . •  Nulliparous. •  Late age 1st preg •  History of breast or colon cancer. •  Gonadal Dysgenesis •  Talcum powder –  Increased risk in women who use talc powder on genital area
  22. 22. Risk Factors •  M.H: – Early menarche. –  Late menopause –  prolonged use of fertility drugs without achieving pregnancy –  Uninterrupted ovulation. •  F.H – Mother, sister or daughter with ovarian cancer. – BRCA
  23. 23. Protective factors •  Multiparity: First pregnancy before age 30 •  Oral contraceptives. •  Hysterectomy •  Lactation •  Bilateral oopherectomy
  24. 24. •  Screening ( Early diagnosis) •  GENETIC TESTING
  25. 25. Treatment •  Depends on – Staging – Tumor type –  Age –  Desire for future fertility •  Include surgery, chemotherapy
  26. 26. Approach When approaching an adnexal mass, there are 2 important questions: •  Does this mass need to be removed or can it be observed? •  What are the chances of cancer?
  27. 27. Principle of surgical management •  Prepare the patient for the appropriate surgery ( GI preparation …..) •  Avoid intraoperative rupture of the cyst •  Obtain frozen section if suspecious •  Try to do the necessary procedure in one setting •  Try to preserve fertility and ovarian function in young patient
  28. 28. Guideline EORTIC, NCCN, NIH, SGO •  The more localized the disease appear , the more extensive the assessment should be( STAGING) Level II-3 A •  Optimal debulking for advance stage provide a median survival benefit Level II-b
  29. 29. Ovarian Ca - advanced disease Optimal Residual Disease better prognosis no residual tumor <0.5 cm 0.5 - 1.5 cm CORRELATES
  30. 30. Ovarian Cancer Staging •  Stage 1 – 1A: One ovary – 1B: Both ovaries – 1C: with malignant ascites, rupture surface tumor
  31. 31. Ovarian Cancer Staging •  Stage 2 – 2A: Reproductive organs – 2B: Other pelvic organs – 2C: with malignant ascites or washings
  32. 32. Ovarian Cancer Staging •  Stage 3 – 3A: microscopic upper abdominal disease – 3B: upper abdominal metastasis less than 2 centimeters – 3C: upper abdominal metastasis greater than 2 centimeters
  33. 33. Ovarian Cancer Staging •  Stage 4 is disease outside the peritoneal cavity – Liver parenchymal metastasis. – Pleural effusion – Supraclavicular nodes
  34. 34. Rationale of debulking •  Goldie-Coldman hypothesis
  35. 35. Adjuvant chemotherapy •  Carboplatin (Calvert AUC = 6-7) •  Taxol (175 mg/m2) •  x6 courses q3 weeks
  36. 36. Serous Tumors •  Bilateral (30-66%).
  37. 37. §  The commenst cystic benign ovarian tumor is cystadenoma. §  The commenst ovarian carcinoma is papillary serous cystoadenocarcino ma.
  38. 38. Mucinous Tumors: •  very large. •  Pseudomyxoma peritonei.
  39. 39. Germ cell tumour
  40. 40. Germ cell tumors classification: –  benign: Teratoma ( mature), –  malignant: Dysgerminoma, endodermal sinus t. immature teratoma, embryomal, choricarcinoma ? gonadoblastoma
  41. 41. ( Tumor marker) •  LDH: dysgerminoma •  AFP : endodermal sinus tumor •  HCG : choriocarcinoma, embryonal carcinoma
  42. 42. Cystic Teratoma
  43. 43. Dysgerminoma •  The most-common malignant germ cell tumor •  5% dysgenetic gonad •  Significant rate of bilaterality •  Radiation therapy; very sensitive
  44. 44. Immature Teratoma •  The second most common GCT •  Contains elements that resemble tissues derived from the embryo.
  45. 45. Endodermal sinus tumor •  Secrete AFP •  Hobnail bodies
  46. 46. Chemotherapy. BEP •  Cisplatin : 100mg/m i.v d1 •  Bleomycin : 10-15mg d1-3(24h inf) •  Etoposide : 100mg/m i.v d1-3
  47. 47. SEX CORD-STROMAL TUMORS( SCTS)
  48. 48. Granulosa Cell Tumor:
  49. 49. Sertoli lydig cell tumour •  Testestrone secreted
  50. 50. Metastatic Tumors of Ovary
  51. 51. Krukenberg Tumor:
  52. 52. Thanks •  www.jcsp.sa.com •  www.cabwt.kau.edu.sa

×