Ovarian cancer is the 5th most common cause of cancer deaths among women. 20% of ovarian tumors are malignant. Risk factors include nulliparity, family history, and talc or asbestos exposure. Symptoms often do not appear until late stages. Ultrasound and CT scans are used to diagnose and stage the cancer. The standard treatment is surgical staging and debulking followed by platinum-based chemotherapy. Prognosis depends on stage, with 5-year survival rates of over 90% for stage I but only 30% for stage III-IV.

2. 15-20% of all genital
malignancies
20% ovarian tumours
are malignant
5th most common
cause of cancer deaths
1 Ca Breast
2.Ca cervix
3.Ca lung
4. Ca Colon
5. Ca Ovary
Any Cancerous growth of ovaries is known as Ovarian Carcinoma
1.Primary Ovarian tumour
2.Secondary Ovarian Tumour

4.  Nulligravida & low parity
 Repeated ovulation trauma
 Excessive use of ovulation induction drugs
 Early menarche
 Late menopause
 White race
 Family history
 Use Of Talcom Powder & asbestos
 Use of coffee, tobacco, alcohol, dietary fat

5.  Age group 40-60 yrs
 Nulliparity and low parity
 Relative or absolute infertility
 Family history of Breast, colon, endometrial, ovarian Cancer
 Lynch II/ HNPCC (Hereditary non-polyposis colorectal
cancer syndrome
 .Post menopausal palpable ovaryvol.8cm3
 Obesity

10. Primary 80%
Epithelial (80-90%)
1. Serous
2. Mucinous
3. Endometroid
4. Brenner
5. Undifferenciated
Secondary
20%
Krukenberg tumour
Non-epithelial
Germ cell tumours
Sex chord stromal tumours

11.  1. Benign
 2. Borderline
 3. Malignant

14.  90% of all primary ovarian carcinomas
 any age but 60%-Post-menopausal,
 20% Pre-menopausal
 Majority are not familial.
 Include both cystic, solid & mixed types
 Bilateral in 50% of cases

19. • Ovarian cancer is called ―Silent Killer‖. When signs &
symptoms appear, it’s too late.
• Patients remain asymptomatic for several months,
even with early stage.
• It is difficult to distinguish the symptoms and make
decisive diagnosis of Ovarian cancer.

25. Ascites
1. Increased transudate
2. Obstruction of peritoneal
fluid outflow from diaphragm.
Right sided Pleural
effusion
More fluid in right
sub-diaphargmatic
space
Left supra-clavicular
lymph node
enlarged
Lymph nodes
1. Para-aortic
2. Superior gastric
3. Supra-clavicular

26.  The presence of a fluid wave or less commonly, flank
bulging suggests the presence of significant ascites.
 In a woman with a pelvic mass and ascites, the diagnosis is
ovarian cancer until proven otherwise.
 However, ascites without an identifiable pelvic mass
suggests the possibility of cirrhosis or other primary
malignancies such as gastric or pancreatic cancers

31.  A pelvic or pelvic-abdominal mass is palpable in most patients with ovarian
cancer.
 In general, malignant tumors tend to be solid, nodular, and fixed,
 To aid surgical planning, a rectovaginal examination also should be
performed. Mass
Feel-solid/ heterogenous
Mobility –restricted
Tenderness-usually present
Surface-irregular
Margins-well defined
lower border-not reachable
Percussion-dull note

32.  In advanced disease, examination of the upper abdomen usually reveals a
central mass signifying Omental caking.
 Auscultation of the chest is also important because patients with malignant
pleural effusions may not be overtly symptomatic. The remainder of the
examination should include palpation of the peripheral nodes in addition to
a general physical assessment

34.  To confirm malignancy pre-operatively
 To identify the extent of disease
 To detect primary site

37.  In general, malignant tumors are multi-loculated, solid or echogenic, large
(>5 cm), and have thick septa with areas of nodularity
 Other features may include papillary projections or neo-vascularization.

38.  Every patient with suspected ovarian cancer should have a chest
radiograph to detect pulmonary effusions or infrequently, pulmonary
metastases.
 Rarely, a barium enema is helpful clinically in excluding diverticular disease
or colon cancer or in identifying involvement of the recto-sigmoid by
ovarian cancer.

39.  The main advantage of computed tomography (CT) scanning is in treatment planning of
women with advanced ovarian cancer.
 Preoperatively, it may detect disease in the liver, retroperitoneum, omentum, or elsewhere
in the abdomen and thereby guide surgical,
 However, CT scanning is not particularly reliable in detecting intra-peritoneal disease
smaller than 1 to 2 cm in diameter.
 Moreover, the accuracy of CT scanning is poor for differentiating a benign ovarian mass
from a malignant tumor when disease is limited to the pelvis. In these cases, transvaginal
sonography is superior.
Positron Emission Tomography
PET-Scan
Differenciates normal from cancerous tissue.
More sensitive than CT_Scan or MRI
Helps identify recurrance

41.  A woman with a pelvic mass and ascites can be assumed to have
ovarian cancer until proven otherwise surgically.
 However, paracentesis may be indicated for patients with ascites and
the absence of a pelvic mass.

51. Common Primary sites
Stomach, colon, Gall bladder,
Pancreas, Breast

54. Prognosis
Poor

56. Stages= Ovarian Carcinoma
Stage I A One ovary involved
Stage 1 B Both ovaries involved
Stage 1 C One or both ovaries + Surface
of ovary+ rupture of capsule+
Ascites/+ peritoneal washings

61.  II A
 Extension and/or metastases to the uterus and/or tubes
 IIB
 Extension to other pelvic tissues
 II C
 Tumor limited to the genital tract or other pelvic tissues, but with
disease on the surface of one or both ovaries; or with capsule(s)
ruptured; or with malignant ascites or positive peritoneal washings

65.  III A
 The cancer is present in one or both of the ovaries, and cancer cells are also
present in small ranges in parts of the abdomen with this stage without nodular
involvement.
 III B
 On this particular stage, the cancer is present in one or both of the ovaries, and
cancer cells are also present in amounts less than 2 cm or 3/4″ in parts of the
abdomen
 III C
 Abdominal implants at least 2 cm in diameter and/or positive pelvic, para-aortic,
or inguinal nodes

70.  Stage IV
 Distant metastasis including Pleural effusion or parenchymal
liver metastasis

72. Stage of disease
Histology of tumour
Age of patient
General condition

74.  Aim
 To stage the disease & resect as much tumour as possible.
Steps
1. General anaesthesia
2. Liberal Vertical incision
3. Aspirate ascitic
fluid/Peritoneal washings
4. Exam ovaries & pelvis
5.Systematic exploration of all
organs
6.Multiple biopsies
7.TAH with B/L S O
8.Infra colic omentectomy
9.Pelvic & para-aortic
lymphadenectomy

75.  When a malignancy appears clinically confined to the ovary,
surgical removal and comprehensive staging should be
performed
 Fertility-Sparing Management :may be an option in
selected patients when disease appears confined to one
ovary in younger patients
 Adjuvant Chemotherapy: In general, patients with stage IA
or IB, tumors should be treated with three to six cycles of
platinum based-combinations

94.  Average age=10-20yrs.
 Rx=Primary treatment- surgery
 Young patient-conservative surgery
 (unilateral oophorectomy)
 Adjuvant therapy with chemotherapy
 All Germ cell tumours-highly chemo sensitive
 Stage Ia Grade I—no need
 Other stages- Bleomycin+Etoposide+Cisplatin

96. Tumour Markers
LDH
hCG
Alpha-fetoproteins
Young patient
Staging laprotomy+Unilateral salpingo-
oophorectomy+
Biopsy of other ovary +
(Chaemotherapy/radiotherapy)
BEP
Bleomycin+Etoposide+Cisplatin
VBP
Vinblastin+bleomycin+cisplatin

98.  Granulosa cell tumour
 Thecoma
 Fibroma
 Sertoli-Leydig cell tumour
 Gynadroblastoma
 Unclassified

99. Most
common
Ostrogen
producing
Any age 10%
pre-pubertal
Coffee
bean
nuclei
Unilateral
salpingo-
oophoreccto
my+chemoth
arapy