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1. OVARIAN CANCER
INTRODUCTION
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of
control and form a tumor. If left untreated, the tumor can spread to other parts of
the body. This is called metastatic ovarian cancer.
RISK FACTORS FOR OVARIANCANCER
The exact cause of ovarian cancer is unknown. Thesefactors can increase your
risk:
 A Family History Of Ovarian Cancer
 Genetic Mutations Of Genes Associated With Ovarian Cancer, Such As
Brca1 Or Brca2
 A PersonalHistory Of Breast, Uterine, Or Colon Cancer
 Obesity
 The Use Of Certain Fertility Drugs Or HormoneTherapies
 No History Of Pregnancy
 Endometriosis
TYPES OF OVARIAN CANCER
The ovaries are made up of three types of cells. Each cell can develop into a
different type of tumor:
 Epithelial tumors formin the layer of tissue on the outside of the
ovaries. About90 percent of ovarian cancers are epithelial tumors
 Stromal tumors grow in the hormone-producing cells. Seven percent of
ovarian cancers are stromaltumors.
 Germcell tumors develop in the egg-producing cells. Germ cell tumors
are rare.
STAGES
Stage I: The cancer is limited to the ovary/ovaries or fallopian tubes and has not
spread.

2. Stage IA : Only one ovary (or fallopian tube) is affected by the cancer, and the
tumour is confined to the inside of the affected ovary or fallopian tube. No cancer
is detected on the surfaceof the ovary or fallopian tube and there are no
malignant (cancerous) cells detected in the washing fluid fromthe tummy
(abdomen) and pelvis.
Stage IB : Both ovaries (or fallopian tubes) are affected by the cancer but no
cancer is detected in either the surfaceof the ovaries (or fallopian tubes) or in
fluid taken fromthe tummy (abdomen) and pelvis.
Stage IC :The cancer is limited to one or both ovaries or fallopian tubes,
Stage II : The cancer is in one or both ovaries or fallopian tubes and has spread
into the pelvis eg onto the uterus or bladder. The pelvis is the area circled by your
hip bones. There is no spread of the tumour outside of the pelvis.
 Stage IIA : The cancer has spread into the uterus (womb) and/or fallopian
tubes.
 Stage IIB : The cancer is affecting other organs in your pelvis (eg bladder or
rectum.)
Stage III: The cancer has spread outsideof the pelvis into the tummy area
(abdomen) and/or the lymph nodes at the back of the abdomen (called
retroperitoneal lymph nodes).
 Stage IIIA :The cancer is in one or both ovaries or fallopian tubes. During
surgery no cancer is visible outside the pelvis within the abdomen to the
naked eye but tiny deposits of cancer are detected in the lining of the
abdomen (peritoneum) or in the fatty apron (omentum) under a
microscope. The cancer might or might not have spread to nearby lymph
nodes.
 Stage IIIB: Tumours less than 2cmin diameter are visible outside the
pelvis within the abdomen and nearby lymph nodes may or may not
contain cancerous cells.
 Stage IIIC: Tumours more than 2cmin diameter are detected outside the
pelvis within the abdomen and may be on the outside of the liver or
spleen.

3. Stage IV: The cancer has spread outsideof the abdomen and pelvis to more
distant organs.
 Stage IVA: The cancer cells are found in the fluid around the lungs.
 Stage IVB: The cancer has spread to the inside of the spleen or liver or to
distant lymph nodes or to other organs such as the lungs and bones.
CLINICAL FEATURES
Abdominal Bloating, Pressure, And Pain
AbnormalFullness After Eating
Difficulty Eating
An IncreaseIn Urination
An Increased UrgeTo Urinate
Fatigue
Indigestion
Heartburn
Constipation
Back Pain
MenstrualIrregularities
Painful Intercourse
Dermatomyositis (A Rare Inflammatory DiseaseThatCan CauseSkin Rash,
Muscle Weakness, And Inflamed Muscles)
DIAGNOSIS
Bloodtest:Tests thatmay be used to diagnoseovarian cancer include:
A complete blood count
A test for cancer antigen 125 levels, which may be elevated if you have
ovarian cancer
A test for hcg levels, which may be elevated if you havea germcell tumor
A test for alpha-fetoprotein, which may be produced by germcell tumors

4. A test for lactate dehydrogenase levels, which may be elevated if you have
a germ cell tumor
A test for inhibin, estrogen, and testosterone levels, which may be elevated
if you havea stromal cell tumor
Liver function tests to determine if the cancer has spread
Kidney function tests to determine if the cancer has obstructed your urine
flow or spread to the bladder and kidneys
Pelvic ultrasound:uses sound waves to producepictures of the structures
and organs in the pelvis and can help identify ovarian or uterine cancers.
In transvaginalultrasound, a probeis inserted into the vagina for a better
view of the uterus and ovaries.
Abdominal and pelvic CT: takes images of the entire belly cavity and is used
to help diagnosethe causeof abdominal or pelvic pain and detect cancers of
the ovaries. An injection of contrastmaterial, as well as oral contrast, is
commonly used to enhance the visibility of the lymph nodes and other tissues
during the exam.
Laparotomy requires an incision by a surgeon in the abdominal wall to
examine the organs in the abdomen and pelvis for signs of cancer. If cancer is
found, this surgery willgenerally include a removalof the ovaries, uterus and
as much tumor tissueas possiblefromthe abdomen.
Laparoscopy is performed with the useof a thin, lighted tube called a
laparoscopethat is inserted through a small incision in the abdomen to look
for signs of cancer.
body MRI can be used to producedetailed pictures of the uterus, lymph
nodes and other tissues in the abdomen and pelvis. An injection of contrast
material may also be used to enhance the visibility of the lymph nodes and
other tissues during the exam.

5. PET is a nuclear medicine imaging exam that uses a small amount of
radioactive material to help determine the extent of or treat a variety of
diseases, including cancer. PET scans can be superimposed with CT or MRI to
producespecial views that can lead to more precise or accurate diagnoses.
PET/CT may be used to evaluate the responseof ovarian cancer to therapy,
such as chemotherapy.
Radiography is an x-ray examination of the large intestine (colon). The
lower gastrointestinaltract is filled with bariumwith the useof a flexible tube
inserted in the rectum for better visualization of possible cancer spread in the
digestive tract.
TREATMENT
1. SURGICAL MANAGMENT
a. Salpingo-oophorectomy This surgery involves removalof the ovaries
and fallopian tubes. If both ovaries and both fallopian tubes are
removed, it is called a bilateral salpingo-oophorectomy. If thewoman
wants to become pregnant in the futureand has early-stagecancer, it
may be possibleto remove only 1 ovary and 1 fallopian tube if the
cancer is located in only 1 ovary. Thatsurgery is called a unilateral
salpingo-oophorectomy. For women with a germ cell type of ovarian
tumor, often only the ovary with the tumor needs to be removed, which
preserves the woman’s ability to become pregnant.
b. Hysterectomy. .
c. Lymphadenectomy/lymph node dissection. During this procedure, the
surgeon may remove lymph nodes in the pelvis and paraortic areas.
d. Omentectomy. This is surgery to remove the thin tissuethat covers the
stomach and intestines.
e. Cytoreductive/debulking surgery.
2. Chemotherapy
3. Targetedtherapy
4. Hormone therapy
5. Radiationtherapy