Benign and malignant ovarian tumors

1. OVARIAN TUMORS
Dr. Fatima
Second Year Trainee
DHQ Hospital, Rwp

2. Anatomy

3. DESCRIPTION
• Size
• Position
• Coverings
• Function
• Blood supply
• Lymphatic drainage

4. BENIGN TUMORS
NON NEOPLASTIC CYSTS NON FUNCTIONING TUMORS FUNCTIONING TUMORS
FOLLICULAR CYSTS TERATOMAS GRANULOSA CELL TUMORS
CORPUS LUTEAL CYSTS MEIGS SYNDROME SERTOLI LEYDIG CELL TUMORS
ENDOMETRIOMAS CYSTADENOMAS STRUMA OVARII
MULLERIAN AND WOLFIAN DUCT
REMNANTS
BRENNER TUMORS

10. Malignant tumors
• Introduction
• Presentations
• Investigations
• FIGO staging system
• Treatment options

11. FIGO STAGING SYSTEM
• Staging of primary ovarian cancer:
I Confined to one/both ovaries
Ia Limited to a single ovary, no ascites; capsule intact with no surface tumour
Ib Limited to both ovaries, no ascites; capsule intact with no surface tumour
Ic One or both ovaries have ruptured capsule or surface tumour, malignant
ascites or positive peritoneal washings
II Extension to pelvic structures
IIa Extension to uterus or fallopian tubes
IIb Extension to other pelvic tissues
IIc As for IIA or IIB but one or both ovaries have ruptured capsule or surface
tumour; malignant ascites or positive peritoneal washings

12. • III As for stage I/II but also with peritoneal Implants outside pelvis or
with positive retroperitoneal lymph nodes
• IIIa Histologically confirmed microscopic seeding of abdominal
peritoneal surfaces and negative retroperitoneal lymph nodes
• IIIb Histologically confirmed implants of abdominal peritoneal
surfaces <2cm and negative retroperitoneal lymph nodes
• IIIc Histologically confirmed implants of abdominal peritoneal
surfaces <2 cm or positive retroperitoneal lymph nodes
• IV Distant metastases (including liver parenchyma/positive pleural
fluid cytology)

13. SURGICAL STAGING
• 1. Midline incision – adequate access for surgical staging and full
inspections Sending ascites or peritoneal washing
• 2. Performing total hysterectomy and bilateral salpingo –
ophorectomy.
• 3. Infracolic omentectomy
• 4. Peritoneal biopsy all suspicious area.
• 5. Diaphragmatic biopsy or scraping.
• 6. Sampling of pelvic and a paraaortic lymph nodes.

14. Primary surgery
Primary surgery in advanced epithelium ovarian cancer.
* Primary cytoreductive surgery followed by chemotherapy is current
gold standard.
* Cytoreductive surgery – remove all primary cancer and if possible
metastatic disease to tumor load to achieve optimal status.

15. PRINCIPLES OF TREATMENT
•
Treatment of ovarian Cancer
• 1. Surgical staging – Laparotomy to classify the growth to its extent of spread.
• 2. Surgical removal of as much malignant tissue as possible( surgical debulking;
cyto reductive treatment), may involve partial resection of bladder and bowel.
• 3. Follow up with intensive chemotherapy using various combination of drugs
Toxanes with platinium are first choice of treatment.
• 4. Second look laparatomy or laparoscopy to determine effectiveness of
chemotherapy only performed for clinical trails.
• 5. CA 125 is usually raised in advanced ovarian cancer and used to assess
response to chemotherapy. Chemotherapy: - Act by inhibiting cell deviation *
Alkalyting agent preventing replication of DNA - cyclophosphoamide -
Chlorambucil

16. THANK YOU.