Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

ovarian tumor

10,282 views

Published on

  • Be the first to comment

ovarian tumor

  1. 1. OVARIAN TUMOUR - an overview Sachin Maiti MD,MRCOG,DFFP Research Registrar Wirral Hospital NHS Trust,UK
  2. 2. Epithelial Ovarian Tumour <ul><li>Most common gynaecological Malignancy in developed countries </li></ul><ul><li>15/100,000 </li></ul><ul><li>4000 deaths/year </li></ul><ul><li>2/3 present in advanced stage </li></ul><ul><li>Life time risk of ov ca = 1.5%, dying 1% </li></ul><ul><li>90% of ovarian tumours are epithelial origin </li></ul>
  3. 3. Epithelial Ovarian Tumour <ul><li>90% derived from coelomic epithelium </li></ul><ul><li>75-80% serous </li></ul><ul><li>10% mucinous </li></ul><ul><li>10% endometriod </li></ul><ul><li>1% Brenner, undifferentiated, clear cell </li></ul>
  4. 4. Epithelial Ovarian Tumour <ul><li>Age 56 </li></ul><ul><li>80-90 > 40 years, 30-40% >60 years </li></ul><ul><li>1 in 10 of ovarian tumour malignant <40 y </li></ul><ul><li>1 in 3 of ovarian tumour malignant >40 y </li></ul><ul><li>1% of ovarian tumours <20 y, 2/3 Germ CT </li></ul><ul><li>30% of ovarian tumours malignant in postmenopausal women </li></ul>
  5. 5. Epithelial Ovarian Tumour <ul><li>Prevention:- </li></ul><ul><li>Pregnancy (RR 0.3-0.4) </li></ul><ul><li>OCP (RR 0.5) </li></ul><ul><li>2 Children and OCP (RR 0.3) </li></ul><ul><li>Oophorectomy </li></ul>
  6. 6. Epithelial Ovarian Tumour <ul><li>SCREENING:- </li></ul><ul><li>TVS (1 in 10) </li></ul><ul><li>Doppler US </li></ul><ul><li>CA125 </li></ul><ul><li>TVS+CA125 (1 in 4 laparotomy) </li></ul>
  7. 7. Hereditary Ovarian CA <ul><li>5-10% </li></ul><ul><li>BRCA1 & BRCA2 </li></ul><ul><li>HNPCC </li></ul><ul><li>AD, mutations </li></ul><ul><li>Risk of ovarian ca 10years earlier </li></ul><ul><li>35-40% risk </li></ul>
  8. 8. Impact of BRCA-1
  9. 9. Differential Diagnosis <ul><li>Benign cyst </li></ul><ul><li>Endometriosis </li></ul><ul><li>PID </li></ul><ul><li>Fibroids </li></ul><ul><li>Pelvic Kidney </li></ul><ul><li>Retroperitoneal tumours </li></ul>
  10. 10. Risk of Malignancy Index (RMI) <ul><li>USS </li></ul><ul><li>Menopausal status </li></ul><ul><li>CA125 </li></ul><ul><li>RMI = UxMxCA125 </li></ul><ul><li>High index of suspicion = RMI> 200 </li></ul>
  11. 11. Investigations <ul><li>History/Examination </li></ul><ul><li>FBC, LFT, CA125 (CEA) </li></ul><ul><li>USS/CT </li></ul><ul><li>Chest X-ray </li></ul><ul><li>Barium/Gastroscopy (if bowel symptoms) </li></ul><ul><li>Endometrial sample (PMB) </li></ul>
  12. 12. CA125 <ul><li>Secreted by Mullarian & Coelomic epithelium </li></ul><ul><li>>30 ku/l in PMW, risk of ov ca 36 fold </li></ul><ul><li>>96ku/l in PMW, PPV 96% </li></ul><ul><li>Stage 1- 50% </li></ul><ul><li>Stage 2- 60% </li></ul>
  13. 13. Poor prognostic factors <ul><li>High grade </li></ul><ul><li>Aneuploidy </li></ul><ul><li>Serous vs Mucinous </li></ul><ul><li>Lymphatic invasion, Ascitis, positive cyto </li></ul><ul><li>Clear cell histology </li></ul><ul><li>Poor performance status </li></ul><ul><li>Poor biochemical/haematological status </li></ul>
  14. 14. Borderline tumours <ul><li>Low malignant potential </li></ul><ul><li>Confined to one ovary for long time </li></ul><ul><li>Good prognosis, 86-90% </li></ul><ul><li>Age 30-50years </li></ul><ul><li>Metastatic implants can occur </li></ul><ul><li>Late recurrence </li></ul>
  15. 15. Aim of Surgery <ul><li>Establish diagnosis </li></ul><ul><li>Staging </li></ul><ul><li>Primary Cytoreduction </li></ul><ul><li>Interval/ Secondary cytoreduction </li></ul><ul><li>Palliative & salvage surgery </li></ul><ul><li>Laparoscopy/Aspiration NOT recommended </li></ul>
  16. 16. Treatment <ul><li>Surgery- cytoreduction <1-2cms </li></ul><ul><li>TAH+BSO+Omental Biopsy+washings </li></ul><ul><li>Bowel resection if impending obstruction </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Stage >1C (>2A) </li></ul><ul><li>Carboplatin +Taxol </li></ul>
  17. 17. Survival <ul><li>Stage 1 76-93% </li></ul><ul><li>Stage 2 60-74% </li></ul><ul><li>Stage 3A 40% </li></ul><ul><li>Stage 3B 25% </li></ul><ul><li>Stage 3C 23% </li></ul><ul><li>Stage 4 11% </li></ul><ul><li>Increased grade - decreased survival </li></ul>
  18. 18. Non Epithelial Ovarian Tumour <ul><li>Uncommon, 10% of all ovarian ca </li></ul><ul><li>Germ Cell Tumours </li></ul><ul><li>Sex Cord Tumours </li></ul><ul><li>Metastatic Tumours </li></ul><ul><li>Rare- Sarcomas, Lipoid cell tumours </li></ul><ul><li>Tumour markers- AFP, HCG, PALP, LDH </li></ul>
  19. 19. Germ Cell Tumours <ul><li>Arise from primordial germ cell </li></ul><ul><li>1/10 as common as testicular tumours </li></ul><ul><li>Most arise from undifferentiated germ cell in ovary </li></ul><ul><li>20-30% of all ovarian neoplasia </li></ul><ul><li>3% malignant, rapidly growing </li></ul><ul><li><20years, 70% Germ CT, 1/3 malignant </li></ul>
  20. 20. Germ cell tumours <ul><li>Dysgerminomas 30-40% </li></ul><ul><li>Teratomas (Immature/Mature) </li></ul><ul><li>Monodermal </li></ul><ul><li>Endodermal Sinus tumour (YST) </li></ul><ul><li>Embryonal carcinomas </li></ul><ul><li>Choriocarcinoma </li></ul><ul><li>Mixed form </li></ul>
  21. 21. Dysgerminoma <ul><li>Most common GCT </li></ul><ul><li>75% -10-30years, 5% <10years </li></ul><ul><li>20-30% of tumours in pregnancy </li></ul><ul><li>5% abnormal gonads </li></ul><ul><li>85% stage 1 </li></ul><ul><li>10-15% bilateral </li></ul><ul><li>95% secrete PALP, LDH, 3% HCG </li></ul>
  22. 22. Dysgerminomas <ul><li>Treatment - Surgery+ Chemotherapy </li></ul><ul><li>Staging, USO </li></ul><ul><li>Fertility preservation </li></ul><ul><li>Stage 1A -surgery alone </li></ul><ul><li>Stage 1B or higher - surgery+chemo </li></ul><ul><li>BEP chemo </li></ul><ul><li>Prognosis- 90-100%, </li></ul>
  23. 23. Immature Teratomas <ul><li>10-20% of ov tumours in <20years </li></ul><ul><li>50% occur 10-20years </li></ul><ul><li>Malignant transformation- .5-2% in PMW </li></ul><ul><li>Tumour markers negative </li></ul><ul><li>Diagnosis- USS/ Histology </li></ul><ul><li>Surgery- Staging +USO, Chemo - BEP >1A </li></ul><ul><li>Survival - 70-80% </li></ul>
  24. 24. Endodermal Sinus tumours (Yolk sac tumours) <ul><li>1/3 present before menarche </li></ul><ul><li>median age 18years </li></ul><ul><li>10% mass </li></ul><ul><li>75% pelvic pain </li></ul><ul><li>Secrete AFP </li></ul><ul><li>Surgery + chemotherapy in all patients </li></ul><ul><li>Response rate 60% </li></ul>
  25. 25. Sex cord-stromal tumours <ul><li>5-8% of all ovarian malignancy </li></ul><ul><li>Granulosa-stromal cell tumour </li></ul><ul><li>Androblastroma </li></ul><ul><li>Gynandroblastoma ( attached slide) </li></ul><ul><li>unclassified </li></ul>
  26. 26. Granulosa cell tumour <ul><li>Low grade malignancy </li></ul><ul><li>2% Bilateral </li></ul><ul><li>Reproductive age, 5% prepubertal </li></ul><ul><li>25-50% endometrial hyperplasia </li></ul><ul><li>5% endometrial carcinoma </li></ul><ul><li>10% ascitis </li></ul><ul><li>Mostly stage 1 </li></ul>
  27. 27. GCT <ul><li>Recurrence 5-30years </li></ul><ul><li>Haematogenous spread </li></ul><ul><li>Secrete Inhibin </li></ul><ul><li>Treatment-Surgery- USO/TAHBSO </li></ul><ul><li>Chemotherapy no benefit </li></ul><ul><li>recurrence BEP </li></ul><ul><li>90% 10 year survival, 75% 20 year survival </li></ul>
  28. 28. Sertoli-Leydig Tumour <ul><li>3-4 decade </li></ul><ul><li>75% <40 years </li></ul><ul><li>Low grade malignancy </li></ul><ul><li>Produce androgens </li></ul><ul><li>70-85% - clinical virilization </li></ul><ul><li>Surgery - USO/TAH+BSO, No chemo </li></ul><ul><li>Survival 70-90% </li></ul>
  29. 29. Metastatic Tumours <ul><li>5-6% of ovarian tumours </li></ul><ul><li>Breast, GIT </li></ul><ul><li>Tubal 13% </li></ul><ul><li>Endometrial 5% </li></ul><ul><li>Breast 24% </li></ul><ul><li>Krukenburg 30-40% of metastatic ov ca (primary- stomach, colon, breast, biliary T) </li></ul>
  30. 30. Thank you

×