1. Malignant Tumors of Ovary
Mehtab Sami
Final year MBBS

2. Investigations
USG:
 Semisolid,semicystic mass with thick
septa,surface papillary growth,bilateral
lesions
 Ascites
 Matted bowel loops
 Mets in liver
 Enlarged pelvic or para aortic nodes.


3. Radiological investigations:
 CXR
 Barium studies
 IVP
 Imaging techniques:
 CT
 MRI
 Lymphangiography


4. 
Cytology:
FNAC of nodes in groin or neck
 Tumor markers:
 CA 125>35µ/l
 CEA abnormal in mucinous cyst adenocarcinoma(level
above 20 ng/ml)
 OCA
 OCCA
 Haematological investig:
 FBC
 Urea
 Creatinine
 LFT
 Electrolytes


5. Treatment
Surgery
 Chemotherapy
 Radiotherapy
 Radioactive isotopes
 Hormonal treatment
 Immunotherapy
 Follow up


6. Surgery
Early disease:
 TAH+BSO+omentectomy
 Young pt with stage 1a:unilateral USO
 When conseravtive tm optex,go for
uterine curettage to exclude a
synchronous endometrial tumor.


7. Advanced Disease:
 TAH+BSO+omentectomy+remove as
much of tumor as possible.
 If bowel involved,resection and end to
end anastomosis.
 If tumor size too large,abdomen
closed,2-4 courses of chemo given to
reduce size and then surgery done.


8. Chemotherapy
Stage 1b—3a:given post op to prolong
remission and survival.
 In advanced cases:given for palliation.
 Sholud be given as soon as possible
after surgery and not delayed beyond
6 weeks.
 5 or 6 cycles;3—4 weekly intervals.
 Single agent therapy
 Combination therapy


9. Single agent therapy:
 Cisplatin
 Carboplatin
 Paclitaxol
 Cyclophosphamide
 5-FU
 Doxorubicin
 Etoposide


10. 
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Combination therapy:
Cisplatin+carboplatin
Cisplatin+paclitaxol
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Side Effects:
N,V
Bone marrow depression
Renal toxicity
Neuropathy
Alopecia
Ototoxicity
Cardiotoxicity

11. Radiotherapy
From diaphragm to pelvic floor
 Alternative to chemo in pts 1b—3a
 30Gy;25 daily fractions
 Other use:
 Palliative treatment for painful
recurrence in pelvis
 Bone mets
 Brain mets


12. Radioactive Isotopes
Gold (Au 198)
 Phosphorous (P 32)
 Alone or with raditherapy.
 Depth of penetration:4-6mm
 Beneficial to pts with small
microscopic deposits on peritoneal
surfaces.


13. Other Treatments
Hormonal TM:
 Progesterone,tamoxifen,cyproterone
acetate,GnRH-a
 No proven benefit.
 Immunotherapy:
 BCG,alpha
interferon,corynebacterium—still
under trial.


14. Follow Up
CA 125
 Second look surgery (laparotomy or
laparoscopy)
