Ovarian cancer is the most common cancer of the female reproductive system. Risk factors include family history of ovarian or breast cancer, genetic factors, older age, and increased number of menstrual cycles. Symptoms are often vague in early stages but may include abdominal bloating, pressure, and pelvic pain. Diagnosis involves pelvic exam, ultrasound, CT scan, and CA125 blood test. Treatment consists of surgery to stage the cancer and remove tumors, followed by chemotherapy.
Vaginal cancer is a rare type of cancer most common in women 60 and older.
Women are more likely to develop vaginal cancer if they have the human papillomavirus (HPV) or if your birth mother took diethylstilbestol (DES) when she was pregnant.
There are several types of vaginal cancer:
Squamous cell carcinoma
About 70 of every 100 cases of vaginal cancer are squamous cell carcinomas. These cancers begin in the squamous cells that make up the epithelial lining of the vagina. These cancers are more common in the upper area of the vagina near the cervix. Squamous cell cancers of the vagina often develop slowly. First, some of the normal cells of the vagina get pre-cancerous changes. Then some of the pre-cancer cells turn into cancer cells. This process can take many years.
The medical term most often used for this pre-cancerous condition is vaginal intraepithelial neoplasia (VAIN). "Intraepithelial" means that the abnormal cells are only found in the surface layer of the vaginal skin (epithelium). There are 3 types of VAIN: VAIN1, VAIN2, and VAIN3, with 3 indicating furthest progression toward a true cancer. VAIN is more common in women who have had their uterus removed (hysterectomy) and in those who were previously treated for cervical cancer or pre-cancer.
In the past, the term dysplasia was used instead of VAIN. This term is used much less now. When talking about dysplasia, there is also a range of increasing progress toward cancer - first, mild dysplasia; next, moderate dysplasia; and then severe dysplasia.
Adenocarcinoma
Cancer that begins in gland cells is called adenocarcinoma. About 15 of every 100 cases of vaginal cancer are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One certain type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother’s womb). (See the section called "What are the risk factors for vaginal cancer?" for more information on DES and clear cell carcinoma.)
Melanoma
Melanomas develop from pigment-producing cells that give skin its color. These cancers usually are found on sun-exposed areas of the skin but can form on the vagina or other internal organs. About 9 of every 100 cases of vaginal cancer are melanomas. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern. More information about melanoma can be found in our document called Melanoma Skin Cancer.
Sarcoma
A sarcoma is a cancer that begins in the cells of bones, muscles, or connective tissue. Up to 4 of every 100 cases of vaginal cancer are sarcomas. These cancers form deep in the wall of the vagina, not on its surface. There are several types of vaginal sarcomas. Rhabdomyosarcoma is the most common type of vaginal sarcoma. It is most often found in children and is rare in adults. A sarcoma called leiomyosarcoma is seen more often in adults.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
Vaginal cancer is a rare type of cancer most common in women 60 and older.
Women are more likely to develop vaginal cancer if they have the human papillomavirus (HPV) or if your birth mother took diethylstilbestol (DES) when she was pregnant.
There are several types of vaginal cancer:
Squamous cell carcinoma
About 70 of every 100 cases of vaginal cancer are squamous cell carcinomas. These cancers begin in the squamous cells that make up the epithelial lining of the vagina. These cancers are more common in the upper area of the vagina near the cervix. Squamous cell cancers of the vagina often develop slowly. First, some of the normal cells of the vagina get pre-cancerous changes. Then some of the pre-cancer cells turn into cancer cells. This process can take many years.
The medical term most often used for this pre-cancerous condition is vaginal intraepithelial neoplasia (VAIN). "Intraepithelial" means that the abnormal cells are only found in the surface layer of the vaginal skin (epithelium). There are 3 types of VAIN: VAIN1, VAIN2, and VAIN3, with 3 indicating furthest progression toward a true cancer. VAIN is more common in women who have had their uterus removed (hysterectomy) and in those who were previously treated for cervical cancer or pre-cancer.
In the past, the term dysplasia was used instead of VAIN. This term is used much less now. When talking about dysplasia, there is also a range of increasing progress toward cancer - first, mild dysplasia; next, moderate dysplasia; and then severe dysplasia.
Adenocarcinoma
Cancer that begins in gland cells is called adenocarcinoma. About 15 of every 100 cases of vaginal cancer are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One certain type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother’s womb). (See the section called "What are the risk factors for vaginal cancer?" for more information on DES and clear cell carcinoma.)
Melanoma
Melanomas develop from pigment-producing cells that give skin its color. These cancers usually are found on sun-exposed areas of the skin but can form on the vagina or other internal organs. About 9 of every 100 cases of vaginal cancer are melanomas. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern. More information about melanoma can be found in our document called Melanoma Skin Cancer.
Sarcoma
A sarcoma is a cancer that begins in the cells of bones, muscles, or connective tissue. Up to 4 of every 100 cases of vaginal cancer are sarcomas. These cancers form deep in the wall of the vagina, not on its surface. There are several types of vaginal sarcomas. Rhabdomyosarcoma is the most common type of vaginal sarcoma. It is most often found in children and is rare in adults. A sarcoma called leiomyosarcoma is seen more often in adults.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
Breast cancer pathology ( Ref: bailey & love 26th edition ) - Abdullah Taskeen
pathology of breast cancer
ductal carcinoma , lobular carcinoma
In situ , Invasiv , vannusclassification
paget disease
inflammatory cancer
local , lymphatic , blood spreading & metastasis
Carcinoma Endometrium ( uterine cancer)
Endometrial cancer starts when cells in the endometrium (the inner lining of the uterus) start to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other parts of the body
Endometrial cancer (also called endometrial carcinoma) starts in the cells of the inner lining of the uterus (the endometrium). This is the most common type of cancer in the uterus
Endometrial carcinomas can be divided into different types based on how the cells look under the microscope. (These are called histologic types.)
They include:
Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid cancer -- see below)
Uterine carcinosarcoma or CS (covered below in the grading section)
Squamous cell carcinoma
Small cell carcinoma
Transitional carcinoma
Serous carcinoma
Clear-cell carcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and serous adenocarcinoma are less common types of endometrial adenocarcinomas. They tend to grow and spread faster than most types of endometrial cancer. They often have spread outside the uterus by the time they're diagnosed.
Endometrioid cancer
Most endometrial cancers are adenocarcinomas, and endometrioid cancer is the most common type of adenocarcinoma, by far. Endometrioid cancers start in gland cells and look a lot like the normal uterine lining (endometrium). Some of these cancers have squamous cells (squamous cells are flat, thin cells), as well as glandular cells.
There are many variants (or sub-types) of endometrioid cancers including:
Adenocarcinoma, (with squamous differentiation)
Adenoacanthoma
Adenosquamous (or mixed cell)
Secretory carcinoma
Ciliated carcinoma
Villoglandular adenocarcinoma
An UPDATE solid knowledge in Vulval cancer, consisting of 12 years experience form lecture notes of
Professor Basel Obaidat~ FRCOG. Gyne/Onco.
24\3\2016
Gain a deeper understanding of uterine and endometrial cancer symptoms, diagnosis, treatment options, and current research trends with Dr. Jason D. Wright, Division Chief of Gynecologic Oncology at New York-Presbyterian/Columbia University Medical Center. This webinar is a collaboration with the Foundation for Women's Cancer.
Breast cancer pathology ( Ref: bailey & love 26th edition ) - Abdullah Taskeen
pathology of breast cancer
ductal carcinoma , lobular carcinoma
In situ , Invasiv , vannusclassification
paget disease
inflammatory cancer
local , lymphatic , blood spreading & metastasis
Carcinoma Endometrium ( uterine cancer)
Endometrial cancer starts when cells in the endometrium (the inner lining of the uterus) start to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other parts of the body
Endometrial cancer (also called endometrial carcinoma) starts in the cells of the inner lining of the uterus (the endometrium). This is the most common type of cancer in the uterus
Endometrial carcinomas can be divided into different types based on how the cells look under the microscope. (These are called histologic types.)
They include:
Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid cancer -- see below)
Uterine carcinosarcoma or CS (covered below in the grading section)
Squamous cell carcinoma
Small cell carcinoma
Transitional carcinoma
Serous carcinoma
Clear-cell carcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and serous adenocarcinoma are less common types of endometrial adenocarcinomas. They tend to grow and spread faster than most types of endometrial cancer. They often have spread outside the uterus by the time they're diagnosed.
Endometrioid cancer
Most endometrial cancers are adenocarcinomas, and endometrioid cancer is the most common type of adenocarcinoma, by far. Endometrioid cancers start in gland cells and look a lot like the normal uterine lining (endometrium). Some of these cancers have squamous cells (squamous cells are flat, thin cells), as well as glandular cells.
There are many variants (or sub-types) of endometrioid cancers including:
Adenocarcinoma, (with squamous differentiation)
Adenoacanthoma
Adenosquamous (or mixed cell)
Secretory carcinoma
Ciliated carcinoma
Villoglandular adenocarcinoma
An UPDATE solid knowledge in Vulval cancer, consisting of 12 years experience form lecture notes of
Professor Basel Obaidat~ FRCOG. Gyne/Onco.
24\3\2016
Gain a deeper understanding of uterine and endometrial cancer symptoms, diagnosis, treatment options, and current research trends with Dr. Jason D. Wright, Division Chief of Gynecologic Oncology at New York-Presbyterian/Columbia University Medical Center. This webinar is a collaboration with the Foundation for Women's Cancer.
Ca ovary staging(AJCC 8th Edition& FIGO 2014) and classificationDr.Bhavin Vadodariya
Pathological classification of ovary in details.
Principles of Staging in Ca Ovary.
Staging according to AJCC 8th edition & Figo 2014.
Summary of changes in 8th Edition AJCC
Morphology and diagnosis of Ovarian Tumors
• Clinical Features of Ovarian Tumors
Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel.
Bloating; abdominal distention or discomfort
Pressure effects on the bladder and rectum
Constipation
Vaginal bleeding
Indigestion and acid reflux
Shortness of breath
Tiredness
Weight loss
Early satiety
------prepared by med_students0-----
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
Ovarian tumors are abnormal growths on the ovaries, the female reproductive organs that produce eggs. Ovarian tumors can be noncancerous (benign) or cancerous (malignant). Many things can make you more likely to develop an ovarian tumor.
Carcinoma breast and its management (1).pptxDr Sajad Nazir
This ppt is about carcinoma breast, its types,presentation, diagnosis, examination,management and recent trends in it.
Sentinel lymph node indications, axillary lymph node management.
Indications for chemotherapy and radiotherapy.
This is mainly for post graduates...
Kindly read anatomy of breast before proceeding for cancer breast and its management
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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2. 2
Ovarian Cancer
General Introduction
Ovarian tumors are
commonest between 30
and 60.
They are particularly
liable to be or to become
malignant.
In their early stages, they
are asymptomatic and
painless.
They may grow to a
large size.
1.4% lifetime risk of
ovarian cancer
3. 3
Ovarian Cancer
Risk Factors
Family history
Ovarian cancer
Breast cancer
Colon cancer
Genetic factors
Older age
Caucasian
More menstrual circles during lifetime
(Ovulation induction)
4. 4
Ovarian Cancer
Incidence
Nearly 25% of all ovarian neoplasm are
malignant.
Approximately 80 % of them are primary
growths of the ovary.
The remainder being secondary , usually
carcinomata.
5. 5
Ovarian Cancer by dr Saleh Bakar
symptoms
Lack of any specific symptoms,
ovarian tumors are often large by
the time the doctor is consulted.
Menstrual function is seldom upset,
and any irregularity is attributed to the
patient’s ‘time of life’.
7. 7
Ovarian Cancer
symptoms
Pressure symptoms
Gastro-intestinal symptoms (Bloating)
Urge to urinate
pelvic pain (a dull pain in the lower abdomen)
Very large tumors may cause respiratory
embarrassment and edema or varicosities in
the legs, and a characteristic ‘ ovarian
cachexia’ develops.
11. 11
Ovarian Cancer
General Rule
An experienced examiner will
recognize an ovarian tumor mainly
because ovarian tumor is, in the
circumstances, the most likely
diagnosis. All abdominal swellings
should be subjected to ultrasound and
X-ray examination.
DIFFERENTIAL DIAGNOSIS
13. 13
Ovarian Cancer
ASCITES
A fluid thrill
may be elicited
from an ovarian
cyst, and ascites
and tumor may
coexist; but as a
rule the
distinction should
be easily made.
DIFFERENTIAL DIAGNOSIS
14. 14
Ovarian Cancer
Uterine Fibroids
A large midline
intramural fibroid may
be impossible to
distinguish from a solid
ovarian tumor until the
abdomen is opened and
an entirely different
surgical problem
encountered.
DIFFERENTIAL DIAGNOSIS
18. 18
Ovarian Cancer
Histological Classification
Most tumors arise from the ovarian
stroma and germinal epithelium. The
embryonic coelom from which that
epithelium develops also gives rise to the
Mullerian duct from which develop the
structures of the genital tract, and it is
this common origin which explains the
great variety of epithelial patterns which
are met with.
19. 19
Ovarian Cancer
Primary Epithelial
TumorMucinous cystadenoma or cystadencarcinoma
(of. Cervical epithelium).
Serous cystadenoma or cystadenocarcinoma
(of . tubal epithelium).
Endometrioma or Endometrioid carcinoma
(of. Endometrium).
Clear cell carcinoma.
Brenner tumour.
Squamous cell tumor
23. 23
Ovarian Cancer
Mucinous cystadenoma
A unilocular or
multilocular cyst of ovary
lined by tall columnar
epithelium resembling that
of the cervix or large
intestine. It is usually large
and may reach immense
proportions, occupying the
whole peritoneal cavity and
compressing other organs.
It may occur at any age.
27. 27
Ovarian Cancer
SEROUS CYSTADENOMA
A unilocular or multilocular
cyst lined by epithelium
similar to the fallopian tube.
They are the most common
benign epithelial tumors and
form 20% of all ovarian
neoplasm. In 10% of cases they
are bilateral. It is uncommon
to find them large than a fetal
head.
31. 31
Ovarian Cancer
Serous cystadenocarcinoma
This is by far the commonest
primary carcinoma, accounting for
60% of all cases, and in over half
the cases it is bilateral. The cysts
are always of papillary type and the
epithelium burrowing through the
capsule produces papillary
processes on the serous surface.
Extension of the growth to the
pelvis and adjacent organs fixes the
tumor. Ascites is always present.
32. 32
Ovarian Cancer
Endometrioid Carcinoma of the Ovary
It is now recognized that
carcinoma of the ovary
may be of endometrial
type, sometimes arising in
endometrioma. Attacks of
pain, unusual with ovarian
cancer, are common.
Sometimes there is uterine
bleeding in post-
menopausal cases.
33. 33
Ovarian Cancer
Endometrioid Carcinoma of the
Ovary
Usually the lesion is cystic
and chocolate brown in color.
If such a cyst ruptures
spontaneously, malignancy
should be suspected. The
histology varies as in uterine
carcinoma. It may be a well-
differentiated adenocarcinoma,
an adeno-acanthoma, mucinous
adenocarcinoma or clear-celled
carcinoma.
34. 34
Ovarian Cancer
Fibroma
This is composed of
fibrous tissue and
resembles fibromata found
elsewhere. It is most
common in the elderly and
accounts for 4-5% of all
ovarian neoplasm.
The fibroma is believed
by many to be a thecoma
which has undergone
fibrous transformation. It
is sometimes associated
with Meig’s syndrome.
36. 36
Ovarian Cancer
Estrogen-producing Tumors
In childhood there is accelerated skeletal
growth and appearance of sex hair.
5% occur in children precocious puberty.
60% occur in child-bearing years irregular
menstruation.
30% occur in post-menopausal women post-
menopausal bleeding.
37. 37
Ovarian Cancer
Andorogen-producing Tumours
Three distinct types of masculinising
ovarian tumor are recognised: a) Sertoli-
Leydig cell tumor (Androblastoma), b)
Hilar cell tumor, c) Lipoid cell tumor. All
three cause amenorrhoea.
38. 38
Ovarian Cancer
Dysgerminoma
This is the only solid
ovarian tumor of
characteristic appearance.
Usually ovoid with a
smooth capsule, it is of
rubbery consistency and
greyish colour. It is
commonest in younger
age groups, under 30
years as a rule, and is
often bilateral. Sometimes
it is found in cases of
intersex.
51. 51
Ovarian Cancer
Spread -Lymphatics
Ovarian drainage is to the para-aortic
glands, but sometimes to the pelvic and
even inguinal groups. Cells seeded on to
the peritoneum are drained via the
lymphatic channels on the underside of
the diaphragm into the subpleural
glands and thence to the pleura.
53. 53
Ovarian Cancer
Staging of ovarian cancer
STAGE I Growth limited to ovaries
Ia Limited to one ovary. No ascites.
Ib Limited to both ovaries. No ascites.
Ic Ascites or positive peritoneal washings also present or
tumour on surface of one or both ovaries or capsule ruptured.
54. 54
Ovarian Cancer
Staging of ovarian cancer
STAGE II Pelvic extension
IIa Spread to uterus/tubes
IIb Spread to other pelvic tissues
IIc IIb with ascites or positive peritoneal washings or tumour
on surface of one or both ovaries or capsule ruptured.
55. 55
2006-11-1 七年制 Ovarian Cancer
Staging of ovarian cancer
Stage III Extrapelvic intraperitoneal spread and/or retroperitoneal
or inguinal positive nodes, or superficial lover metastases.
IIIa Apparent limitation to true pelvis
IIIb Histologically proven abdominal peritoneal superficial
implants<2cm diameter.
IIIc Abdominal implants>2cm diameter or positive
retroperitoneal or inguinal nodes.
56. 56
Ovarian Cancer
Staging of ovarian cancer
Stage IV
Distant metastases
or pleural effusion
with positive
cyotlogy or
parenchymal liver
metastases.
64. 64
Ovarian Cancer
TORSION of the PEDICLE
The commonest
complication
Occur with any
tumor
Except those
with adhesions
65. 65
Ovarian Cancer
Clinical Features-Subacute
The patient complains of recurrent
abdominal pain which passes off as the
pedicle untwists. There is a rise in pulse
and temperature during the bleeding;
And over a period anemia develops.
TORSION of the PEDICLE
66. 66
Ovarian Cancer
Clinical Features-acute
The signs and symptoms are those of an
acute abdominal condition. The problem
becomes one of differential diagnosis to
exclude those conditions in which laparotomy
is not needed and laparoscopy may be useful.
Pain tends to be intense and
continuous.
ORSION of the PEDICLE
67. 67
Ovarian Cancer
Ruptured Cyst
This may occur alone or in conjunction with
torsion. Rupture is not particularly upsetting to the
patient unless the contents are irritant.
TORSION of the PEDICLE
68. 68
Ovarian Cancer
Suggestive of Malignancy
Age. If the patient is over 50 the chance of
malignancy is over 50% as opposed to less
than 15% in premenopausal women.
Tumors in childhood are usually malignant.
Rapid growth.
Ascites.
69. 69
Ovarian Cancer
Suggestive of Malignancy
Solid tumours, especially when bilateral.
Multilocular cysts with solid areas. (At least
10% of cysts are malignant).
Pain. Pressure pain can occur with any tumor;
But referred pain suggests malignant
involvement of nerve roots.
Tumor markers, such as CA125, may be
measured in the blood, but a normal level does
not exclude malignancy.
71. 71
Ovarian Cancer
Surgical Procedures
To classify the growth according to its
extent of spread (staging) as accurately as
possible.
To remove as much cancerous tissue as
possible (‘surgical debulking’;’cyto-
reductive treatment’).
72. 72
Ovarian Cancer
Surgical Procedures
Benign ovarian over 10 cm in diameter
must be removed, but clinical and
ultrasonically diagnosed cysts under 10 cm
(the size of a lemon) in women under 35
years may be reviewed in a few months if
there is no suspicion of malignancy. A
follicular or luteral cyst may resolve
spontaneously.
76. 76
Ovarian Cancer
Follow-up
Follow-up with intensive
chemotherapy, using various
combinations of antineoplastic
drugs. Taxanes, probably combined
with platinum compounds, are an
appropriate first choice.
77. 77
Ovarian Cancer
Second Look
A ‘second look’ laparotomy or laparoscopy
operation (SLO), to determine the actual
effectiveness of the chemotherapy and to
decide whether it should be stopped does not
affect prognosis, so should only be performed
with informed consent in clinical trials.
78. 78
Ovarian Cancer
Surgical Procedures -Incision
A vertical incision which can
be extended is essential to allow a
full inspection. Reduction of a
cyst by tapping and extraction
through a suprapubic incision is
not acceptable practice.
79. 79
Ovarian Cancer
Surgical Procedures - Cytology
Before handling the tumour, take
specimens of ascitic fluid or peritoneal
saline washings for cytological
examination, and a cytology smear
from the underside of the diaphragm.
82. Prophylaxis
I popularization of cancer prevention knowledge
II. health education: physical and gyn. Examination, CA125
and HE4,US examination
III. Early treatment
85. 85
Ovarian Cancer
Hereditary Breast and Ovarian
Cancer: BRCA1
• Autosomal Dominant TransmissionAutosomal Dominant Transmission
• Precise Risk for Male Breast Cancer UnclearPrecise Risk for Male Breast Cancer Unclear
• Increased Risk for Prostate Cancer?Increased Risk for Prostate Cancer?
Breast cancerBreast cancer 50%50%−−85%85%
Second primary breast cancerSecond primary breast cancer 40%40%−−60%60%
Ovarian cancerOvarian cancer 20%20%−−60%60%
86. 86
Ovarian Cancer
Hereditary Breast and Ovarian
Cancer: BRCA2
• Autosomal Dominant TransmissionAutosomal Dominant Transmission
• Increased risk of prostate, laryngeal,Increased risk of prostate, laryngeal,
melanoma and pancreas cancersmelanoma and pancreas cancers
breast cancerbreast cancer
(50%(50%−−85%)85%)
ovarian cancerovarian cancer
(10%(10%−−20%)20%)
male breast cancermale breast cancer
(6%)(6%)