The document provides an overview of epithelial ovarian tumours, which make up 90% of ovarian tumours. They most commonly originate from the coelomic epithelium. The four main histological types are serous, mucinous, endometrioid, and clear cell. Risk factors include increased age, family history, and lack of pregnancy. Screening and tumor markers like CA125 are used for early detection but have limitations. Surgery is the main treatment and chemotherapy is used for advanced stages. Prognosis depends on stage, with 5-year survival rates ranging from 76-93% for stage 1 to 11% for stage 4.

1. OVARIAN TUMOUR - an overview Sachin Maiti MD,MRCOG,DFFP Research Registrar Wirral Hospital NHS Trust,UK

2. Epithelial Ovarian Tumour Most common gynaecological Malignancy in developed countries 15/100,000 4000 deaths/year 2/3 present in advanced stage Life time risk of ov ca = 1.5%, dying 1% 90% of ovarian tumours are epithelial origin

3. Epithelial Ovarian Tumour 90% derived from coelomic epithelium 75-80% serous 10% mucinous 10% endometriod 1% Brenner, undifferentiated, clear cell

4. Epithelial Ovarian Tumour Age 56 80-90 > 40 years, 30-40% >60 years 1 in 10 of ovarian tumour malignant <40 y 1 in 3 of ovarian tumour malignant >40 y 1% of ovarian tumours <20 y, 2/3 Germ CT 30% of ovarian tumours malignant in postmenopausal women

5. Epithelial Ovarian Tumour Prevention:- Pregnancy (RR 0.3-0.4) OCP (RR 0.5) 2 Children and OCP (RR 0.3) Oophorectomy

6. Epithelial Ovarian Tumour SCREENING:- TVS (1 in 10) Doppler US CA125 TVS+CA125 (1 in 4 laparotomy)

7. Hereditary Ovarian CA 5-10% BRCA1 & BRCA2 HNPCC AD, mutations Risk of ovarian ca 10years earlier 35-40% risk

8. Impact of BRCA-1

9. Differential Diagnosis Benign cyst Endometriosis PID Fibroids Pelvic Kidney Retroperitoneal tumours

10. Risk of Malignancy Index (RMI) USS Menopausal status CA125 RMI = UxMxCA125 High index of suspicion = RMI> 200

11. Investigations History/Examination FBC, LFT, CA125 (CEA) USS/CT Chest X-ray Barium/Gastroscopy (if bowel symptoms) Endometrial sample (PMB)

12. CA125 Secreted by Mullarian & Coelomic epithelium >30 ku/l in PMW, risk of ov ca 36 fold >96ku/l in PMW, PPV 96% Stage 1- 50% Stage 2- 60%

13. Poor prognostic factors High grade Aneuploidy Serous vs Mucinous Lymphatic invasion, Ascitis, positive cyto Clear cell histology Poor performance status Poor biochemical/haematological status

14. Borderline tumours Low malignant potential Confined to one ovary for long time Good prognosis, 86-90% Age 30-50years Metastatic implants can occur Late recurrence

15. Aim of Surgery Establish diagnosis Staging Primary Cytoreduction Interval/ Secondary cytoreduction Palliative & salvage surgery Laparoscopy/Aspiration NOT recommended

16. Treatment Surgery- cytoreduction <1-2cms TAH+BSO+Omental Biopsy+washings Bowel resection if impending obstruction Chemotherapy Stage >1C (>2A) Carboplatin +Taxol

17. Survival Stage 1 76-93% Stage 2 60-74% Stage 3A 40% Stage 3B 25% Stage 3C 23% Stage 4 11% Increased grade - decreased survival

18. Non Epithelial Ovarian Tumour Uncommon, 10% of all ovarian ca Germ Cell Tumours Sex Cord Tumours Metastatic Tumours Rare- Sarcomas, Lipoid cell tumours Tumour markers- AFP, HCG, PALP, LDH

19. Germ Cell Tumours Arise from primordial germ cell 1/10 as common as testicular tumours Most arise from undifferentiated germ cell in ovary 20-30% of all ovarian neoplasia 3% malignant, rapidly growing <20years, 70% Germ CT, 1/3 malignant

20. Germ cell tumours Dysgerminomas 30-40% Teratomas (Immature/Mature) Monodermal Endodermal Sinus tumour (YST) Embryonal carcinomas Choriocarcinoma Mixed form

21. Dysgerminoma Most common GCT 75% -10-30years, 5% <10years 20-30% of tumours in pregnancy 5% abnormal gonads 85% stage 1 10-15% bilateral 95% secrete PALP, LDH, 3% HCG

22. Dysgerminomas Treatment - Surgery+ Chemotherapy Staging, USO Fertility preservation Stage 1A -surgery alone Stage 1B or higher - surgery+chemo BEP chemo Prognosis- 90-100%,

23. Immature Teratomas 10-20% of ov tumours in <20years 50% occur 10-20years Malignant transformation- .5-2% in PMW Tumour markers negative Diagnosis- USS/ Histology Surgery- Staging +USO, Chemo - BEP >1A Survival - 70-80%

24. Endodermal Sinus tumours (Yolk sac tumours) 1/3 present before menarche median age 18years 10% mass 75% pelvic pain Secrete AFP Surgery + chemotherapy in all patients Response rate 60%

25. Sex cord-stromal tumours 5-8% of all ovarian malignancy Granulosa-stromal cell tumour Androblastroma Gynandroblastoma ( attached slide) unclassified

26. Granulosa cell tumour Low grade malignancy 2% Bilateral Reproductive age, 5% prepubertal 25-50% endometrial hyperplasia 5% endometrial carcinoma 10% ascitis Mostly stage 1

27. GCT Recurrence 5-30years Haematogenous spread Secrete Inhibin Treatment-Surgery- USO/TAHBSO Chemotherapy no benefit recurrence BEP 90% 10 year survival, 75% 20 year survival

28. Sertoli-Leydig Tumour 3-4 decade 75% <40 years Low grade malignancy Produce androgens 70-85% - clinical virilization Surgery - USO/TAH+BSO, No chemo Survival 70-90%

29. Metastatic Tumours 5-6% of ovarian tumours Breast, GIT Tubal 13% Endometrial 5% Breast 24% Krukenburg 30-40% of metastatic ov ca (primary- stomach, colon, breast, biliary T)

30. Thank you