Ovary

1. The Ovary
The Ovary
Dr.Mudathir
Dr.Mudathir Omer Abdelmaboud
Omer Abdelmaboud
Clinical Lecturer
Clinical Lecturer-
-Obstetrics & Gynaecology
Obstetrics & Gynaecology
2009
2009-
-2010
2010

2. Anatomy
Anatomy

3. Ovarian Structure
Ovarian Structure

4. Blood supply
Blood supply

 Ovarian artery
Ovarian artery –
–
branch of abdominal
branch of abdominal
aorta L2
aorta L2

 Uterine artery
Uterine artery –
–
branch of internal iliac
branch of internal iliac
artery
artery

5. Conditions of the ovary
Conditions of the ovary
Ovarian Disease
Benign Malignant

6. Benign Conditions
Benign Conditions
Benign Ovarian Tumours
Epithelial Germ Cell Sex Cord
•Mucinous
cystadenoma
•Serous
cystadenoma
•Dermoid cyst •Fibroma

7. Simple Ovarian Cysts
Simple Ovarian Cysts

 Ovarian Cysts /Follicular
Ovarian Cysts /Follicular
cysts
cysts

 Usually asymptomatic
Usually asymptomatic

 Occasionally rupture/
Occasionally rupture/
haemorrhage into
haemorrhage into
cyst/torsion
cyst/torsion

 Conservative
Conservative
management
management

 If symptomatic
If symptomatic –
–
laparoscopy+/
laparoscopy+/-
- drainage
drainage

8. Dermoid
Dermoid Cyst
Cyst

9. Malignant Conditions
Malignant Conditions
Malignant Conditions
Primary Secondary
Metastatic spread-
breast, GIT→
Krukenburg tumour

10. 1º Malignant Ovarian Tumours
Epithelial Germ Cell Sex Cord
•Mucinous
Adenocarcinoma
10%
•Serous
Adenocarcinoma
50%
•Endometroid
20%
•Dysgerminoma
•Teratoma
•Granulosa Cell
Tumour

11. Ovarian Carcinoma
Ovarian Carcinoma

 NB Silent disease!
NB Silent disease!

 70% present at stage 3
70% present at stage 3-
-4
4

 85%
85% cases
cases→
→Age
Age 50+.
50+.

 4
4th
th commonest cause of death from Ca women.
commonest cause of death from Ca women.

 Leading cause of death from
Leading cause of death from gynae
gynae cancer.
cancer.

 Lifetime risk 1 in 48.
Lifetime risk 1 in 48.

 Protective factors
Protective factors-
-

 Multiparity
Multiparity

 COCP
COCP

 Breast
Breast feeeding
feeeding.
.

12. High Risk Groups(
High Risk Groups(  no of
no of
Ovulations)
Ovulations)
HX Breast CA
HX Breast CA
Ovulation
induction
Ovulation
induction Family HX
Family HX
Early menarche/
late menopause
Early menarche/
late menopause
Nulliparity
Nulliparity
Ovarian
Cancer
Ovarian
Cancer

13. Clinical presentation
Clinical presentation

 Usually presents late!
Usually presents late!

 Weight loss / loss of appetite
Weight loss / loss of appetite

 Abdominal distension
Abdominal distension -
- ascites
ascites

 Vaginal bleeding
Vaginal bleeding

 Pain
Pain

14. Clinical Examination
Clinical Examination

 Cachexia
Cachexia.
.

 Ascites
Ascites.
.

 Abdominal mass.
Abdominal mass.

 Pelvic mass
Pelvic mass

 Palpate breasts.
Palpate breasts.

15. Investigations
Investigations

 USS
USS –
– solid/
solid/septate/ascites
septate/ascites

 CT/MRI
CT/MRI-
- pelvis/abdomen/thorax
pelvis/abdomen/thorax

 CA125
CA125→↑
→↑in 80%
in 80%

 CXR
CXR-
- pleural effusions.
pleural effusions.

 Paracentesis
Paracentesis of
of ascites
ascites

 Laparoscopy
Laparoscopy

 FBC/LFT s/U&E
FBC/LFT s/U&E

 Laparotomy
Laparotomy-
- ovarian biopsy/staging
ovarian biopsy/staging

16. Disease Spread
Disease Spread

 Direct spread
Direct spread →
→ pelvis & abdomen
pelvis & abdomen

 Transcoelomic
Transcoelomic

 Lymphatic.
Lymphatic.

 Blood
Blood –
– borne.
borne.

17. USS images
USS images
Solid Ovarian mass Simple Ovarian Cyst

18. Ovarian Carcinoma
Ovarian Carcinoma

19. Ovarian Carcinoma
Ovarian Carcinoma

21. Staging of Ovarian Ca
Staging of Ovarian Ca

22. Treatment
Treatment-
- Surgical
Surgical

 Laparotomy
Laparotomy-
- midline incision.
midline incision.

 Total Abdominal Hysterectomy ( TAH) +
Total Abdominal Hysterectomy ( TAH) +
Bilateral
Bilateral Salpingo
SalpingoÖ
Öpherectomy
pherectomy (BSO).
(BSO).

 Peritoneal washings.
Peritoneal washings.

 Omentectomy
Omentectomy

23. Adjuvant Rx
Adjuvant Rx

 Chemotherapy
Chemotherapy-
- Cisplatin/Carboplatin
Cisplatin/Carboplatin.
.

 CA125
CA125-
- monitor response to Rx.
monitor response to Rx.

 Radiotherapy
Radiotherapy-
- only
only dysgerminomas
dysgerminomas

24. Follow
Follow-
-up
up

 5 years
5 years →
→3
3-
-12 monthly intervals.
12 monthly intervals.

 CA125
CA125-
- monitor response to Rx.
monitor response to Rx.

 Compute tomography scan (CTS)
Compute tomography scan (CTS) →
→detect
detect
residual disease or relapse.
residual disease or relapse.

 Interval
Interval debulking
debulking surgery of residual disease.
surgery of residual disease.

 Overall 5 yr survival 25%
Overall 5 yr survival 25%

25. The future
The future –
– Screening?
Screening?

 Why? 70% of cases present with advanced disease.
Why? 70% of cases present with advanced disease.

 High risk groups/ family
High risk groups/ family hx
hx ovarian ca.
ovarian ca.

 BRCA 1/BRCA 2/HNPCC.
BRCA 1/BRCA 2/HNPCC.

 CA125 & trans
CA125 & trans-
-vaginal USS
vaginal USS

 Problems
Problems-
- CA125
CA125→
→ false +
false +ve
ve
-
-Endometriosis
Endometriosis
-
-Pregnancy
Pregnancy
-
-PID
PID
-
-Other malignancies.
Other malignancies.

 Prophylactic
Prophylactic oophorectomy
oophorectomy.
.