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OVARIAN CANCER

OVARIAN CANCER. Di Wen, M.D.,Ph.D. OVARIAN TUMOURS. Definition Ovarian tumors may arise at any age, but are commonest between 30 and 60. 1.Ovarian tumors are particularly liable to be or to become malignant. 2.In their early stages they are asymptomatic and painless.

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OVARIAN CANCER

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  1. OVARIAN CANCER Di Wen, M.D.,Ph.D

  2. OVARIAN TUMOURS • Definition • Ovarian tumors may arise at any age, but are commonest between 30 and 60. • 1.Ovarian tumors are particularly liable to be or to become malignant. • 2.In their early stages they are asymptomatic and painless. • 3.They may grow to a large size and tend to undergo mechanical complications such as torsion and perforation. Ovarian Cancer

  3. CARCINOMA OF THE OVARY • Definition • In developed countries，women have a lifetime risk of developing ovarian cancer of about 1.4%，which is slightly greater than the risk of cervical or endometrial cancers, but well below the 7% average risk of breast cancer． Ovarian Cancer

  4. CARCINOMA OF THE OVARY • Risk Factor • Genetic factor are sometimes involved、as in the Lynch Syndrome of familial breast colorectal and ovarian cancer．Ovulation induction with Clomiphene over more than year carries a l0-fold increased risk of ovarian cancer, Long-term ora1contraceptive use reduces the incidence of ovarian cancers． Ovarian Cancer

  5. CARCINOMA OF THE OVARY • 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． Ovarian Cancer

  6. CARCINOMA OF THE OVARY • Primary Carcinoma of the Ovary • 80％ of all cases of primary carcinoma of the ovary arise in serous or mucinous cysts. Ovarian Cancer

  7. CARCINOMA OF THE OVARY • Solid Carcinoma of the Ovary • This accounts for 10% of primary carcinoma. It is arise commonly bilateral but one tumor is usually larger than the other. The ovarian shape is retained for a time and there is a well-marked pedicle but soon the tumors become fixed. Secondary deposits occur in the omentum and ascites develops. Ovarian Cancer

  8. CLINICAL FEATURES OF OVARIAN TUMOURS • Symptoms due to Size • Lack of any specific symptoms, ovarian tumors are often large by the time the doctor is consulted. Ovarian Cancer

  9. Menstrual function is seldom upset, and any irregularity is attributed to the patient’s ‘time of life’. Ovarian Cancer

  10. She may have noticed that her clothes are getting tight ant attributed this to weight gain or, if the abdominal swelling has coincided with amenorrhea she may believe herself to be pregnant. Ovarian Cancer

  11. CLINICAL FEATURES OF OVARIAN TUMOURS • Pressure Symptoms • These are commonly increased frequency of micturition, gastro-intestinal symptoms and 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, due perhaps to interference with alimentary function. Ovarian Cancer

  12. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  13. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  14. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  15. CLINICAL FEATURES OF OVARIAN TUMOURS Ovarian Cancer

  16. DIFFERENTIAL DIAGNOSIS • 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. Ovarian Cancer

  17. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  18. DIFFERENTIAL DIAGNOSIS • 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. Ovarian Cancer

  19. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  20. DIFFERENTIAL DIAGNOSIS • 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. Ovarian Cancer

  21. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  22. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  23. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  24. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  25. DIFFERENTIAL DIAGNOSIS Ovarian Cancer

  26. TORSION of the PEDICLE • Complications of Ovarian Tumors • This is the commonest complication and may occur with any tumor except those with adhesions. The thin-walled veins of the pedicle are obstructed first while the arterial supply continues. As a result there is hemorrhage into the tumor and into the peritoneum, and if not treated gangrene will occur. Very rarely the pedicle atrophies and the tumor obtains a new blood supply through its adhesions to surrounding viscera (parasitic tumor). Ovarian Cancer

  27. TORSION of the PEDICLE Ovarian Cancer

  28. TORSION of the PEDICLE • 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. Ovarian Cancer

  29. TORSION of the PEDICLE • 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. Ovarian Cancer

  30. TORSION of the PEDICLE • Clinical Features • Differential Diagnosis • ‘Surgical Conditions’ (i.e. those conditions commonly seen and dealt with by a general surgeon.) • Acute appendicitis • Meckel’s diverticulitis • Obstruction of bowel • Diverticulitis Ovarian Cancer

  31. TORSION of the PEDICLE • Ruptured Cyst • This may occur alone or in conjunction with torsion. Rupture is not particularly upsetting to the patient unless the contents are irritant. Ovarian Cancer

  32. TORSION of the PEDICLE Ovarian Cancer

  33. TORSION of the PEDICLE Ovarian Cancer

  34. RUPTURE OF OVARIAN CYST Ovarian Cancer

  35. RUPTURE OF OVARIAN CYST RUPTURE OF OVARIAN CYST RUPTURE OF OVARIAN CYST Ovarian Cancer

  36. RUPTURE OF OVARIAN CYST • PSEUDOMYXOMA PERITONEI • This rare condition occasionally but not inevitably follows mthe rupture of a mucinous cystadenoma. The epithelial cells implant on the peritoneum and continue to secrete a gelatinous pseudomucin which is not absorbed, or secretion is faster than absorption. The abdominal cavity is eventually filled with the jelly, while the secreting cells spread over the parietal and visceral peritoneum. Ovarian Cancer

  37. RUPTURE OF OVARIAN CYST • HYDROTHORAX • Hydrothorax may accompany ascites due to any cause, or may occur as an accompaniment of a lung tumor. The so-called Meigs’ syndrome describes the specific condition of ascites and hydrothorax in conjunction with benign ovarian fibroma. Ovarian Cancer

  38. Features suggestive of malignancy • 1.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. • 2.Rapid growth. • 3.Ascites. Ovarian Cancer

  39. Features suggestive of malignancy • 4.Solid tumours, especially when bilateral. • 5.Multilocular cysts with solid areas. (At least 10% of cysts are malignant). • 6.Pain. Pressure pain can occur with any tumor; but referred pain suggests malignant involvement of nerve roots. • 7.Tumor markers, such as CA125, may be measured in the blood, but a normal level does not exclude malignancy. Ovarian Cancer

  40. OVARIAN TUMOURS • 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. Ovarian Cancer

  41. OVARIAN TUMOURS • PRIMARY EPITHELIAL TUMOR • 1.Mucinous cystadenoma or cystadencarcinoma (of. Cervical epithelium). • 2.Serous cystadenoma or cystadenocarcinoma (of . tubal epithelium). • 3.Endometrioma or Endometrioid carcinoma (of. Endometrium). • 4.Clear cell carcinoma. • 5.Brenner tumour. Ovarian Cancer

  42. OVARIAN TUMOURS • STROMATOUS TUMOURS GERM CELL TUMOURS • .Fibroma or sarcoma. • .Dysgerminoma. • .Teratoma. • .Gonadoblastoma. • .Yolk sac tumour. • .Carcinoid • .Thyroid tumour Choriocarcinoma Ovarian Cancer

  43. OVARIAN TUMOURS • HORMONE-PRODUCING TUMORS • Estrogen-producing: • Granulosa cell tumour. • Thecoma. • Androgen-prodicing: • Sertoli-Leydig cell tumour (Arrhenoblastoma). • Hilar cell tumour. • Lipoid cell tumour. Ovarian Cancer

  44. OVARIAN TUMOURS krukenberg tumour • There is one well-known secondary tumour of the ovary, the krukenberg tumour, a secondary of a stomach carcinoma. Ovarian Cancer

  45. OVARIAN TUMOURS --MUCINOUS CYSTADENOMA • Definition • 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. Ovarian Cancer

  46. OVARIAN TUMOURS --MUCINOUS CYSTADENOMA Ovarian Cancer

  47. OVARIAN TUMOURS --MUCINOUS CYSTADENOMA • signs and symptoms • The signs and symptoms are those generally associated with any non-functioning ovarian tumor. Rupture may occur and seeding of the epithelium on the peritoneal surface may cause pseudomyxoma peritonei. Ovarian Cancer

  48. OVARIAN TUMORS --MUCINOUS CYSTADENOCARCINOMA • Definition • This is only a third as common as the serous variety. Malignancy in a mucinous cyst is characterised by the formation of areas of solid carcinoma in the wall. The cells are columnar, show mitoses and tend to form glandular structures. Ovarian Cancer

  49. OVARIAN TUMORS --SEROUS CYSTADENOMA • Definition • 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. Ovarian Cancer

  50. OVARIAN TUMORS --SEROUS CYSTADENOMA Ovarian Cancer

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