The ovaries are part of a woman's reproductive system. They are in the pelvis. Each ovary is about the size of an almond.

The ovaries make the female hormones -- estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus).

A malignant tumor that most commonly

arises from the surface epithelium of the

ovaries

REPRODUCTIVE FACTORS

▪ Nulliparity ▪ Early menarche ▪ Late age at menopause ▪ Endometrosis ▪ Subfertility and its T/M

GENETIC FACTORS

▪ Familial ovarian cancer syndrome ▪ Lynch syndrome [HNPCC] ▪ Hereditary breast ovarian cancer

OTHERS

▪ Post menopausal use of estrogen replacement therapy

▪ Talc user

▪ Obesity

▪ Asbestos worker

Diet: a high-fat diet may play a role in the aetiology of ovarian cancer.

Oral contraceptives appear to reduce the risk of ovarian cancer for up to 10 years following cessation of use. This protective effect appears to apply to patients with BRCA mutations as well.

Patients who have used fertility drugs

should be counseled as to their possible increase in risk of ovarian cancer.

EPITHELIAL TUMORS (Benign, Borderline, Malignant) ▪Serous tumor▪Mucinous tumor ▪Endometroid tumor▪Clear cell tumor▪Brenner tumors▪Undifferentiated carcinomas

SEX CORD STROMAL TUMOR

▪Granulosa stromal cell tumor ▪Sertoli-Leydig cell tumor▪Gynandroblastoma

CLASSIFICATION

GERM CELL TUMOR▪Dysgerminoma▪Yolk sac tumor▪Embryonal cell tumor▪Choriocarcinoma▪Teratoma▪Mixed tumors

METASTATIC TUMORS

Abdominal bloating, increased girth, pressure Unusual fatigue Tiredness GI disturbances such as nausea, indigestion, gas, constipation or diarrhea Urinary frequency or incontinence Unexplained weight loss or gain Shortness of breath DVT Hormone producing tumors Consider ovarian cancer when one or more of

these symptoms is present for a month or more.

Blood CP Electrolytes LFTS, CT-Scan MRI FNA CA-125 levels Trans vaginal U/S Laparoscopy radiology

Stage I : Growth limited to

ovaries Ia: growth limited 2

one ovary No ascites No tumor on

ext.surface Capsule intact

Ib : growth limited 2 both ovaries

No ascites No tumor on

ext.surface Capsule intact Ic : stage Ia , Ib On ext.surface Ruptured capsule Ascites +ive

Ovarian Cancer Staging

www.freelivedoctor.com

Stage II : Growth involving ovaries with pelvic

extension IIa : extension 2 uterus / tubes IIb : to other pelvic organs IIc : either IIa or IIb On ext.surface Capsule ruptuered Ascites +ive

Ovarian Cancer Staging

www.freelivedoctor.com

Stage III : Involving ovaries, peritoneal implants

outside the pelvis ,+ive retropertioneal or inguinal nodes

IIIa : limited 2 true pelvis with –ive nodes ,microscopic seeding on abd.peritoneal surfaces

IIIb : tumor with implant on abd.peritoneal surface <2cm

IIIc : abd.implant >2cm, +ive inguinal nodes Superficial liver metastases equal 2 stage III

Ovarian Cancer Staging

www.freelivedoctor.com

Ovarian Cancer Staging

www.freelivedoctor.com

Stage IV : Involving both ovaries with distant

metastases +ive pleural effusion Parenchymal liver metastasis

Ovarian cysts < 6 cms usually regress by absorption or spontaneous rupture and the patient may be managed conservatively over 2 menstrual cycles with monthly rectovaginal examination.

If regression fails to occur, assessment is indicated

Diagnostic tests include laboratory blood studies and pelvic examination. Usually, ultrasound studies with and without blood flow measurements to the involved ovary are used for diagnosis and to help determine the best therapy.

Some tumors require surgery to diagnose accurately, ruling out malignancy, or to treat. If one ovary must be removed, normal conception and childbirth is possible as long as a normal ovary remains on the other side.

The treatment of ovarian cancers based on the stage of the disease which is a reflection of the extent or spread of the cancer to other parts of the body.

It also depends on histologic cell type, and the patient's age and overall condition.

There are basically three forms of treatment of ovarian cancer:surgery Chemotherapy radiation treatment,

Standard treatment is surgery (staging and optimal debulking) followed by adjuvant chemotherapy in most cases. Even if optimal surgery is not possible, removing as much tumor as possible will provide significant palliation of symptoms.

Borderline lesions may be treated with conservative surgery

Germ cell tumors are treated with surgery and multi-agent chemotherapy in most cases

Advanced epithelial ovarian cancer is very sensitive to chemotherapy with responses in the range of 70-80% to first-line chemotherapy. The majority, however, relapse and ultimately die of chemotherapy-resistant disease. Second-line chemotherapy to date is disappointing in all forms of epithelial ovarian cancer with virtually no chance of successful second-line treatment following failure of initial regime.

Ovarian Cancer Surgery Vertical incision Multiple cytologic washings Intact tumor removal Total abdominal hysterectomy &

removal of both fallopian tubes & ovaries

Omentectomy Lymph node sampling Biopsy adhesions and suspicious

areas

Optimal cytoreduction – “tumor debulking”

Resection of as much tumor as possible this makes chemotherapy and radiotherapy more effective

Theoretical and clinical benefits of cytoreduction have been demonstrated.

30% of “early disease” cases in fact have metastases

Ovarian Cancer Treatment Cisplatin Carboplatin Paclitaxel Etoposide Ifosfamide Adriamycin Doxil Hexamethylmelamine Vinorelbine Topetecan Docetaxel Gemcitabine Oxaliplatin Tamoxifen Megace Femara

REGIMEN DOSE

CP CISPLATIN PACLITAXEL

75 mg/sq.m135-175mg/sq.m

CT CARBOPLATINPACITAXEL

AUC=5135-175mg/ sq.m

DC CISPLATINCYCLOPHOSPHAMIDE

75mg/ sq.m750mg/ sq.m

CAP CYCLOPHOSPHAMIDEDOXORUBICINCISPLATIN

600mg/sq.m50mg/sq.m75mg/sq.m

BEP BLEOMYCINETOPOSIDECISPLATIN

10mg/sq.m x 3 days20mg/sq.m x 5days100mg/sq.m

Overall 5-year survival in ovarian epithelial carcinoma is low because of the preponderance of late-stage disease at diagnosis. Stage I and II: 80-100% Stage III: 15-20% Stage IV: 5%

Patients under 50 in all stages have considerably better 5-year survival than older patients (40% compared to 15%)

Dysgerminomas treated by surgery and radiation have an excellent cure rate in both early and late-stage disease

Endodermal sinus tumour has poor prognosis.

Torsion Rupture of cyst Hemorrhage Degeneration Infection Intestinal obstruction Malignancy in benign tumor