Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Ovarian cancer
1. ovarian cancer Presented BY :
Mohammed Jamal
Guided By :
Dr. Eva Torosyan
Haybusak university- Yerevan
2. CONTENTS
DEFINITIONS
Anatomy and physiology
Screening Test
Epidemiology
Symptoms
Risk factors
Protective Factors
Types of ovarian cancer
Classification of Ovarian Cancer
Tumor Markers
Classic Histology Types of Ovarian Cancer
Diagnosis
Treatment
3. Definition
A pelvic mass identified after menopause
Note : Ovaries in the postmenopausal age
group should be atrophic(shrinkage); anytime they are enlarged, the
suspicion of ovarian cancer arises.
4. Anatomy and physiology
Female organs (glands producing sex hormones and the ova )
Size :one ovary is long , 2 cm wide and 1 cm thick
Shape: almond shape
Location: on each side of the uterus in pelvice
5.
6. Screening Test
There is no current screening test for ovarian cancer. Pelvic ultrasound is
excellent for finding pelvic masses, but is not specific for identifying which
are benign and which are malignant.
Only 3% of patients undergoing laparotomy for sonographically
detected pelvic masses actually have ovarian cancer.
7. Epidemiology :
Ovarian carcinoma is the second most common gynecologic malignancy,
with a mean age at diagnosis of 69 years.
One percent of women die of ovarian cancer
It is the most common gynecologic cancer leading to death
The most compelling theory of epithelial ovarian carcinogenesis suggests
that serous, endometrioid, and clear cell carcinomas are derived from the
fallopian tube and endometrium, and not directly from the ovary.
8. Which cancers has higher risk mortality in gynecology ?
Answer :
1-ovaroan cancer Most common
2-endometrium cancer
3-cervical cancer
Which cancer has high risk of incidence in gynecology ?
1-Endometrium cancer most common
2-ovarian cancer
3- cervical cancer
9. Symptoms
Early symptoms of ovarian caner :
Pain in pelvic
Pain on the lower side of the body
Back pain
Indigestion or heart burn
More frequent and urgent urination
Pain during sexual intercourse
As ovarian cancer progresses these symptoms are also possible :
Nausea , weight loss , breathlessness , fatigue (tiredness) loss of appetite
10. Risk factors :
BRCA1 gene
positive family history
high number of lifetime
Ovulations
Infertility
perineal talc powder
11.
12. Protective Factors
These are conditions that decrease the total number of lifetime
ovulations: oral contraceptive pills, chronic anovulation, breast-feeding,
and short reproductive life.
Removal or occlusion of the fallopian tubes: bilateral salpingectomy or
tubal ligation
Decreased lifetime ovulations: combination steroid contraception, chronic
anovulation, breast feeding and short reproductive life
14. Types of ovarian cancer
The ovaries contain 3 main kinds of cells :
Epithelial , Germ cells , stromal cells , each of these cells can develop into
different type of tumors .
Subsequently there are 3 main types of ovarian tumors :
Epithelial tumors , Germ cell tumors , stromal tumors
15. Classification of Ovarian Cancer
Epithelial tumors—80%. The most common type of histologic ovarian
carcinoma
is epithelial cancer, which predominantly occurs in postmenopausal
women. These include serous, mucinous, Brenner, endometrioid, and clear
cell tumors. The most common malignant epithelial cell type is serous
17. Germ cell tumors—15%. Another histologic type of ovarian cancer is the
germ cell tumor, which predominantly occurs in teenagers. Examples are
dysgerminoma, endodermal sinus tumors, teratomas, and
choriocarcinoma. The most common malignant germ cell type is
dysgerminoma.
18. Stromal tumors—5%. The third type of ovarian tumor is the stromal
tumor, which is functionally active. These include granulosa-theca cell
tumors, which secrete estrogen and can cause bleeding from endometrial
hyperplasia and Sertoli-Leydig cell tumors, which secrete testosterone
can produce masculinization syndromes.
Patients with stromal tumors usually present with early stage disease and
are treated either with removal of the involved adnexa(removal of the
ovaries and fallopian tubes ) , metastasize infrequently , chemotherapy
(vincristine, actinomycin, and Cytoxan).
19. Metastatic tumor. These are cancers from a primary site other than the
ovary. The most common sources are the endometrium, GI tract, and
breast. Krukenberg tumors are mucin-producing tumors from the
stomach or breast metastatic to the ovary.
20. Tumor Markers
• CA-125 (cancer antigen 125) and CEA (carcinoembryonic antigen) should
also be
drawn for the possibility of ovarian epithelial cancer.
• LDH, hCG, and α-fetoprotein should be drawn for the possibility of germ
cell tumors.
• Estrogen and testosterone should be drawn for the possibility of stromal
tumors.
21. Classic Histology Types of Ovarian
Cancer
Type Percentage Age Group Tumors marker and
tests that should be
done
Epithelial 80% Older CA-125 , CEA
Germ cell 15% Young LDH , HCG , α-
fetoprotein
Stromal 5% All Estrogen ,
Testosterone
25. TREATMENT
A surgical exploration(LAPARATOMY) should follow preoperative studies and
medical evaluation.
If abdominal or pelvic CT scan shows no evidence of ascites or spread to the
abdominal cavity, and if the surgeon is an experienced laparoscopist, then the
evaluation could be performed laparoscopically.
Benign Histology. If the patient is not a good surgical candidate or the
patient desires to maintain her uterus and contralateral ovary, a USO is
sufficient treatment , then a TAH and BSO maybe performed
Malignant Histology. In this case, a debulking procedure (cytoreduction)
should be performed. This procedure consists of a TAH and BSO,
omentectomy, and bowel resection, if necessary. Postoperative chemotherapy
(carboplatin and Taxol) should be administered.
26. Follow-Up. If the final pathology report of the enlarged adnexa was
benign, If the pathology report was carcinoma, then she would be
up every 3 months for the first 2 years and then every 6 months for the
next 2 years with follow-up of the CA-125 tumor marker.
Borderline Cancers. Another entity of ovarian cancer is the borderline
tumors also known as tumors of low malignant potential. These are
characterized by no invasion of the basement membrane and can also be
treated conservatively.
27. • Conservative surgery. A patient who desires further fertility with a
unilateral borderline cancer of the ovary can be treated with a USO with
preservation of the uterus and the opposite adnexa.
• Aggressive surgery. If the patient has completed her family then the
most acceptable treatment would be a TAH and BSO.
• Chemotherapy. Patients with borderline cancer of the ovary do not
require chemotherapy unless they have metastasis, and this is a rare
occurrence.
