2. 15-20% of all genital
20% ovarian tumours are
5th most common cause of
1 Ca Breast
4. Ca Colon
5. Ca Ovary
Any Cancerous growth of ovaries is known as Ovarian Carcinoma
1.Primary Ovarian tumour
2.Secondary Ovarian Tumour
4. Socio-Epidemiological Features
• Nulligravida & low parity
• Repeated ovulation trauma
• Excessive use of ovulation induction drugs
• Early menarche
• Late menopause
• White race
• Family history
• Use Of Talcom Powder & asbestos
• Use of coffee, tobacco, alcohol, dietary fat
5. • Age group 40-60 yrs
• Nulliparity and low parity
• Relative or absolute infertility
• Family history of Breast, colon, endometrial, ovarian Cancer
• Lynch II/ HNPCC (Hereditary non-polyposis colorectal cancer
• .Post menopausal palpable ovaryvol.8cm3
20. Clinical Presentation
• Ovarian cancer is called “Silent Killer”. When signs & symptoms
appear, it’s too late.
• Patients remain asymptomatic for several months, even with
• It is difficult to distinguish the symptoms and make decisive
diagnosis of Ovarian cancer.
1. Increased transudate
2. Obstruction of peritoneal fluid
outflow from diaphragm.
Right sided Pleural
More fluid in right sub-
2. Superior gastric
• The presence of a fluid wave or less commonly, flank bulging suggests
the presence of significant ascites.
• In a woman with a pelvic mass and ascites, the diagnosis is ovarian
cancer until proven otherwise.
• However, ascites without an identifiable pelvic mass suggests the
possibility of cirrhosis or other primary malignancies such as gastric or
31. Physical Examination
• A pelvic or pelvic-abdominal mass is palpable in most patients with
• In general, malignant tumors tend to be solid, nodular, and fixed,
• To aid surgical planning, a rectovaginal examination also should be
lower border-not reachable
32. Physical Examination
• In advanced disease, examination of the upper abdomen usually reveals
a central mass signifying omental caking.
• Auscultation of the chest is also important because patients with
malignant pleural effusions may not be overtly symptomatic. The
remainder of the examination should include palpation of the peripheral
nodes in addition to a general physical assessment
34. • To confirm malignancy pre-operatively
• To identify the extent of disease
• To detect primary site
• In general, malignant tumors are multi-loculated, solid or echogenic,
large (>5 cm), and have thick septa with areas of nodularity
• Other features may include papillary projections or neo-vascularization.
• Every patient with suspected ovarian cancer should have a chest
radiograph to detect pulmonary effusions or infrequently, pulmonary
• Rarely, a barium enema is helpful clinically in excluding diverticular
disease or colon cancer or in identifying involvement of the recto-
sigmoid by ovarian cancer.
39. Computed Tomography Scanning
• The main advantage of computed tomography (CT) scanning is in treatment planning
of women with advanced ovarian cancer.
• Preoperatively, it may detect disease in the liver, retroperitoneum, omentum, or
elsewhere in the abdomen and thereby guide surgical,
• However, CT scanning is not particularly reliable in detecting intra-peritoneal disease
smaller than 1 to 2 cm in diameter.
• Moreover, the accuracy of CT scanning is poor for differentiating a benign ovarian mass
from a malignant tumor when disease is limited to the pelvis. In these cases,
transvaginal sonography is superior.
Positron Emission Tomography
Differenciates normal from cancerous tissue.
More sensitive than CT_Scan or MRI
Helps identify recurrance
• A woman with a pelvic mass and ascites can be assumed to have ovarian cancer
until proven otherwise surgically.
• However, paracentesis may be indicated for patients with ascites and the
absence of a pelvic mass.
52. Staging ovarian cancers
Stages= Ovarian Carcinoma
Stage I A One ovary involved
Stage 1 B Both ovaries involved
Stage 1 C One or both ovaries + Surface of
ovary+ rupture of capsule+ Ascites/+
57. Stage II-Ovarian carcinoma
• II A
• Extension and/or metastases to the uterus and/or tubes
• Extension to other pelvic tissues
• II C
• Tumor limited to the genital tract or other pelvic tissues, but with disease on
the surface of one or both ovaries; or with capsule(s) ruptured; or with
malignant ascites or positive peritoneal washings
61. Stage III-Ovarian carcinoma
• III A
• The cancer is present in one or both of the ovaries, and cancer cells are also present in small
ranges in parts of the abdomen with this stage without nodular involvement.
• III B
• On this particular stage, the cancer is present in one or both of the ovaries, and cancer cells
are also present in amounts less than 2 cm or 3/4″ in parts of the abdomen
• III C
• Abdominal implants at least 2 cm in diameter and/or positive pelvic, para-aortic, or inguinal
70. Staging Laprotomy
• To stage the disease & resect as much tumour as possible.
1. General anaesthesia
2. Liberal Vertical incision
3. Aspirate ascitic
4. Exam ovaries & pelvis
5.Systematic exploration of
7.TAH with B/L S O
8.Infra colic omentectomy
9.Pelvic & para-aortic
71. Management of Early-Stage Ovarian Cancer
• When a malignancy appears clinically confined to the ovary, surgical
removal and comprehensive staging should be performed
• Fertility-Sparing Management :may be an option in selected
patients when disease appears confined to one ovary in younger
• Adjuvant Chemotherapy: In general, patients with stage IA or IB,
tumors should be treated with three to six cycles of platinum
92. • Average age=10-20yrs.
• Rx=Primary treatment- surgery
• Young patient-conservative surgery
• (unilateral oophorectomy)
• Adjuvant therapy with chemotherapy
• All Germ cell tumours-highly chemo sensitive
• Stage Ia Grade I—no need
• Other stages- Bleomycin+etoposide+cisplatin