2. 15-20% of all genital
malignancies
20% ovarian tumours are
malignant
5th most common cause of
cancer deaths
1 Ca Breast
2.Ca cervix
3.Ca lung
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
syndrome
• .Post menopausal palpable ovaryvol.8cm3
• Obesity

10. Primary 80%
Epithelial (80-90%)
1. Serous
2. Mucinous
3. Endometroid
4. Brenner
5. Undifferenciated
Secondary
20%
Krukenberg tumour
Non-epithelial
Germ cell tumours
Sex chord stromal tumours

11. • 1. Benign
• 2. Borderline
• 3. Malignant

12. Classification Of Ovarian tumours
Sister Meera Began Experiencing Cancer. Doctor Examined The Cancer. She
Felt Good.
Epithelial Tumours
Serous
Mucionous
Brenner
Endometriod
Clear cell
Sex chord stromal tumours
Sertoli Leydig cell
Fibroma
Granulosa Theca cell
Germ Cell tumours
Dysgerminoma
Endometrial sinus tu.
Teratoma
Chorio-carcinoma

13. Types Of Ovarian Carcinoma

15. • 90% of all primary ovarian carcinomas
• any age but 60%-Post-menopausal,
• 20% Pre-menopausal
• Majority are not familial.
• Include both cystic, solid & mixed types
• Bilateral in 50% of cases

17. Mucinous Cyst adenocarcinoma

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
early stage.
• It is difficult to distinguish the symptoms and make decisive
diagnosis of Ovarian cancer.

23. Malignant Ovarian tumour

25. Bloating of abdomen

26. Ascites
1. Increased transudate
2. Obstruction of peritoneal fluid
outflow from diaphragm.
Right sided Pleural
effusion
More fluid in right sub-
diaphargmatic space
Left supra-clavicular
lymph node
enlarged
Lymph nodes
1. Para-aortic
2. Superior gastric
3. Supra-clavicular

27. Signs
• 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
pancreatic cancers

31. Physical Examination
• A pelvic or pelvic-abdominal mass is palpable in most patients with
ovarian cancer.
• In general, malignant tumors tend to be solid, nodular, and fixed,
• To aid surgical planning, a rectovaginal examination also should be
performed.
Mass
Feel-solid/ hetrogenous
Mobility –restricted
Tenderness-usually present
Surface-irregular
Margins-well defined
lower border-not reachable
Percussion-dull note

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

33. Omental caking

34. • To confirm malignancy pre-operatively
• To identify the extent of disease
• To detect primary site

37. Ultra-sonography/TVS
• 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.

38. Radiography
• Every patient with suspected ovarian cancer should have a chest
radiograph to detect pulmonary effusions or infrequently, pulmonary
metastases.
• 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
CT-Scan
• 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
PET-Scan
Differenciates normal from cancerous tissue.
More sensitive than CT_Scan or MRI
Helps identify recurrance

41. Paracentesis
• 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.

43. Abdominal Paracentesis

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/+
peritoneal washings

57. Stage II-Ovarian carcinoma
• II A
• Extension and/or metastases to the uterus and/or tubes
• IIB
• 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
nodes

66. Stage IV-Ovarian carcinoma
• Stage IV
• Distant metastasis including Pleural effusion or parenchymal liver
metastasis

68. Stage of disease
Histology of tumour
Age of patient
General condition

70. Staging Laprotomy
• Aim
• To stage the disease & resect as much tumour as possible.
Steps
1. General anaesthesia
2. Liberal Vertical incision
3. Aspirate ascitic
fluid/Peritoneal washings
4. Exam ovaries & pelvis
5.Systematic exploration of
all organs
6.Multiple biopsies
7.TAH with B/L S O
8.Infra colic omentectomy
9.Pelvic & para-aortic
lymphadenectomy

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
patients
• Adjuvant Chemotherapy: In general, patients with stage IA or IB,
tumors should be treated with three to six cycles of platinum
based-combinations

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

94. Tumour Markers
LDH
hCG
Alpha-fetoproteins
Young patient
Staging laprotomy+Unilateral salpingo-
oophorectomy+
Biopsy of other ovary +
(Chaemotherapy/radiotherapy)
BEP
Bleomycin+Etoposide+Cisplatin
VBP
Vinblastin+bleomycin+cisplatin

96. Sex chord stromal carcinoma
• Granulosa cell tumour
• Thecoma
• Fibroma
• Sertoli-Leydig cell tumour
• Gynadroblastoma
• Unclassified

97. Most common
Ostrogen
producing
Any age 10% pre-
pubertal
Coffee bean
nuclei
Unilateral salpingo-
oophorecctomy+chaemoth
arapy

104. Common Primary sites
Stomach, colon, Gall bladder, Pancreas,
Breast

107. Signet Ring appearance
Prognosis
Poor