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Dr . Saadeh Jaber OBGYN consultant 2010
Ovarian Cancer Dr . Saadeh Jaber OBGYN consultant 2010
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Epidemiology Second most common gynecological cancer .
>35 , median 70 It accounts for deaths more than cancer of cervix and uterus together
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Etiology The ovulation theory Genetics others
These two associations support the ‘incessant ovulation’ theory of ovarian cancer. Each month a woman’s ovary releases an egg (ovulation). Release of the egg disrupts the outer lining of the ovary (epithelium) which the body repairs. The ‘incessant ovulation’ theory postulates that the greater the number of times a women ovulates (produces eggs) in her lifetime, the greater the risk of developing ovarian cancer as during the repair of the epithelium the cells become abnormal and develop into cancer cells. Alcohol and milk
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Risk factors and Prevention
Number of life time ovulations age > 35 Infertility Nulliparity Late menopasue Family history BRCA 1 +2 Prevention Use of OCP Breastfeeding Multiparity Tubal sterilization
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Genetics Familial Ovarian cancer
5-10% of epithelial cancers (usually serous adencarcinoma) 1 relative % 2 relatives % Most have breast and colorectal cancer BRCA 1 & BRCA 2 HNPCC 5-10% are associated with genetically predisposed syndromes
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Classification Primary vs Secondary Histological type
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Primary Vs Secondary Secondary : 7%
Common primary cancers are breast cancer and gastrointestinal cancer “Krukenberg tumour”
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Histological origin
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Epithelial Serous Mucinous Endometroid Sex cord stromal Granulosa Sertoli-Leydig cell Germ cell Dysgerminoma Endodermal sinus Immature teratoma Choriocarcinoma Epithelial
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Epithelial Cell tumor 85 % of malignant tumors 60-70 yrs
Worst prognosis CEA , CA-125 Arise from the surface epithelium
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Serous Mucinous Clear cell Brenner Endometroid Epithelial Serous
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Borderline epithelial tumors
10% of the epithelial cells Atypia, mitotic activity , but no invasion of the stroma Good prognosis Most are serous or mucinous
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Germ Cell tumor Second most common type of ovarian cancer 5-10%
20-40 yrs Better prognosis LDH, AFP,B-HCG Usually solid
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Sex Cord Tumors Least common ovarian neoplasm
5-8 % of ovarian cancers and 30 % of all tumors Low grade malignancy Hormonally active Arise from the sex cords of the embyonic gonads before they differentiate into male or female
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Clinical findings Usually absent or nonspecific GI symptoms
Urinary symptoms Postmenopausal bleeding Virilization Acute abdomen 2\3 in stage 3 GI: abdominal pain anddiscomfort are most common presenting coplaint . NV , distention, early satiety,bowel habit changes – speard in the peritoneal cavity Estrogen – unopposed hyperplasia
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Diagnosis – Investigations
U\S Tumor markers Bariun enema IVP Chest X-ray, abdominal X-ray CT/PET
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U/S Solid and cystic, septation, irregularly shaped
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Diagnosis – Markers Ovarian Tumor Serum marker Dysgerminoma LDH
Endodermal sinus AFP Choriocarcinoma B-HCG Granulosa tumor Inhibin Sertoli-leydig cell Testosterone
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Metastasis Mainly through the peritoneal fluid Lymphatic spread
Least common hematogeneous
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Management Surgery: TAH/BSO Pelvic and aortic lymph node dissection
Omentectomy Appendectomy Washings Biopsies
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Prognosis The five-year survival rate for all stages of ovarian cancer is 45.5%. Germ cell tumors of the ovary have a much better prognosis than other ovarian cancers, in part because they tend to grow rapidly to a very large size, hence they are detected sooner.
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Incidence Mortality
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