1. Dr. Saadeh Jaber OBGYN consultant 2010

2. Epidemiology Second most common gynecological cancer. >35, median 70 It accounts for deaths more than cancer of cervix and uterus together

4. Etiology The ovulation theory Genetics others

5. Risk factors and Prevention Risk factors Number of life time ovulations age > 35 Infertility Nulliparity Late menopasue Family history BRCA 1 +2 Prevention Use of OCP Breastfeeding Multiparity Tubal sterilization

6. Genetics Familial Ovarian cancer 5-10% of epithelial cancers (usually serous adencarcinoma) 1 relative ---- 2.5% 2 relatives 30-40 % Most have breast and colorectal cancer BRCA 1 & BRCA 2 HNPCC

7. Primary vs Secondary Histological type Classification

8. Primary Vs Secondary Secondary : 7% Common primary cancers are breast cancer and gastrointestinal cancer “Krukenberg tumour”

9. Histological origin

10. Epithelial Serous Mucinous Endometroid Sex cord stromal Granulosa Sertoli- Leydig cell Germ cell DysgerminomaEndodermal sinus Immature teratoma Choriocarcinoma Epithelial

11. Epithelial Cell tumor 85 % of malignant tumors 60-70 yrs Worst prognosis CEA, CA-125

12. Epithelial SerousMucinousEndometroidBrenner Clear cell Endometroid Mucinous Serous

13. Borderline epithelial tumors 10% of the epithelial cells Atypia, mitotic activity, but no invasion of the stroma Good prognosis Most are serous or mucinous

14. Germ Cell tumor Second most common type of ovarian cancer 5-10% 20-40 yrs Better prognosis LDH, AFP,B-HCG

15. Sex Cord Tumors Least common ovarian neoplasm 5-8 % of ovarian cancers and 30 % of all tumors Low grade malignancy Hormonally active

16. Clinical findings Usually absent or nonspecific GI symptoms Urinary symptoms Postmenopausal bleeding Virilization Acute abdomen

17. Diagnosis – Investigations U\S Tumor markers Bariun enema IVP Chest X-ray, abdominal X-ray CT/PET

18. U/S Solid and cystic, septation, irregularly shaped

19. Diagnosis – Markers Ovarian TumorSerum marker DysgerminomaLDH Endodermal sinusAFP ChoriocarcinomaB-HCG Granulosa tumorInhibin Sertoli-leydig cellTestosterone

20. Metastasis Mainly through the peritoneal fluid Lymphatic spread Least common hematogeneous

21. Management Surgery: TAH/BSO Pelvic and aortic lymph node dissection Omentectomy Appendectomy Washings Biopsies

22. 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.

23. IncidenceMortality