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 Ovarian Cancer

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dr snow pink



المساهمات : 19
تاريخ التسجيل : 11/02/2008

مُساهمةموضوع: Ovarian Cancer   الخميس فبراير 14, 2008 8:16 pm

Ovarian Cancer


FEATURES:

  • Third most common site of malignancy in the reproductive tract but most common cause of death than all gyne Ca combined.
  • Fourth leading cause of cancer death in the female after Breast, Colorectal, and Lung




Incidence:

19/100,000 women diagnosed annually

ETIOLOGY: Cause unknown.

Predisposing factors:

3-5 times more common in the industrialised nations---Japan excluded.

Whites and black similar

Mostly postmenopausal---Peak age 61 yrs

60%----45 – 65 years

20%---Below 45 years

20%---Above 65 years



Etiology:

Higher in Nulliparas

Lower in patients with repeated pregnancies, chr. Anovulation and breastfeeding.

O.C. pill users ---- Protected in later years.

Repeated ovulation – causally related to the dev of this disease.

Rep ov may provide ample opportunity for somatic gene deletions and mutations to occur which in turn can contribute to tumor initiation and progression.

Ovulation induction --- slight increase of the disease

Familial: 1-3%

Colon, breast, endometrial Ca maybe in the same patient. 90% inheritance due to a mutation in the BRAC 1 gene.

Foreign body involved? – Females in asbestos and Talc industries.



CLASSIFICATION:

FIGO System is HISTOLOGIC

90% ---- Epithelial in origin.

1. Serous cystadenocarcinoma --- (Commonest)

2. Mucinous cystadenocarcinoma

3.Endometriod Cancer.

4. Mesonephric or Clear cell cancer

5. Undifferentiated

6. Secondaries to the ovaries.




الرجوع الى أعلى الصفحة اذهب الى الأسفل
معاينة صفحة البيانات الشخصي للعضو
dr snow pink



المساهمات : 19
تاريخ التسجيل : 11/02/2008

مُساهمةموضوع: رد: Ovarian Cancer   الخميس فبراير 14, 2008 8:22 pm

Borderline Tumors (or Low Malignant Potential):

Tumors which are intermediate in both BEHAVIOUR and HISTOLOGIC features between benign and malignant tumors:-mitotic figures and nuclear abnorm


-no evidence of stromal invasion.

Extraovarian spread can occur – slow

Staging same as Ov Ca

Prognosis:

-Degree of differentiation of tumor

-Extent of spread



Serous Cystadenocarcinoma:

Commonest of the malignant primary ov tumors

May be predominantly cystic or solid uni or multilocul with coarse, irregular papillae

Bilateral in 40 -60% cases.

Worst prognosis



Mucinous Cystadenocarcinoma:

Second most common type of epithelial Ov. Ca

Bilateral in 10% cases.

Attain very large size, multiloculated cysts

May have benign, borderline and malignant HP in the same tumor

Pseudomyxoma peritonei may result



Endometrioid Cancer:

HP resembles endometrial adenoCa.

Bilateral in 30 – 50% cases

Rarely (<10% cases) arises in foci of endometriosis.

10-20 cm diameter, more solid tumor with cystic spaces containing dark hemorr fluid.

Associated with endometrial CA---30% pts

Best prognosis



Clear Cell Carcinoma:

Smaller in size than serous and mucinous tumors

Biologically aggressive –hypercal, hyperpyrexia

Cystic to solid

Commonly unilateral

Prognosis worse than endometriod Ov.Ca.



Undifferentiated Carcinoma:

Absence of any distinguishing microscopic features.

Solid tumors

Bilateral – 50%

Prognosis: Poor



METASTATIC Ca to the ovary:

· 25% of all Ov malignancies, bilateral usually, 25% unilateral

breast, stomach, colon, endometrium
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Admin
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المساهمات : 39
تاريخ التسجيل : 30/08/2007
العمر : 35
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مُساهمةموضوع: رد: Ovarian Cancer   الجمعة فبراير 15, 2008 4:31 pm

الف شكر يا دكتوره على المشاركه الجميله دي

ونورتي المنتدى بتاعك يا دكتوره
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dr snow pink



المساهمات : 19
تاريخ التسجيل : 11/02/2008

مُساهمةموضوع: رد: Ovarian Cancer   الأربعاء فبراير 20, 2008 11:22 pm

شكرا لمرورك يادكتور نورت الموضوع
الرجوع الى أعلى الصفحة اذهب الى الأسفل
معاينة صفحة البيانات الشخصي للعضو
dr snow pink



المساهمات : 19
تاريخ التسجيل : 11/02/2008

مُساهمةموضوع: رد: Ovarian Cancer   الأربعاء فبراير 20, 2008 11:27 pm

STAGING of Ovarian Carcinoma:

Stage 1: Growth limited to the Ovaries

1a ---- one ovary involved

1b ---- both ovaries involved

1c ---- 1a or 1b with ov surface tumor, ruptured capsule, peritoneal washings positive for malignant cells.

Stage II: Extension of the neoplasm from the ovary to the pelvis

IIa --- extension to the uterus or fallopian tubes -- serosa

IIb --- extension to other pelvic tissues

IIc --- IIa or IIb and tumor on surface capsule, ruptured capsule,

+ peritoneal cytology

Stage III: Disease extension to the abdominal cavity

IIIa ----- Abdominal peritoneal surfaces with microscopic metastases.

IIIb ---- tumor metastases < 2 cm in size

IIIc ---- tumor metastases > 2 cm in size or pelvic, para-aortic or inguinal lymph nodes involved

Stage IV: Distant metastatic disease.

-malignant pleural effusion

-pulmonary parenchymal metastases

-liver or splenic parenchymal metastases

-metastases to the supraclavicular lymph nodes or skin, bone etc



Metastases:

70% pts have metst outside the true pelvis at the time of daignosis.

Peritoneum—85%

Omentum and other ovary---70%

Liver—35%, pleura---33%, lung---25%

Uterus--- 20%, Vagina—15%, Bone—15%

Spleen, kidney, adrenal, skin: 5-10%

Vulva, Brain: 1%

80% ---- Para-aortic lymph nodes

50% ---- Mediastinal or supraclavicular L. nodes



CLINICAL PRESENTATION:

15% pts asyptomatic at the time of diagnosis.

EARLY: Few sympts, vague nonspecific digestive sympts.

LATE: Abd pain/distention, pressure sympts, pelvic discomfort, weight or pressure

Menstrual irregularity in 15% pts only.

ADVANCED disease: abd distention, pain, wt loss, cachexia, LL edema, varicosities, hemorrhoids.

TERMINAL: Pleural effusion, DVT, Intestinal obstruction

Bladder symptoms: frequency, urgency, or retention

Change in bowel habits

Signs: Solid, fixed, rapidly growing pelvi-abd mass, ascites, irregular masses in POD

Investigations:

CBC, Full Chemistry, Urine, Cx smear, Ca 125

Chest and Abd x-ray, IVP, Ba meal and series.

USG: pelvi-abdominal

CT scans and MRI

Liver, spleen, bone scans.

PARACENTESIS: not advocated routinely

Diagnostic thoracocentesis may be useful

Screening mammogram study



TREATMENT:

SURGICAL: Cornerstone of therapy

LAPAROTOMY----- vertical incisssion

Staging: determines prognosis and TT decisions

Explore: peritoneum, ovary, para-aortic and pelvic LN, omentum, liver mesentry, bowel

Peritoneal washings to be taken

Biopsy of para-aortic lymph nodes

Document findings thoroughly

HP type of tumor and Histology grade

Monitoring the course of the disease and Pt response:

Second look laparotomy: second cyto reductive surgery

Follow up: Examinations of the pt, tumor markers, scans etc



Surgery:

Stage I and II: TAH and BSO and infracolic omentectomy

Later Stages: Debulking of the tumor mass



Chemotherapy:

Stage I: grade 1a & b and 2 tumors---no need for chemotherapy----low risk of recurrence, does not improve 5-yr survival rate of 90%

INDICATIONS:

ALL OTHER STAGES: postop chemo given

If tumor is Stage I adherent/ ruptured/ grade III or clear cell cancer post operative chemo to be started after wound has healed—6 cycles at 3-week intervals.

Stages 2,3 : Debulk and 6 courses of systemic combination chemo.

Stage 4: Chemotherapy and later debulk

Alkylating agents + cis platinum or carboplatin, vincristin, hexamethylmelamine, adriamycin, paclitaxel ----------- multiagents used.



Radiation therapy:

Currently very limited role in this disease.

Radioisotopes e.g. Intraperitoneal P32 may benefit in Stg Ic and those with microscopic positive second look ops







ALTERNATIVE THERAPIES:

-Immunotherapeutic approaches: (still experimental)

systemic or intraperitoneal administration of recombinant cytokines-----30% response rates in otherwise chemo-resistant pts.

-Several gene therapeutic approaches developed.



Prognosis:

Overall 5-yr survival rate: 35-38%

Low malignant potential: 95%

Stg I: 90% -- lesion was intracystic

56% -- cyst ruptured

51% -- if cyst was adherent

Stg II: 60 – 74%

Stg III: 25 - 41%

Stg: IV: 4.2 - 11%





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Ovarian Cancer
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