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oviducts
General introduction
The fifth most
common cancer in
women
1/70 of newborn
girls will develop
ovarian cancer.
Etiology
Unknown
Repeated ovulation
Infertility treatment
Polycystic ovarian syndrome ( PCOS )
Chromosomal abnormal: Turner’s
syndrome ( 45,XO )
Hereditary : ( BOC –breast and ovarian
cancer syndrome )
P53 gene
Histopathology
Epithelial neoplasms
Germ cell neoplasms
Sex cord-stromal tumors of the ovary
Neoplasms metastatic to the ovary
Epithelial neoplasms (over
60% of all; over 90% of
malignant)
Serous neoplasms: ovarian serous
cystadenocarcinoma – common one,
bilateral in 50%,
Mucinous neoplasms:
Endometrioid neoplasms: bilateral in
40%.
Clear cell carcinoma: hypercalcemia,
hyperpyrexia, cystic and solid, clear
cell and hobnail cell.
Germ cell neoplasms
( 20-30+years, better
prognosis )
Dysgerminoma : unilateral in 90%,
solid, malignant
Endodermal sinus tumor: ( yolk sac
tumor ), acute abdomen alpha-
fetoprotein (AFP),malignant
Immature teratomas: malignant, AFP
Mature teratomas: 2% malignant in
40years.
Embryomal carcimoma: malignant,
hCG/AFP
Sex cord-stromal tumors of
the ovary
Granulosa cell tumors: malignant,
hyperestrogenism, precocious
puberty,
Ovarian thecoma: benign
Ovarian fibroma: Merg’s syndrome –
the occurrence of an ovarian
fibroma, ascites, and pleural effusion,
which collectively mimic the
presentation of ovarian cancer.
Sertoli-stromal cell tumors:
Neoplasms metastatic to
the ovary
25% of all malignant.
Bilateral
From: breast, stomach, colon,
endometrium
Krukenberg tumors: (from stomach)
Diagnosis
Gastrointestinal complaints: nausea,
dyspepsia
Distention: ascites, constipation
Pain, urinary retention, rectal
discomfort, obstruction
Menstrual abnormal
Examination \ ultrasound\ CA125.
Staging
Stage I: limited to the ovaries. a– one
ovary; b– both; c-- rupture, ascites(+),
peritoneal cytology (+)
Stage II: extension to pelvic. a– uterus or
tube; b– others; c– a or b rupture,
ascites(+), peritoneal cytology (+)
Stage III: abdominal cavity. a– microscopic
metastases; b-- <2cm; c-- >2cm, inguinal
lymph node(+), liver surface.
Stage IV: distant.
Surgical treatment of
epithelial ovarian cancer
Surgery is cornerstone, over 70% of
patients have metastases beyond the
pelvis.
Fluid or peritoneal washings should
be obtained.
Bilateral adnexectomy;
hysterectomy; infracolic
omentectomy ( omentum );
cytoreductive surgery.
Surgical treatment of germ
cell neoplasms
Young patients: removal of the
involved adnexa
Contralateral ovary biopsy is not
recommended.
Chemotherapy of
epithelial
Stage Ia and grade I no need
chemotherapy.
Others –undergo systemic
chemotherapy
Cisplatin, carboplatin,
cyclophosphamide, paclitaxel
Paclitaxel 175mg/m2+ cisplatin
75mg/m2or carboplatin – prefer. 6
cycles at 3-week intervals.
Chemotherapy of germ
cell
Dysgerminoma – radiation-sensitive.
Curable
Complications of
chemotherapy
Cisplatin : nephrotoxicity, neurotoxicity,
ototoxicity
Carboplatin: thrombocytopenia, neutropenia
Cyclophosphamide: hemorrhagic cystitis,
pulmonary fibrosis
Paclitaxel: myelosuppression
Altretamine: peripheral neuropathy
Etoposide: myelosuppression
Bleomycin: pulmonary fibrosis
Doxorubicin: cardiac toxicity
Vincristine: neuropathy
Ifosfamide: hemorrhagic cystitis, central
neurotoxicity
Radiation therapy
Dysgerminoma
Prognosis
5-yrs survival epithelial stage I 76-
93%
Stage II 60-74%
Stage III 23-41%
Stage IV 11%
Dysgerminoma 95%
Immature teratoma 70-80%
Endodermal sinus 60-70%
Malignant neoplasms of the
fallopian tube
Etiology : 0.3%
Clinical presentation: sixth decade,
Latzko’s sign – watery vaginal
discharge and palpable adnexal
mass.
Histopathology: papillary carcinoma
(95%), bilateral in45%, fusiform or
sausage-shaped
Treatment: same with epithelial.
Prognosis: 5-yrs survival 50%.