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Ovarian Cancer

Ovarian Cancer. Dr . Saadeh Jaber OBGYN consultant 2010. Epidemiology. Second most common gynecological cancer . >35 , median 70 It accounts for deaths more than cancer of cervix and uterus together. Etiology. The ovulation theory Genetics others. Risk factors and Prevention.

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Ovarian Cancer

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  1. Ovarian Cancer Dr . Saadeh JaberOBGYN consultant 2010

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

  3. Etiology • The ovulation theory • Genetics • others

  4. 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

  5. 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

  6. Classification • Primary vs Secondary • Histological type

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

  8. Histological origin

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

  10. Serous Mucinous Endometroid Clear cell Brenner

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

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

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

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

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

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

  17. Diagnosis – Markers

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

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

  20. 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.

  21. Incidence Mortality

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