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Ovarian Cancer
Ovarian cancer: Primary ovarian cancer
Secondary ovarian cancer or Krukenburg’s tumor
Primary ovarian cancer:
a- These arise intraovarian form serous or mucinous cysts in 80%
b- Are bilateral
c- Maybe papilliferous or mucinous
d- The solid cancer maybe small to huge size, smooth or nodular surface
e- Cut section shows consolidated appearance with grayish necrosis
Stage grouping for primary ovarian cancer as per FIGO cancer committee 1985:
Stages: I
I Growth limited to ovaries
IA Growth limited to one ovary, no ascitis. No tumor on the external surfaces. Capsule is intact.
IB Growth limited to both ovaries; no ascitis. No tumors on external surface, capsule is intact
IC Tumor on surface of one or both ovaries or with capsule ruptured or ascitis present.
Stage: II
II Growth involving in one or both ovaries with pelvis extension.
IIa Extension and / metastasis to the uterus and tubes
IIb Extension to other pelvis tissues
IIc Tumor on surface of both or one ovary or with capsule ruptured or with ascitis present, containing malignant cells
Stage: III
tumor involving one or both ovaries with peritoneal implants outside pelvis, involving lymph nodes, ascitis present.
Stage IV:
Growth involving one or both ovaries with distal metastasis (liver, abdominal carcinomaous, bladder, bones and lung)
Spread:
1- Direct spread: to adjacent structures – peritoneum, uterus, omentum and ovary.
2- Lymphatic spread: To other ovary (>50%) uterus, tubes and lymph nodes
3- Blood spread: To liver, lungs and bones
Clinical symptoms:
1- Predisposing factors: Family, history, infertility, endometritis, early menopause, blood group A, high social status
2- Age: it may occur at 40 – 70 years
3- In early stages it is asymptomatic
When symptoms are there:
a- Abdominal swelling (70%) - due to ascitis
b- Pain (due to spread of carcinoma to liver, peritoneum, etc)
c- Rapid enlargement of abdomen
d- Dysplasia
e- Progressive loss of weight
f- Unilateral oedema of legs – rare
g- Abnormal uterine bleeding
h- Symptoms of bowel obstruction (due to Ascitis compressing diaphragm, n. diaphragmaticus, bowel)
Investigations:
1- Per vaginal and per rectum (metastasis in Douglas pouch can be seen –very hard tumor)
2- Cytology of aspirated ascitis fluid
3- US, CT scan, skigram of chest, pelvis.
4- Leparascopy, biopsy
5- FGS and colonoscopy, proctoscopy
Management:
1- Prophylaxis Removal of all benign neoplastic tumor of ovary is important
2- Primary ovarian cancer is treated as follows:
a- Surgery, operable case- Stage I and II- Total Hysterectomy with adnexis and removal of omentum.
b- Inoperable cases (60%) stage III- the growth should be removed as much as possible
c- Chemotherapy:
- · Single alkylating agent – Endoxan 500-1000mg IV weekly in a month. Alternatively oral Melphalen (Alkeran) 10mg/day is given 5 days every 4 weeks, 12 months.
- · Recently multiple agent therapy – Cisplatinum (50 mg/kg/day) Oral Hexamethylmelamine (150mg/day 1-7days), IV Adriamycine (30 mg/kg/ day 1) and Endoxan (cyclophosphamide500 mg/kg/ day1) is given every 4 weeks for 1 year The therapy shows initial response at 90% level with fouling survival rate to 30% in 4 -5 years.
e- Radiotherapy; is given as soon as possible after operation, but epithelial ovarian cancer don’t respond well to radiotherapy.
dr.rufusrajadurai |
Latest page update: made by dr.rufusrajadurai
, Oct 31 2008, 2:25 PM EDT
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