Ovarian cancer by dr.saleh bakar
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very informative lecture by Dr.Saleh Bakar, Taishan Medical University, Taian, Shandong, China
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Ovarian cancer by dr.saleh bakar
- 1. Ovarian Cancer Dr.Saleh Bakar Taishan Medical University, Taian, Shandong, China
- 2. 2 Ovarian Cancer General Introduction Ovarian tumors are commonest between 30 and 60. They are particularly liable to be or to become malignant. In their early stages, they are asymptomatic and painless. They may grow to a large size. 1.4% lifetime risk of ovarian cancer
- 3. 3 Ovarian Cancer Risk Factors Family history Ovarian cancer Breast cancer Colon cancer Genetic factors Older age Caucasian More menstrual circles during lifetime (Ovulation induction)
- 4. 4 Ovarian Cancer Incidence Nearly 25% of all ovarian neoplasm are malignant. Approximately 80 ％ of them are primary growths of the ovary. The remainder being secondary ， usually carcinomata.
- 5. 5 Ovarian Cancer by dr Saleh Bakar symptoms Lack of any specific symptoms, ovarian tumors are often large by the time the doctor is consulted. Menstrual function is seldom upset, and any irregularity is attributed to the patient’s ‘time of life’.
- 6. 6 2006-11-1 七年制 Ovarian Cancer symptoms Increased abdominal size
- 7. 7 Ovarian Cancer symptoms Pressure symptoms Gastro-intestinal symptoms (Bloating) Urge to urinate pelvic pain (a dull pain in the lower abdomen) Very large tumors may cause respiratory embarrassment and edema or varicosities in the legs, and a characteristic ‘ ovarian cachexia’ develops.
- 8. 8 Ovarian Cancer CLINICAL FEATURES OF OVARIAN TUMOURS
- 9. 9 Ovarian Cancer CLINICAL FEATURES OF OVARIAN TUMOURS
- 10. 10 Ovarian Cancer CLINICAL FEATURES OF OVARIAN TUMOURS
- 11. 11 Ovarian Cancer General Rule An experienced examiner will recognize an ovarian tumor mainly because ovarian tumor is, in the circumstances, the most likely diagnosis. All abdominal swellings should be subjected to ultrasound and X-ray examination. DIFFERENTIAL DIAGNOSIS
- 13. 13 Ovarian Cancer ASCITES A fluid thrill may be elicited from an ovarian cyst, and ascites and tumor may coexist; but as a rule the distinction should be easily made. DIFFERENTIAL DIAGNOSIS
- 14. 14 Ovarian Cancer Uterine Fibroids A large midline intramural fibroid may be impossible to distinguish from a solid ovarian tumor until the abdomen is opened and an entirely different surgical problem encountered. DIFFERENTIAL DIAGNOSIS
- 18. 18 Ovarian Cancer Histological Classification Most tumors arise from the ovarian stroma and germinal epithelium. The embryonic coelom from which that epithelium develops also gives rise to the Mullerian duct from which develop the structures of the genital tract, and it is this common origin which explains the great variety of epithelial patterns which are met with.
- 19. 19 Ovarian Cancer Primary Epithelial TumorMucinous cystadenoma or cystadencarcinoma (of. Cervical epithelium). Serous cystadenoma or cystadenocarcinoma (of . tubal epithelium). Endometrioma or Endometrioid carcinoma (of. Endometrium). Clear cell carcinoma. Brenner tumour. Squamous cell tumor
- 20. 20 Ovarian Cancer Ovarian Germ Cell Tumor Fibroma or sarcoma. .Dysgerminoma. .Teratoma. .Gonadoblastoma. .Yolk sac tumour. .Carcinoid .Thyroid tumour Choriocarcinoma
- 21. 21 Ovarian Cancer Gonadal Sex Cord Stromal Tumor Estrogen-producing:Estrogen-producing: Granulosa cell tumour. Theca cell tumor. Androgen-prodicing:Androgen-prodicing: Sertoli-Leydig cell tumor (Androblastoma). Hilar cell tumour. Lipoid cell tumour.
- 22. 22 Ovarian Cancer Krukenberg Tumor There is one well- known secondary tumour of the ovary, the krukenberg tumour, a secondary of a stomach carcinoma.
- 23. 23 Ovarian Cancer Mucinous cystadenoma A unilocular or multilocular cyst of ovary lined by tall columnar epithelium resembling that of the cervix or large intestine. It is usually large and may reach immense proportions, occupying the whole peritoneal cavity and compressing other organs. It may occur at any age.
- 26. 26 Ovarian Cancer VARIAN TUMOURS --MUCINOUS CYSTADENOMA
- 27. 27 Ovarian Cancer SEROUS CYSTADENOMA A unilocular or multilocular cyst lined by epithelium similar to the fallopian tube. They are the most common benign epithelial tumors and form 20% of all ovarian neoplasm. In 10% of cases they are bilateral. It is uncommon to find them large than a fetal head.
- 30. 30 Ovarian Cancer VARIAN TUMORS --SEROUS CYSTADENOMA
- 31. 31 Ovarian Cancer Serous cystadenocarcinoma This is by far the commonest primary carcinoma, accounting for 60% of all cases, and in over half the cases it is bilateral. The cysts are always of papillary type and the epithelium burrowing through the capsule produces papillary processes on the serous surface. Extension of the growth to the pelvis and adjacent organs fixes the tumor. Ascites is always present.
- 32. 32 Ovarian Cancer Endometrioid Carcinoma of the Ovary It is now recognized that carcinoma of the ovary may be of endometrial type, sometimes arising in endometrioma. Attacks of pain, unusual with ovarian cancer, are common. Sometimes there is uterine bleeding in post- menopausal cases.
- 33. 33 Ovarian Cancer Endometrioid Carcinoma of the Ovary Usually the lesion is cystic and chocolate brown in color. If such a cyst ruptures spontaneously, malignancy should be suspected. The histology varies as in uterine carcinoma. It may be a well- differentiated adenocarcinoma, an adeno-acanthoma, mucinous adenocarcinoma or clear-celled carcinoma.
- 34. 34 Ovarian Cancer Fibroma This is composed of fibrous tissue and resembles fibromata found elsewhere. It is most common in the elderly and accounts for 4-5% of all ovarian neoplasm. The fibroma is believed by many to be a thecoma which has undergone fibrous transformation. It is sometimes associated with Meig’s syndrome.
- 35. 35 Ovarian Cancer Estrogen-producing Tumors These belong to the granulosa- theca cell group and are found at all ages. They account for 3% of all solid tumors of the ovary.
- 36. 36 Ovarian Cancer Estrogen-producing Tumors In childhood there is accelerated skeletal growth and appearance of sex hair. 5% occur in children precocious puberty. 60% occur in child-bearing years irregular menstruation. 30% occur in post-menopausal women post- menopausal bleeding.
- 37. 37 Ovarian Cancer Andorogen-producing Tumours Three distinct types of masculinising ovarian tumor are recognised: a) Sertoli- Leydig cell tumor (Androblastoma), b) Hilar cell tumor, c) Lipoid cell tumor. All three cause amenorrhoea.
- 38. 38 Ovarian Cancer Dysgerminoma This is the only solid ovarian tumor of characteristic appearance. Usually ovoid with a smooth capsule, it is of rubbery consistency and greyish colour. It is commonest in younger age groups, under 30 years as a rule, and is often bilateral. Sometimes it is found in cases of intersex.
- 39. 39 Ovarian Cancer Teratoma Cystic teratoma or dermoid Solid teratoma
- 40. 40 Ovarian Cancer Yolk Sac Tumor rare Children and young adults highly malignant alphafetoprotein
- 41. 早期卵 癌的可疑 断巢 诊 ◆绝经后不明原因出血 ◆绝经后可触及卵巢综合征 ◆青春期少女卵巢增大 ◆卵巢癌三联征： 40 岁以上妇女；胃肠道症 状； 卵巢功能障碍。 ◆妇科检查特点：凡两侧性肿瘤应首先考虑 为卵 巢恶性肿瘤；肿瘤为实质性、表面高低不 平、 活动受限或固定者；子宫直肠陷凹触及质
- 42. 42
- 43. 43
- 45. 45 钳夹蒂部
- 46. 46 切除肿瘤
- 47. 47
- 48. 48 剖视肿瘤
- 50. 50 Ovarian Cancer Spread -Direct The first spread is directly into neighbouring structures – peritoneum, uterus, bladder, bowel and omentum.
- 51. 51 Ovarian Cancer Spread -Lymphatics Ovarian drainage is to the para-aortic glands, but sometimes to the pelvic and even inguinal groups. Cells seeded on to the peritoneum are drained via the lymphatic channels on the underside of the diaphragm into the subpleural glands and thence to the pleura.
- 52. 52 Ovarian Cancer Spread -Blood Stream Blood spread is usually late, to the liver and lungs.
- 53. 53 Ovarian Cancer Staging of ovarian cancer STAGE I Growth limited to ovaries Ia Limited to one ovary. No ascites. Ib Limited to both ovaries. No ascites. Ic Ascites or positive peritoneal washings also present or tumour on surface of one or both ovaries or capsule ruptured.
- 54. 54 Ovarian Cancer Staging of ovarian cancer STAGE II Pelvic extension IIa Spread to uterus/tubes IIb Spread to other pelvic tissues IIc IIb with ascites or positive peritoneal washings or tumour on surface of one or both ovaries or capsule ruptured.
- 55. 55 2006-11-1 七年制 Ovarian Cancer Staging of ovarian cancer Stage III Extrapelvic intraperitoneal spread and/or retroperitoneal or inguinal positive nodes, or superficial lover metastases. IIIa Apparent limitation to true pelvis IIIb Histologically proven abdominal peritoneal superficial implants<2cm diameter. IIIc Abdominal implants>2cm diameter or positive retroperitoneal or inguinal nodes.
- 56. 56 Ovarian Cancer Staging of ovarian cancer Stage IV Distant metastases or pleural effusion with positive cyotlogy or parenchymal liver metastases.
- 57. 57 Ovarian Cancer Diagnosis Pelvic exam Ultrasound CT scan CA125 blood test SURGERY
- 61. Metastasis, Krukenberg tumor from gastric cancer
- 62. Lymph node metastasis from ovarian cancer
- 63. 5. 肿瘤标志物 (1)CA125 ： 80 ％的卵巢上皮性癌患者 CA125 水平高于正常值； 90 ％以上患者 CA125 水平 的消长与病情缓解或恶化相一致，尤其对浆 液性腺癌更具特异性。 (2)AFP ：对卵巢内胚窦瘤有特异性价值， 或未成熟畸胎瘤、混合性无性细胞瘤中含卵 黄囊成分者有协助诊断意义。 (3)HCG ：对于原发性卵巢绒癌有特异性。 (4) 性激素：颗粒细胞瘤、卵泡膜细胞瘤产 生较高水平雌激素。浆液性、粘液性或勃勒 纳瘤有时也可分泌一定量的雌激素。
- 64. 64 Ovarian Cancer TORSION of the PEDICLE The commonest complication Occur with any tumor Except those with adhesions
- 65. 65 Ovarian Cancer Clinical Features-Subacute The patient complains of recurrent abdominal pain which passes off as the pedicle untwists. There is a rise in pulse and temperature during the bleeding; And over a period anemia develops. TORSION of the PEDICLE
- 66. 66 Ovarian Cancer Clinical Features-acute The signs and symptoms are those of an acute abdominal condition. The problem becomes one of differential diagnosis to exclude those conditions in which laparotomy is not needed and laparoscopy may be useful. Pain tends to be intense and continuous. ORSION of the PEDICLE
- 67. 67 Ovarian Cancer Ruptured Cyst This may occur alone or in conjunction with torsion. Rupture is not particularly upsetting to the patient unless the contents are irritant. TORSION of the PEDICLE
- 68. 68 Ovarian Cancer Suggestive of Malignancy Age. If the patient is over 50 the chance of malignancy is over 50% as opposed to less than 15% in premenopausal women. Tumors in childhood are usually malignant. Rapid growth. Ascites.
- 69. 69 Ovarian Cancer Suggestive of Malignancy Solid tumours, especially when bilateral. Multilocular cysts with solid areas. (At least 10% of cysts are malignant). Pain. Pressure pain can occur with any tumor; But referred pain suggests malignant involvement of nerve roots. Tumor markers, such as CA125, may be measured in the blood, but a normal level does not exclude malignancy.
- 70. 70 Ovarian Cancer Treatment Surgery Chemotherapy Radiation Therapy ? Hormonal Therapy
- 71. 71 Ovarian Cancer Surgical Procedures To classify the growth according to its extent of spread (staging) as accurately as possible. To remove as much cancerous tissue as possible (‘surgical debulking’;’cyto- reductive treatment’).
- 72. 72 Ovarian Cancer Surgical Procedures Benign ovarian over 10 cm in diameter must be removed, but clinical and ultrasonically diagnosed cysts under 10 cm (the size of a lemon) in women under 35 years may be reviewed in a few months if there is no suspicion of malignancy. A follicular or luteral cyst may resolve spontaneously.
- 73. 73 2006-11-1 七年制 Ovarian Cancer URGICAL TREATMENT OF OVARIAN TUMMOURS
- 74. 74 2006-11-1 七年制 Ovarian Cancer SURGICAL TREATMENT OF OVARIAN TUMMOURS
- 75. 75 Ovarian Cancer URGICAL TREATMENT OF OVARIAN TUMMOURS
- 76. 76 Ovarian Cancer Follow-up Follow-up with intensive chemotherapy, using various combinations of antineoplastic drugs. Taxanes, probably combined with platinum compounds, are an appropriate first choice.
- 77. 77 Ovarian Cancer Second Look A ‘second look’ laparotomy or laparoscopy operation (SLO), to determine the actual effectiveness of the chemotherapy and to decide whether it should be stopped does not affect prognosis, so should only be performed with informed consent in clinical trials.
- 78. 78 Ovarian Cancer Surgical Procedures -Incision A vertical incision which can be extended is essential to allow a full inspection. Reduction of a cyst by tapping and extraction through a suprapubic incision is not acceptable practice.
- 79. 79 Ovarian Cancer Surgical Procedures - Cytology Before handling the tumour, take specimens of ascitic fluid or peritoneal saline washings for cytological examination, and a cytology smear from the underside of the diaphragm.
- 80. 80 Ovarian Cancer URGICAL PROCEDURES IN OVARIAN CANCER
- 81. 81 2006-11-1 七年制 Ovarian Cancer
- 82. Prophylaxis I popularization of cancer prevention knowledge II. health education: physical and gyn. Examination, CA125 and HE4,US examination III. Early treatment
- 83. Thanks for Your Attention
- 84. 84 2006-11-1 七年制 Ovarian Cancer
- 85. 85 Ovarian Cancer Hereditary Breast and Ovarian Cancer: BRCA1 • Autosomal Dominant TransmissionAutosomal Dominant Transmission • Precise Risk for Male Breast Cancer UnclearPrecise Risk for Male Breast Cancer Unclear • Increased Risk for Prostate Cancer?Increased Risk for Prostate Cancer? Breast cancerBreast cancer 50%50%−−85%85% Second primary breast cancerSecond primary breast cancer 40%40%−−60%60% Ovarian cancerOvarian cancer 20%20%−−60%60%
- 86. 86 Ovarian Cancer Hereditary Breast and Ovarian Cancer: BRCA2 • Autosomal Dominant TransmissionAutosomal Dominant Transmission • Increased risk of prostate, laryngeal,Increased risk of prostate, laryngeal, melanoma and pancreas cancersmelanoma and pancreas cancers breast cancerbreast cancer (50%(50%−−85%)85%) ovarian cancerovarian cancer (10%(10%−−20%)20%) male breast cancermale breast cancer (6%)(6%)
- 87. Dr.Saleh Bakar Taishan Medical University 87 Ovarian Cancer by Dr.Saleh Bakar