Ovarian Cancer Topic Discussion
Ovarian Cancer Topic Discssion
Table of Contents:-
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Factors reducing risk of Ovarian Cancer:-
OCPs have been found to reduce the risk of ovarian cancer by about 7% .
Age group with highest risk of different Cancers :-
Malignant ovarian germ cells tumors of the ovary most commonly occur in the age group of 0 - 20 years.
In contrast the highest risk of ovarian cancer per year in UK is in the age group of 75 to 79 years.
The age group with the highest risk of cervical cancer is 25 to 29 years.
The highest risk of uterine cancer is in the age group of 70 to 74 years.
Origin of Metastatic Tumours of Ovary :-
Vagina
Types of Ovarian Tumours:-
Benign Ovarian Tumors :-
1)- Dysgerminoma
2)- Ovarian Teratoma
3)- Dermoid Cyst
4)- Gonadoblastoma
5)- Endometroid Tumor
6)- Hamorrhagic Cyst
7)- Granulosa Cells Tumor
8)- Sertoli Cells Tumor
9)- Estrogen Secreting Ovarian Tumor
10)- Ovarian Carcinoid
11)- Brenner Tumour
12)- Ovarian Hilus Tumour (Also called Ledig cells Tumour)
Malignant Ovarian Tumors :-
1)- Serous Cystadenoma
2)- Mucinous Cystadenoma
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BENIGN OVARIAN TUMORS :-
Dysgerminoma
Dysgerminoma is the most common malignant ovarian germ cells tumor. Its a unilateral Ovarian tumour .
On histopathological examination of ovarian tumor after laparotomy T cells lymphocytic infilteration is found.
A dysgerminoma is a tumour of the ovary that is composed of primitive, undifferentiated germ cells.
97% are benign proliferations (mature teratomas); the remaining 3% are malignant.
Dysgerminoma constitutes <1% of ovarian malignancies; it is bilateral in 15%.
The five-year survival rate is 95%.
15%–20% of tumours will recur.
Chemotherapy including platinum is successful in almost all of the tumours.
Tumor Marker of Dysgerminoma :-
LDH
HCG
Ovarian Teratoma
Histologically the presence of immature fetal like cells indicate that ovarian teratoma is malignant.
Dermoid Cysts(benign not malignant ) are types of Mature teratoma.
Dermoid Cyst :-
It is the most common cyst diagnosed after 16 weeks of gestation.
Gonadoblastoma
Its the tumor which is most likely to occur in inguinal mass.
Androgens are produced in large amount by gonadoblastoma.
Endometroid tumor
This tumor arises from ovarian germinal epithelium.
Haemorrhagic Cyst
On TVS , there is adnexal mass with spider web appereance.
Granulosa Cells Tumours:-
This type of ovarian tumour accounts for less than 5 % of ovarian tumours.
In this type of germ cells tumour there is raised estrogen level which causes thickening of endometrium which can result ultimately in endometrial carcinoma.
ET is found to be increased on Ultrasound scan of the patient.
Sertoli Cells Tumours:-
This type of tumor accounts for less than 1 percent of ovarian tumours . Majority of these tumors are bnign but 10 % can become malignant.
These tumours produce excess androgens and can result in virilization.
These tumours produce excess androgens and can result in virilization.
Patients with this type of ovarian tumour have enlarged clitoris.
Estrogen secreting Ovarian Tumour:-
The incidence of oestrogen-producing ovarian tumours in young adolescents is only 5% .
Oestrogen-secreting ovarian tumours cause breast development and irregular uterine bleeding rather than a regular menstrual bleed.
Ovarian Carcinoid :-
It is a type of cyst in which histologic investigations shows an insular pattern of round uniform cells with 80% neurosecretory granules.
The urine of such patients show 5 hydroxyundoleacetic acid.
Brenner Tumour :-
It is the ovarian neoplasm with lowest malignancy rate.
Stromal Hyperthecosis :-
It is the benign ovarian tumor in which nests of leutinized stromal cells are present within gonadal stroma . Over several years time period , gross morphological changes take place in ovaries resulting in the appearence like PCOD.
METASTATIC OVARIAN TUMORS :-
Serous Cystadenoma:-
Secondary Tumour of Ovary :-
Ovarian tumor can be secondary in about 10 percent of the cases , means about 10 % of ovarian tumours are non ovarian in origin.
It usually arises from the endometrium. Krukenberg tumour is also an example of secondary tumor of the ovary which arises from the stomach and colon.
Discussion with patients about Prognosis of Ovarian Cancer :-
In patients with ovarian cancer who underwent sugery for ovarian cancer there should be a detailed discussion regarding prognosis and further plans. Patients are counselled that the response to chemotherapy is related to the amount of residual disease.
In adnexal mass , what is the incidence of non - ovarian origin :-
About 10 % of adnexal mass are of non ovarian in origin.
Mucinous Cystadenoma:-
Mucinous Cysadenoma are large tumors of upto 30 cm in diameter . The are associated with lower rate of malignancy (about 15 % ) as compared to the serous cystadenomas . Pseudomyxoma peritoni refer to intra-abdominal accumilation of geleatinous materials that result from rupture of mucinous tumors.
Virilizing Tumours of the Ovary :-
The list of Virilizing tumours of Ovary include the following
1)- Sertoli Ledig Cells Tumour ( 1 % )
2)- Granulosa Cells Tumour ( Less than 5 % )
3)- Fibrothecomas ( 1 - 4.7 % )
4)- Ovarin Hilus / Ledig Cells tumour (rare tumour)
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