Dr . Saadeh JaberOBGYN consultant

2010

EpidemiologySecond most common gynecological

cancer .

>35 , median 70

It accounts for deaths more than cancer of cervix and uterus together

EtiologyThe ovulation theoryGeneticsothers

Risk factors and PreventionRisk factors

Number of life time ovulationsage > 35 InfertilityNulliparity Late menopasueFamily historyBRCA 1 +2

PreventionUse of OCPBreastfeedingMultiparityTubal sterilization

GeneticsFamilial Ovarian cancer5-10% of epithelial cancers (usually serous

adencarcinoma)1 relative ---- 2.5% 2 relatives 30-40 %Most have breast and colorectal cancerBRCA 1 & BRCA 2 HNPCC

Primary vs Secondary

Histological type

Classification

Primary Vs SecondarySecondary : 7%Common primary cancers are breast cancer

and gastrointestinal cancer “Krukenberg tumour”

Histological origin

Epithelial Cell tumor85 % of malignant tumors

60-70 yrs

Worst prognosis

CEA , CA-125

Brenner

Clear cell

Endometroid

Mucinous

Serous

Borderline epithelial tumors10% of the epithelial cellsAtypia, mitotic activity , but no invasion of

the stromaGood prognosisMost are serous or mucinous

Germ Cell tumorSecond most common type of ovarian cancer5-10%20-40 yrsBetter prognosisLDH, AFP,B-HCG

Sex Cord TumorsLeast common ovarian neoplasm5-8 % of ovarian cancers and 30 % of all

tumorsLow grade malignancyHormonally active

Clinical findingsUsually absent or nonspecific GI symptomsUrinary symptomsPostmenopausal bleedingVirilizationAcute abdomen

Diagnosis – InvestigationsU\STumor markersBariun enemaIVPChest X-ray, abdominal X-rayCT/PET

U/S

Solid and cystic, septation, irregularly shaped

Diagnosis – Markers

Ovarian Tumor Serum markerDysgerminoma LDHEndodermal sinus

AFP

Choriocarcinoma B-HCGGranulosa tumor InhibinSertoli-leydig cell

Testosterone

MetastasisMainly through the peritoneal fluid

Lymphatic spread

Least common hematogeneous

ManagementSurgery: TAH/BSO Pelvic and aortic lymph node dissection OmentectomyAppendectomy Washings Biopsies

PrognosisThe 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.

Incidence Mortality