Ca ovaryGROUP D

Dr.Tarig Hassan

Introduction

.

- The incidence of Ca ovary 62/100,000 women.- Increase in women more than 40 yrs- The maximum incidence occur in 80 to 84 yrs old- Ovarian cancer is the 5th commonest cancer among Us

women

-about 15,000 women die every year in US from CA ovary.- white women more than black women.- .Not the commonest but the most serious gynecological

tumor. (silent killer)

Risk factors1 -Age.

2-Family history 3-Ethnicity:

>white women<black women &Asian

4 -Diet5-INHERETED GENE MUTATIONS.

(BRCA1( & )BRCA2.)5 percent to 10 percent of ovarian cancers

inherited syndrome called hereditary nonpolyposis colorectal cancer )HNPCC(.

-Risk of ovarian cancer associated with HNPCC is lower than is that of ovarian cancer associated with BRCA mutations.

6 -Menstrual history/pregnancy history/infertility:

-early menstruation&late menopause -Nulliparity

-having a first child after age 30-Multiple pregnancy↓risk

-Birth control pills40-50% ↓in risk

7-Fertility drugs:

Ovulation induction:

-clomiphene citrate

-menotrpins

LMP

8-Androgens

Danazol increases androgen levels

9-Estrogen and HRT

10-Talcum powder

??carcinogenic

11-Other cancers

12-Smoking and alcohol use

Signs&symptomsClinical presentation..

Early stages of disease:• fatigue• Bloating• constipation• Difficulty eating or feeling full quickly • indigestion• back pain• chronic cough• menstrual irregularity• vaginal bleeding or discharge

Late stages of disease:• Abdominal mass & ascites• abdominal pain• unexplained wt loss• cachexia • pleural effusion

Screening methods for CA ovary

Why screening methods?

Vague symptoms

Not easy to select high risk group

• U/S:not useful as a primary method

• Ca-125

DIAGNOSISIf the physician suspects ovarian cancer, medical history, physical examination

and various tests performed to diagnose it.

A- History:1. Regularity of menstrual period2. Previous pregnancies3. Contraception4. Breast feeding history5. Previous cancer history6. Family history of ovarian cancer

B- Examination:1. General examination 2.Abdominal examination: - Signs of distention - Dilated veins -Tenderness -Shifting dullness

C- Investigations:

-Routine examination:

Complete haematogram

RFT

LFT

Random blood sugar

Chest X ray

Echo may be needed

-imaging:

U/S

CT-scan

MRI

-Ovarian Cancer Staging Is Done by laparotomy and Biopsy Taking. The Stages Are:

1) Stage I:

Limited to One or Both Ovaries.

2) Stage II:

Pelvic Extensions or Implants.

3) Stage III:

Microscopic Peritoneal Implants Outside of the Pelvis, or Limited to the Pelvis With Extension to the Small Bowl or omentum.

4) Stage IV:

Distant Metastases to the Liver or Outside the Peritoneal Cavity.

* Stages I,II, and III Are Further Divided Into:

Stage I:

Ia:

Involves One Ovary, Capsule Is Intact, No Tumor on the Ovarian Surface and No Malignant Cells in the ascitis or in the Peritoneal Washing.

Ib:

Involves Both Ovaries, No Tumor on Ovarian Surface, and Negative Washings.

Ic:

tuomor Limited to the Ovaries With Any of the Following: Capsule Ruptured, Tumor on Ovarian Surface, and Positive Washing.

* Stage II:

IIa:

Extension or Implants Onto Uterus or Fallopian Tubes With Negative Washings.

IIb:

Extension or Implants Onto Other Pelvic Structures With Negative Washings.

IIc:

Pelvic Extensions or Implants With Positive Peritoneal Washings.

* Stage III:

IIIa:

Microscopic Peritoneal Metastases Beyond Pelvis.

IIIb:

Macroscopic Peritoneal Metastases Beyond Pelvis Less Than 2 Cm in Size.

IIIc:

Peritoneal Metastases Beyond Pelvis More Than 2 Cm or Lymph Node Metastases.

Types of ovarian tumors;.Most of these tumors are benign (non cancerous) and

never spread beyond the ovaries.the others are malignant, which can metastasize.

.ovarian tumors are named according to the kind of cells the tumor started from.

.types;1-epithelial tumors ( most common)

2-germ cell tumors3-stromal tumors

classification

epithelial tumors1- benign epithelial ovarian tumors. (most common);• Serious adenomas• Mucinous adenomas• Brenner tumors2-tumors of low malignant potential (LMP).(affect women at young ages).it grows slowly and are less life threatening.3-malignant epithelial ovarian tumors;.about 85% to 90% of ovarian cancer are epithelial ovarian carcinoma• Mucinous• Endometrioid• Clear cell• Undeffrentiated• .it tend to grow and spread more quickly than others.

Germ cell tumors-life threatening

-about 5%of ovarian cancers are GCT-the most common GC, Teratoma, Dysgerminoma, endodermal sinus tumors and

choriocarcinoma-Teratoma;

*Benign form called mature teratoma, but the malignant one called immature teratoma*The mature teratuma is the most common and Affects women of reproductive age

can contain different kined of benign tissues including bone ,hair and teeth*the immature teratoma occur in girls and young women<18

-dysgerminoma:*These are rare affect teens and 20s

*its malignant ,not grow or spread very rapidly•endodermal sinus tumors and choriocarcinoma

*very rare,affect girls and young women*grow and spread rapidly

Stromal tumor

-about 5-7%

-most of them are granulosa cell tumor

<-1/2 in older than 50 yrs old,but 5% occur in young

Types of malignant:

-granulosa cell tumor

-granulosa theca tumor.

-Sertoli -Leydig cell tumors

Treatmentsurgerylaprotomy- needed for diagnosis and staging of cancer.

fluid aspiration for cytology-in chronic casesTypes of surgery,

OopherectomySalpingectomyHysterectomyCystectomyOmemtectomy

Debulking- in metastatic casesIs patient able to withstand the surgery?

ChemotherapyVery important esp beyond stage 2

Chemical debulking- chemo before surgery.

Chemo drugsCisplatin, paditaxel, carboplatin.

Side effectsNausea, vomiting, diarrhoea, alopeciaAnaemia,thrombocytopenia, leukopeniaNephrotoxicity, neurotoxicity, ototoxicityPeripheral neuropathy

RadiotherapyUsually ineffective, however is sometimes used in recurrent cases.

Prognosis• Poor prognosis

1. Early detection

2. Screening test

3. Late presentation

• Probably germ cell tumor has better prognosis

Complications-Spread of the cancer to other organs

-Progressive function loss of various organs

-Ascites

-Intestinal obstructions ►

• Samih Ahmed Alawi• Noon Salah Eldin• Nusaiba Al Tigani• Ghada Babikir• Sara Abbas• Nihal Hanafi Abdallah• Noha Salah Eldin• Aula Muntasir Mostafa• Khalid ElSadig• Alaa Eldin Abdelbadee• Rouaa Shouayeb• Dalia Amin Osman• Nadeen Magdi Faried• Mohammad Ahmed Sayid

►

Directed by Dr.Tarig Hassan

Thanks