GRANULOSA-THECA LUTEAL
POLYCYSTIC
ENDOMETRIOTIC
CYST
EPITHELIA
L
OVARIAN
NEOPLAS
M
PRIMARY
GERM
CELL
TUMORS
BENIGN
BORDERLIN
E
MALIGNANT
DERMOID CYST
MALIGNANT
MUCINOU
S
SEROUS
ENDOMETRIOI
CLEAR CELL
(MESONEPHROI
D)
BRENNET
SOLID
TERATOMA
NONGESTATIONAL
CHORIOCARCINO
YOLK SAC
DYSGERMINO
MA
FIBROMA (MEIGS
GERM CORD
(GONADAL STROMAL)
TUMORS
SECONDARY
FOLLICULAR CYST
- Usually less than 5 cm
- Benign and asymptomatic
- Thin wall, contain clear fluid
- Rescan in 4 weeks
- If enlarge or symptomatic,
consider surgery
OVARIAN NEOPLASM
NON-NEOPLASTIC FUNCTIONAL CYST
CORPUS LUTEAL CYST
GRANULOSA-THECA LUTEIN
CYST
Excessive bleeding into corpus - in molar pregnancy or part
luteum
of hyperstimulation
Cyst filled with blood
syndrome
- Due to excessive
Delayed period + pain
gonadotrophin
Usually the following period is
heavy
POLYCYSTIC OVARY
ENDOMETRIOTIC
CYST
BRENNER
- Usually benign.occur
in reproductive life
- May be associated
with endometrial
hyperplasia
- May coexist with
mucinous
cystadenoma
CLEAR CELL
@MESONEPHROID
- Associated with
endometriosis in 25%
- Worst prognosis
OVARIAN NEOPLASM
PRIMARY OVARIAN TUMORS
B] GERM CELL TUMORS
BENIGN
DERMOID CYST @ BENIGN CYSTIC
TERATOMA
- 25% of all ovarian neoplasm
- Contain tissue derived from two or
more germ cell layers
- Unilocular cyst. May contain teeth,
bone , cartilage, nerves, hair, thyroid,..
Tissues
- Almost always benign. Malignant
changes may occur in any component
- Occur at any age. Peak is 20-30 years.
- Bilateral in 20%
MALIGNANT
Rare. 3% of ovarian cancers
SOLID
TERATOMA
Peak
incidence in
second
decade
NONGESTATIONAL
CHORIOCARCINO
MA
- Secrete HCG
- May be
component of
solid teratoma
YOLK SAC @
ENDODERMAL
SINUS
- Highly malignant.
Affect young age
- Partly solid.
Secrete alpha fetoprotein
DYSGERMINOMA
- Most common.
Highly malignant
- Usually spread by
lymphatics
- Very radiosensitive
- Occur in young
women. May arise in
gonadal dysgenesis
INTRODUCTION
- Wide variety of tumors
- 25% of female genital tract
tumors
- In U.K, the most common
pelvic cancer
- Worst prognosis of all
female genital tract cancers
- Life time risk is 1%
- Spread by local spread,
lymphatic and rarely by blood
COMPLICATION
Torsion
- common with dermoid/fibroma
- Severe abdominal pain/vomitting
Rupture
Haemorrhage
Impaction
infection
FIGO STAGING
Stage
Growth limited to one or both ovaries
1
Stage
Growth limited to one or both ovaries with
2
pelvic extension
Stage
Tumor involving one/both ovaries with
3
peritoneal implants outside pelvis/positive
retroperitoneal or inguinal nodes.
INVESTIGATION
Uss /CT scan
Tumor markers( ca125,CEA,
HCG,alpha FP
Urea and electrolyte
LFT
Chest X ray
Ascitic tap
Calculate risk malignancy index.
Stage
4
PRIMARY
- Primary cytoreduction
- TAH, BSO, OMETECTOMY,
WASHINGS, BOWEL SURGERY
- Optimal debulking: less
than 2 cm residual tumors
- Staging once histology is
available
- If confined to ovary and
young age, conservative
surgery
CHEMOTHERAPY
Indication stage 1c and
above
Platinium based
- Taxol
- 6 cycles at 3 weekly
intervals
- Monitoring:
examination
CA125
FBC, U&E
PALLIATIVE SURGERY
- Removal of intestinal
obstruction
- Survival is very poor
- Quality of life
considerations
SCREENING
Life time risk is 1%
5% of tumors are genetic
History of breast cancer increases risk by factor of 2
History of ca ovary increases the risk by factor of 3
One first degree relative affected: risk 2.7%
2 first degree relatives affected : risk is 13%
If BRCA1 mutation carrier :
risk is 50%
Problems :
- no pre-cancerous stage
- unknown natural course
TVS AND CA125 ON YEARLY BASIS
ONGOING STUDY TO EVALUATE THIS.