MANAGEMENT OF

OVARIAN TUMOURS
BISSALLAH EKELE,
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY,
USMANU DANFODIYO UNIVERSITY
TEACHING HOSPITAL,
SOKOTO, NIGERIA.
 THE OVARY
• MAIN INTERNAL FEMALE
REPRODUCTIVE ORGAN
• TRIPLE ORIGIN (CE,MESODERM,GC)
• EACH IS ALMOND SHAPED (3X2X1)
• NOT COVERED BY PERITONEUM
• SURFACE(GE), CORTEX, MEDULLA
• PRODUCE EGGS AND HORMONES
OVARIAN TUMOURS MAY BE
• FUNCTIONAL (PHYSIOLOGICAL)*

• INFLAMMATORY

• ENDOMETRIOSIS

• NEOPLASTIC*

*PRIORITY
FUNCTIONAL OVARIAN CYSTS:
• FOLLICULAR CYST

• CORPUS LUTEUM CYST

• THECA-LUTEIN CYST

• POLYCYSTIC OVARIAN SYNDROME

• LUTEOMA OF PREGNANCY

(Repro. age group, asymptomatic, expectant mgt -60/d)

NEOPLASTIC OVARIAN TUMORS

- BENIGN
• PRIMARY
-MALIGNANT

• SECONDARY (Breast,Stomach,Colon,Endometrium)

‘Krukenberg Tumors’
 BENIGN OVARIAN TUMOURS:
(ovary’s triple heritage)
• EPITHELIAL
-SEROUS
-MUCINOUS
-ENDOMETRIOD
-CLEAR CELL TUMOUR (MESONEPHROID)
-TRANSITIONAL CELL TUMOUR (BRENNER)

• SEX-CORD STROMAL
-THECOMA
-FIBROMA (MEIG’S SYNDROME)

• GERM CELL
-TERATOMAS (DERMOID CYST)

MANAGEMENT:
SURGERY (Age, Parity, Tumour characteristics)
-Cystectomy, unilateral oophorectomy or TAH + BSO
 MALIGNANT OVARIAN TUMORS
• Greatest challenge to the Gynecologist

• No pre-malignant phase

• Inaccessible location

• Late presentation (75%)

• 3rd common cause of cancer death in African

women
 OVARIAN CARCINOMA
HIGH RISK FACTORS
-Reduced family size
-Late age at 1st pregnancy
-Family history (BOC Synd, Lynch II Syndrome)
-Use of fertility drugs
-Previous irradiation to ovaries
-Higher socioeconomic status
-White women
-Blood group A
 OVARIAN CARCINOMA
REDUCED RISK:
-Long term oral contraceptive users
-Multiparous women
-Women who breast-feed
-Low socioeconomic status
-Black women
-Blood group O
 OVARIAN CANCER DIAGNOSIS
• CLINICAL
History - Vague, non-specific, abd swelling, pain
Exam - Abdomino-pelvic mass (B vs M)

• RADIOLOGICAL – ultrasound, cxray, ct, mri

• BIOCHEMICAL – tumor markers

CA125,AFP,HCG,CEA

• SURGICAL – diagnosis, staging, treatment

 STAGING OVARIAN CANCER
(FIGO)
• STAGE I, growth limited to the ovaries
a, b, c
• STAGE II, + extension to the pelvis
a, b, c
• STAGE III, + extension abdominal cavity
a, b, c (micro,<2cm, >2cm or nodes)
• STAGE IV, + distant metastasis, liver para
Pattern of spread = Direct, transcoelomic*,
lymphatic, haematogenous.
 TREATMENT
• OPTIMAL THERAPY = MULTIDISCIPLNARY TEAM
DESIGNATED GYNE CANCER CENTRE

• SURGERY PRIMARY STEP

(Remove all visible tumor) ‘OPTIMAL DEBULKING’ ‘CR’
- BSO
- TAH
- Omentectomy
- Lymphadenectomy(Pelvic &para-aortic)
- Appendix / Bowel where indicated
 TREATMENT
• CHEMOTHERAPY (ADJUVANT-given after 1 rx)
- None
- Alkylating agents(cyclophosphamide)
- Platinums (Cisplatin, Carboplatin)
‘Non-classic alkylators’
- Taxanes (paclitaxel, docetaxel)
‘Promote microtubule polymer formation’
- Combination Chemotherapy (Gold
Standard, P-C, D-C)
. How many courses?
• RADIOTHERAPY
- Intraperitoneal radio-isotopes (32P, Au 198)
- External Beam Therapy
Limited use/ Out of favour

. IMMUNOTHERAPY (Experimental: Interleukin-2,

interferons)

. ? SECOND LOOK SURGERY

OVARIAN CANCER PROGNOSIS

DEPENDS ON STAGE OF DISEASE

- Stage I, 85% 5-Year Survival
- Stage II, 70%
- Stage III, 30%
- Stage IV ,10%
(Histology type, grade, response chem)
 PREVENTION
• PRIMARY, SECONDARY AND TERTIARY LEVELS

• NO UNIVERSAL SCREENING TOOL YET

• POSITIVE FAMILY HISTORY

(BRCA1 gene -17, BRCA2 -13)

?ULTRASOUND SCAN YEARLY

?CA 125 SERUM MEASURE

THANK YOU!