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L44 Ovarian cancer
Ovarian cancer is the second most common gynecological cancer and the leading cause of gynecological cancer death. It is usually discovered late in advanced stages due to a lack of effective screening methods. The most common type is epithelial ovarian cancer. Risk factors include family history of breast or ovarian cancer and genetic mutations like BRCA1/2. Prophylactic salpingo-oophorectomy can reduce risk for those who test positive for BRCA mutations. Symptoms are often vague, including bloating, pelvic pain, and feeling full quickly. Diagnosis involves ultrasound, tumor markers, and surgical staging. Treatment consists of chemotherapy and surgery when possible, with the most important prognostic factor being residual disease after
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L44 Ovarian cancer
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- 2. Introduction ļµ Ovarian canceris the second most common gynaecological malignancy ļµ the major cause of death from gynaecological cancer ļµ Usually discovered late ( present in advanced stages ) ļµ No effective screening method ļµ Life time risk is 1:70 (1.4 %) ļµ The mean age of presentation is 64 ļµ Mean age of diagnosis is 54 ļµ The most common type is epithelial ļµ More in old age , white , family history of ovarian and breast cancer , nulliparas ļµ OCP , hysterectomy and salpingectomy are protective
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- 4. Epithelial tumors ļµ Benign, borderline and malignant ļµ Borderline tumors (10 % , well differentiated and doesnāt invade the basement membranes, spread locally, surgery is the treatment of choice , mostly serous) ļµ Mucinous: may rise from GIT origin, multiloculated and lead to pseudomyxoma peritoneii. ļµ Serous : the most common type , characterized histologically by concentric rings of calcification, known as āpsammoma bodies ļµ Endometroid : histologically similar to endometrial cance , 10 % with endometrial cancer too ļµ Clear cell : similar to renal cells , endometriosis increase the risk of this type
- 5. Risk factors Hereditary : 10% of cases BRCA1 (80% risk) and BRCA 2(15 % risk) gene mutation + high risk for breast cancer LYNCH syndrome (HNPCC) with risk of colon cancer , uterine cancer and 10 % risk of ovarian cancer
- 6. Preventing ovarian cancer ļµprophylactic salpengoophorectomy : Women who test positive for a BRCA mutation are offered risk-reducing prophylactic BSO when they have completed their families (mid-30s in BRCA1 ) and (early 40s in BRCA 2 carriers ) Other methods decreases the risk : Salpingectomy Hysterectomy OCP
- 7. Clinical picture ļµ Usuallylate and vague (GI or urinary symptoms ) ļµ The most common symptoms are: ā¢ Increased abdominal girth/bloating. ā¢ Persistent pelvic and abdominal pain. ā¢ Difficulty eating and feeling full quickly.
- 8. Investigations ļµ Ultrasound (TVUS) ļµ Tumor markers ļµ RMI (risk of malignancy index)
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- 10. Management ļµ Chemotherapy andsurgery when operable
- 11. Prognosis The most importantprognostic factor is RESIDUAL AFTER SURGERY