Download Microsoft Word Version For Printing

 

Ovarian Cancer

by

Thomas Ind

Consultant Gynaecological Surgeon

St George's & Royal Marsden Hospitals

 

Types of ovarian cancer

Ovarian cancers can arise from any cell element of the ovary and are therefore categorised into one of three main types (Epithelial, Sex cord/stromal, & Germ Cell). The most common type is Epithelial Ovarian Cancer (EOC).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In addition to these three main types of ovarian cancer it is possible to get metastases. A metastasis from the gastro-intestinal tract is often called a Krukenburg tumor. Other types that exist included mixed ovarian cancers, and sarcomas but these are rare.

 

Epithelial Ovarian Cancer

-INCIDENCE

About 5000 every year.

 

-AGE

Occur in 60s

 

-GEOGRAPHIC

Racial variations are small

More common in western world

 

-Predisposing factors

Few aetiological factors known

5% are inherited in an autosomal dominant manner.

BRCA1 and BRCA2 genes give a 30 – 50% life-time risk.

 

-Clinical features

Present as ovarian cysts on ultrasound.

Common complaints include;

abdominal distention

gastrointestinal changes

urinary symptoms

pelvic pain

 

-Investigations

 

Blood tests

The tumor marker CA125 is elevated in 90% of cases

CEA (bowel), CA19.9 (pancreas), & CA15.3 (breast) markers can also be raised

 

Radiological tests

Pelvic ultrasound (transvaginal ultrasound is best)

Doppler ultrasound

 

-Stage (FIGO)

I - Confined to ovary

    a - Not b or c

    b - Bilateral

    c - Surface involvement, positive ascites or positive washings.

II - Spread to pelvis but not lymph nodes or abdomen

III - Spread to abdomen or lymph nodes

IV - Distant spread

 

-Treatment

Combination of surgery and chemotherapy

Surgery;

            Midline laparotomy

            Pelvic washings

            Total hysterectomy

            Removal of both ovaries and tubes

            Excision of omentum

            Appendicectomy

            Inspection of all peritoneal surfaces, bowel, liver,        
            spleen , pancreas & kidneys

            Pelvic & para-aortic lymphadenectomy if required for
            staging

Conservative surgery;

            I stage 1a and wishes to maintain fertility

            Unilateral oophorectomy but full staging (as above but
            with a biopsy of the contralateral ovary and no
            hysterectomy). 30% of apparent stage 1a will be stage
            3 or above due to microscopic metastases in the final
            specimens.

Chemotherapy;

            Carboplatin & Taxol (most common)

            Allopecia, nausea, thrombocytopenia, nephropathy, and
            peripheral neuropathy

            Others included single agent platinum, doxorubicin, and
            topotecan

 

-Prognosis

Most present as stage 3 disease

Average survival about 3 – 4 years after stage 3 disease

 

Sexcord stromal tumors

Much rarer than EOC

Present in younger women

Granulosa cell tumors may have elevated markers (Inhibin & Oestradiol)

Treatment is often the same surgically for diagnosis however, the aim is to preserve fertility as chemotherapy is the mainstay of treatment.

 

Germ cell tumors

Much rarer than EOC

Present in younger women

Yolk sac tumors have elevated AFP

Choriocarcinomas have elevated hCG

Dysgerminomas may have elevated PlAP (Placental Alkaline Phosphatase)

Treatment is often the same surgically for diagnosis however, the aim is to preserve fertility as chemotherapy is the mainstay of treatment.

 

Download Microsoft Word Version For Printing