Download presentation
Presentation is loading. Please wait.
Published byGarry Garrett Modified over 8 years ago
1
3.4.2016 Mark Browning, M.D. IUSME
2
22,000 Cases 14,000 Deaths Overall Survival Rate is 35% Survival Rate Depends on Stage
3
Epithelial Cancer 90% of Cases Surface of Ovary or Special Cells in Fallopian Tubes High Grade Serous Tumors Low Grade Serous Tumors Germ Cell Tumor Stromal Cell Tumor
4
Usually presents with advanced disease ¾ have disease beyond the ovary at diagnosis Pelvic exams are helpful in diagnosing large masses Premenopausal adnexal mass usually a cyst that regresses over time (7% are cancer) Postmenopausal adnexal mass is worrisome (30% are cancer)
5
95% of women DO report symptoms. Symptoms can be vague and not gynecologic: Abdominal bloating Swollen abdomen Fatigue Diarrhea or constipation Urinary symptoms Abdominal/pelvic pain Menstrual irregularities
6
Spread by direct exfoliation of cells onto peritoneal surface/cavity Most common mode of spread Follow path of peritoneal fluid circulation into pericolic gutter and hemidiaphragm (develop a pleural effusion) Peritoneal mets/adhesions
7
Pelvic Exam, Transvaginal Ultrasound, CA 125 CT Scan, MRI, PET Biopsy
8
Surgical staging is mandatory CA-125 is non-specific marker AFP and b-HCG if suspect germ cell tumor (younger woman)
9
Adenocarcinomas Primary peritoneal carcinoma Germ Cell Tumors Rare Low malignant potential (LMP) “borderline tumors” Single ovary, confined, younger age, pre- menopausal
10
Salpingo-oophorectomy Hysterectomy Lymph Node Dissection Omentectomy Cytoreductive/Debulking Surgery Chemo…Adjuvant…Neoadjuvant Chemo for Recurrence
11
Ovarian cancer originates from the cells that cover the ovary (epithelium). Ovarian epithelium represents < 1% of the ovary.
12
Women who carry a known mutation that predisposes to ovarian cancer (BRCA gene mutation) Women who have a family history of ovarian or breast cancer These women should be followed closely (CA125, gynecologic exam and ultrasound) These women should consider removal of ovaries (oophorectomy) preventively.
13
559 women, carriers of BRCA 1 or 2 259 women surgery: 6 diagnosed with stage 1 ovarian cancer 2 developed primary peritoneal cancer 292 no surgery: 58 developed ovarian cancer Risk reduction: 96% (Rebbeck, NEMJ, 2002)
15
Family history and parity are most impt risk factors BRCA-1 is a strong risk factor (50% risk) BRCA-2 also a risk factor, but much less so Lynch II syndrome (DNA mismatch repair defect): HNPCC, ovarian, breast, endometrial ca Prophylactic oophorectomy reduces risk 96% Incessant ovulation hypothesis: risk decreases with decreasing ovulation Use of OCP that suppress ovulation reduces lifetime risk by as much as 50%
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.