1. Dr . Saadeh Jaber OBGYN consultant 2010
Ovarian Cancer
Dr . Saadeh Jaber OBGYN consultant 2010

2. Epidemiology Second most common gynecological cancer .
>35 , median 70
It accounts for deaths more than cancer of cervix and uterus together

4. Etiology The ovulation theory Genetics others
These two associations support the ‘incessant ovulation’ theory of ovarian cancer.  Each month a woman’s ovary releases an egg (ovulation).  Release of the egg disrupts the outer lining of the ovary (epithelium) which the body repairs.  The ‘incessant ovulation’ theory postulates that the greater the number of times a women ovulates (produces eggs) in her lifetime, the greater the risk of developing ovarian cancer as during the repair of the epithelium the cells become abnormal and develop into cancer cells. 
Alcohol and milk

5. Risk factors and Prevention
Number of life time
ovulations
age > 35
Infertility
Nulliparity
Late menopasue
Family history
BRCA 1 +2
Prevention
Use of OCP
Breastfeeding
Multiparity
Tubal sterilization

6. Genetics Familial Ovarian cancer
5-10% of epithelial cancers (usually serous adencarcinoma)
1 relative %
2 relatives %
Most have breast and colorectal cancer
BRCA 1 & BRCA 2
HNPCC
5-10% are associated with genetically predisposed syndromes

7. Classification
Primary vs Secondary
Histological type

8. Primary Vs Secondary Secondary : 7%
Common primary cancers are breast cancer and gastrointestinal cancer “Krukenberg tumour”

9. Histological origin

10. Epithelial
Serous
Mucinous
Endometroid
Sex cord stromal
Granulosa
Sertoli-Leydig cell
Germ cell
Dysgerminoma
Endodermal sinus
Immature teratoma
Choriocarcinoma
Epithelial

11. Epithelial Cell tumor 85 % of malignant tumors 60-70 yrs
Worst prognosis
CEA , CA-125
Arise from the surface epithelium

12. Serous Mucinous Clear cell Brenner Endometroid Epithelial Serous

13. Borderline epithelial tumors
10% of the epithelial cells
Atypia, mitotic activity , but no invasion of the stroma
Good prognosis
Most are serous or mucinous

14. Germ Cell tumor Second most common type of ovarian cancer 5-10%
20-40 yrs
Better prognosis
LDH, AFP,B-HCG
Usually solid

15. Sex Cord Tumors Least common ovarian neoplasm
5-8 % of ovarian cancers and 30 % of all tumors
Low grade malignancy
Hormonally active
Arise from the sex cords of the embyonic gonads before they differentiate into male or female

16. Clinical findings Usually absent or nonspecific GI symptoms
Urinary symptoms
Postmenopausal bleeding
Virilization
Acute abdomen
2\3 in stage 3
GI: abdominal pain anddiscomfort are most common presenting coplaint .
NV , distention, early satiety,bowel habit changes – speard in the peritoneal cavity
Estrogen – unopposed hyperplasia

17. Diagnosis – Investigations
U\S
Tumor markers
Bariun enema
IVP
Chest X-ray, abdominal X-ray
CT/PET

18. U/S
Solid and cystic, septation, irregularly shaped

19. Diagnosis – Markers Ovarian Tumor Serum marker Dysgerminoma LDH
Endodermal sinus
AFP
Choriocarcinoma
B-HCG
Granulosa tumor
Inhibin
Sertoli-leydig cell
Testosterone

20. Metastasis Mainly through the peritoneal fluid Lymphatic spread
Least common hematogeneous

21. Management Surgery: TAH/BSO Pelvic and aortic lymph node dissection
Omentectomy
Appendectomy
Washings
Biopsies

22. Prognosis
The five-year survival rate for all stages of ovarian cancer is 45.5%.
Germ cell tumors of the ovary have a much better prognosis than other ovarian cancers, in part because they tend to grow rapidly to a very large size, hence they are detected sooner.

23. Incidence
Mortality