Ovarian cancer

Ovarian cancer_
risk factor_1 low parity 2 decreased fertility 3 delayed child bearing 4 family history 5 colon,breast ca and endometrial carcinoma r associated with
6 genetic 1%malignant ovarian tomour involeves BRCA-1 gene.
7 age-risk increase with age upto 70 yr.  8 mumps prior to menarche. 9 high dietary fat intake. 10 environomental factor industrial pollution.Multiparity,breastfeeding ,ocp are protective.
Type_1 epithelial ovarian ca
2 non epithelial ca
Epithelial ca_
serous histological type_75%
Mucinous 20%
endometrial
brennar tumor
clear cell ca.
Undiff.Ca

10-20% of these tumour are borderline tumour.
They hv low malignant potential
remains confine to ovary for long. Predominant in age group 30-50 yr.
Diagnose by epithelial proliferation with papilly formation and pseudostratification.,nuclear atypia and inareased mitotic activity,absence of true stromal inuasiom.

2 non epithelial malignancy_
germ cell malignancy are derived from priamary germ cell
eg_dysgerminoma,teratoma,endodermal sinus tumour,embryonal carcinoma..
-Endodermal sinus tumour_second most common tumour of germ cell origin.
rich in AFP and alpha fetoprotein.
Usually child or young women presenting with abdominal pain,pelvis mass which grow rapidly.
Respond to chemotherapy with good surviaval rate.
-choriocarcinoma_
part of mixed germ cell tomour.
Origin as teratoma can b confirmed in pre pubertal girl.,when the possibility of gastetional origin can b excluded.It is very vascular tumour.It secret large quanty of hCG,a good tumour marker.It is highly malignant.

Embryonic cell carcinoma-
seen in pubertal girl.It secrete alpha fetoprotein.
Symptoms_precocious peberty and menstrual irregularities.

Sex cord stromal tumour_
consist of female and male cells.
Secondaries ovarian tumor_krukenberg tumour_bilateral,smooth surface,freely movable in pelvis.

Clinical featues of ovarian cancer_Age_adolescent,menopausal or postmenopausal of low parity,initially asymptomatic,later on abdominal discofort,pain,lump and abnormal or postmenopeusal bleeding..
p/v_fixed nodule in pouc of douglas apart from adnexal mass felt separate frm uterus.
Investigation- CT,MRI,-for extent growth.
Tissue marker like hCG,AFI,AAT.!
Barium meal,enema.
Breast examination if metastatic tumour is suspected.
FIGO staging-
stage1 tumour restricted to overies.
1A-1overy is invole only.
1B-both overy involve.
1C-capsule ruptured/malignant ascites.
Steg 2-pelvic extension also
2A-metastasis to uterus n/pelvic extension tube.
2B-extension to other pelvic organ
2C-above plus surface growth ,rupture capsule,malignant ascietes.
Stage 3A-microscopic seeding of peritoneum.
3B-abd peritoneal implant<2 cm and node negetive.
3C-  ">2 cm and /node positive.
Stage4 distant metastasis in lung liver n pleura.
Management-
laparotomy is to b done in all ovarian tumour.
Surgical staging is followed by definative surgergy debulking followed by chemotherapy/radiotherapy.
Boarderline malignancy-total abdominal hysterectomy and bilateral salphingo oophorectomy should b done in older women and conservative ovariotomy in young women  provided peritoneal wash.
St 1 n 2_Operable cases should undergoes TAH and BSO with omentectomy
st 3 and 4 inoperable cases are managed by debulking surgery or removal with postoperative chemo/radiotherapy.
Terminal stage requires analgesic and sedative...