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Ovarian Cancer

• 5000 cases / year - 4000 deaths

• 80% diagnosed at stage 3

• Screening trials - scanning and CA 125 (indicates peritoneal irritation)

• managed in cancer centres

Aetiology

• ?super ovulation

• talc

• genetic (5%)

Pathology

• 90% epithelial in origin

  • serous cystadenocarcinoma

    • resembles tubular mucosa

  • mucinous cystadenocarcinoma

    • resembles endocervix

  • endometroid carcinoma /clear cell carcinoma

    • resembles endometrium

  • transitional cell

    • resembles urothelium

  • undifferentiated carcinoma

• germ cell - rare but do well

  • dysgerminoma

  • teratoma

    • mature (benign)

    • immature

    • monodermal

  • endodermal sinus tumour

  • choriocarcinoma

  • yolk-sac

• gonadal stroma

  • thecoma

  • granulosa cell

  • Sertoli-Leydig Cell

  • gonadoblastoma

  • steroid cell tumours

• metastatic

  • GI tract

  • breast

History

• abdominal distension due to ascites

• epigastric discomfort

• dyspepsia

• urinary frequency

• weight change

Examination

• pelvis mass

• ascites

• pleural effusion

Investigations

• FBC / U&E / LFTs / CA 125

• CXR

• CT scan

• PET scan

• Laparotomy

Staging

• Stage 1 - limited to ovaries

• Stage 2 - ovaries and pelvis

• Stage 3 - ovaries and upper abdomen

• Stage 4 - distant metastasis

Treatment

• Very early disease (stage 1ai) - unilateral salpingoopherectomy + removal omentum

• Advanced disease - TAH + BSO + omentectomy + para-aortic nodes +/- cisplatinum & taxol