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Zhai jianjun
Department of Obstetric &
Gynecolgy
Beijing tongren hospital
卵巢肿瘤概论
Histological types vary
Ovarian cancer: one of the three comm
on female genital carcinoma
Usually found during later period
Mortality of ovarian germ cell tumors ha
s dropped as a result of effective chem
otherapy
Epithelial ovarian cancer has become t
he major threaten to women's lives
Classification Manifestation Complication Metastasis Clinical stage Diagnosis
Histological classification
Coelomic epithelial origin(80%~85%)
"Common" epithelial tumor; benign,
borderline, malignant
Undifferentiated carcinoma
Carcinosarcoma or malignant mixed
mesodermal tumors
Histological classification
Germ cell origin(10%~15%)
Teratoma
Dysgerminoma
Endodermal sinus tumor
Embryonal sinus tumor
Choriocarcinoma
Gonadoblastoma
Mixed germ cell tumors
Histological classification
Specialized gonadal-stromal origin(3%~5%)
Granulosa-theca cell tumors
Sertoli-Leydig tumors
Gynandroblastoma
Lipid cell tumors
Histological classification
Nonspecific mesenchymal origin(fewer than 1
%)
Fibroma, hemangioma, leiomyoma, lipoma
Lymphoma
Sarcoma
Clinical manifestations
Clinical manifestations
Advanced-stage ovarian cancer
Abdominal pain
swelling
Abdomeinal mass
Signs
A solid ,irregular ,fixed pelvic mass ,s
ometimes combined with an lower par
t abdominal mass , ascites,or both
Complications
Torsion
Rupture
Infection
Malignancy
Torsion
Fallopian tube
Pelvic ligament funnel
Intrinsic ovarian ligament
Diagnosis:
Screening for ovarian cancer—very difficulty
Ultrasonography and available tumor markers ar
e not feasible
For example, CA125 lack specificity and sensitivi
ty.
diagnosis
Basic examination
History, symptoms, pelvic examination, physical
examination
Special examination
B-mode ultrasound examination
Tumor markers
Laparoscopy
Diagnostic Radiology
Cytology
diagnosis
Uterine myoma
Preoprative evaluation
Routine preoprative hematologic and bioche
mical studies
Chest radiograph
Pelvic and abdominal CT scan
Endometrial biopsy
Endocervical curettage
Abdominal radiograph
Gastrointestinal endoscopy
Pelvic ultrasonography
Tumor markers
Age
Propertys and range of lesions
Fertility requirements
Surgery,espescialy micro-invasive operati
on,such as laparoscopy
Surgery:
Chemical treatment
Radiation therapy
Immunotherapy
Thermal treatment
Prognosis
prevention
metastatic cancers
Epithelial ovarian carcinomas Germ cell tumors Specialized gonadal-stromal tumors
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Serous cystadenoma
Resemble fallopian
tube epithelium
Common. Accounte
d for 25% of benign
ovarian tumors.
Mostly unilateral, s
mooth surface, cyst
ic, capsule filled wit
h clear yellow liquid
.
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Serous cystadenocarcinoma
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Mucinous cystadenoma
Resemble endocervical
epithelium
Common, accounting for
20% of benign ovarian tu
mors
Mostly unilateral, round
or oval, smooth, larger o
r huge.
Section for multi-room, fil
led with jelly-like mucous
cysts.
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Mucinous cystadenocarcinoma
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
treatment
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
treatment
Advanced stage tumors: cytoreductive surgery
("debulking")—to remove the primary tumor and
all of the metastases,if possible.
If all macroscopic disease cannot be removed, a
n attempt should be made to reduce individual tu
mor nodules to 1cm or less in diameter.
In patient who are medially unfit or have a poor p
erformance status, give two or three neoadjuvant
chemotherapy before radical surgery.
Not respond to chemotherapy—palliative care.
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
treatment
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
treatment
Second-Look Laparotomy(if necessay)
To determine whether the patient, who are
clinically free of disease after completing c
hemotherapy, has had a complete respons
e to chemotherapy
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Prognosis
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Dysgerminoma
Medium malignant s
olid tumors.
Occur in adolescenc
e and childbearing w
omen.
Round or oval, medi
um sized, solid, suc
h as rubber-like touc
h.
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Endodermal sinus t
umor
Rare, highly malignant
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Myeloid tumor:
Low grade, can secrete estrogen, Call-Ex
ner bodies, surrounded by granulosa cells into
small round cysts, arrange cauliflower
Theca cell tumor:
With endocrine function, often co-exist wit
h the granulosa cells, solid cut surface, white
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Fibroma:
Meig's syndrome: often a
ccompanied by pleural effusi
on
Sertoli cell - Leydig c
ell tumor (testicular n
euroblastoma):
Body with bloody serous and
mucus, a masculine role
Tumor cells produce estroge
n.
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
Krukenberg tumor:
The primary site i
s gastrointestinal tract,
bilateral, multi-ascites, s
howing signet-ring cell
metastatic cancers
Epithelial ovarian tumors Germ cell tumors Specialized gonadal-stromal tumors
treatment
Benign tumors: surgery
malignant tumors:
Surgery
Chemotherapy
Radiation therapy
Metastatic ovarian Tumors: surgery, chem
otherapy
metastatic cancers
Summary
Hard to find ,poor prognosis
Stage
Surgery is the major choice , combine with
chemotherapy and radiotherapy
5 year survive is still poor