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Ovaries and

oviducts
General introduction
 The fifth most
common cancer in
women
 1/70 of newborn
girls will develop
ovarian cancer.
Etiology
 Unknown
 Repeated ovulation
 Infertility treatment
 Polycystic ovarian syndrome ( PCOS )
 Chromosomal abnormal: Turner’s
syndrome ( 45,XO )
 Hereditary : ( BOC –breast and ovarian
cancer syndrome )
 P53 gene
Histopathology
 Epithelial neoplasms
 Germ cell neoplasms
 Sex cord-stromal tumors of the ovary
 Neoplasms metastatic to the ovary
Epithelial neoplasms (over
60% of all; over 90% of
malignant)
 Serous neoplasms: ovarian serous
cystadenocarcinoma – common one,
bilateral in 50%,
 Mucinous neoplasms:
 Endometrioid neoplasms: bilateral in
40%.
 Clear cell carcinoma: hypercalcemia,
hyperpyrexia, cystic and solid, clear
cell and hobnail cell.
Germ cell neoplasms
( 20-30+years, better
prognosis )
 Dysgerminoma : unilateral in 90%,
solid, malignant
 Endodermal sinus tumor: ( yolk sac
tumor ), acute abdomen alpha-
fetoprotein (AFP),malignant
 Immature teratomas: malignant, AFP
 Mature teratomas: 2% malignant in
40years.
 Embryomal carcimoma: malignant,
hCG/AFP
Sex cord-stromal tumors of
the ovary
 Granulosa cell tumors: malignant,
hyperestrogenism, precocious
puberty,
 Ovarian thecoma: benign
 Ovarian fibroma: Merg’s syndrome –
the occurrence of an ovarian
fibroma, ascites, and pleural effusion,
which collectively mimic the
presentation of ovarian cancer.
 Sertoli-stromal cell tumors:
Neoplasms metastatic to
the ovary
 25% of all malignant.
 Bilateral
 From: breast, stomach, colon,
endometrium
 Krukenberg tumors: (from stomach)
Diagnosis
 Gastrointestinal complaints: nausea,
dyspepsia
 Distention: ascites, constipation
 Pain, urinary retention, rectal
discomfort, obstruction
 Menstrual abnormal
 Examination \ ultrasound\ CA125.
Staging
 Stage I: limited to the ovaries. a– one
ovary; b– both; c-- rupture, ascites(+),
peritoneal cytology (+)
 Stage II: extension to pelvic. a– uterus or
tube; b– others; c– a or b rupture,
ascites(+), peritoneal cytology (+)
 Stage III: abdominal cavity. a– microscopic
metastases; b-- <2cm; c-- >2cm, inguinal
lymph node(+), liver surface.
 Stage IV: distant.
Surgical treatment of
epithelial ovarian cancer
 Surgery is cornerstone, over 70% of
patients have metastases beyond the
pelvis.
 Fluid or peritoneal washings should
be obtained.
 Bilateral adnexectomy;
hysterectomy; infracolic
omentectomy ( omentum );
cytoreductive surgery.
Surgical treatment of germ
cell neoplasms
 Young patients: removal of the
involved adnexa
 Contralateral ovary biopsy is not
recommended.
Chemotherapy of
epithelial
 Stage Ia and grade I no need
chemotherapy.
 Others –undergo systemic
chemotherapy
 Cisplatin, carboplatin,
cyclophosphamide, paclitaxel
 Paclitaxel 175mg/m2+ cisplatin
75mg/m2or carboplatin – prefer. 6
cycles at 3-week intervals.
Chemotherapy of germ
cell
 Dysgerminoma – radiation-sensitive.
 Curable
Complications of
chemotherapy
 Cisplatin : nephrotoxicity, neurotoxicity,
ototoxicity
 Carboplatin: thrombocytopenia, neutropenia
 Cyclophosphamide: hemorrhagic cystitis,
pulmonary fibrosis
 Paclitaxel: myelosuppression
 Altretamine: peripheral neuropathy
 Etoposide: myelosuppression
 Bleomycin: pulmonary fibrosis
 Doxorubicin: cardiac toxicity
 Vincristine: neuropathy
 Ifosfamide: hemorrhagic cystitis, central
neurotoxicity
Radiation therapy
 Dysgerminoma
Prognosis
 5-yrs survival epithelial stage I 76-
93%
 Stage II 60-74%
 Stage III 23-41%
 Stage IV 11%
 Dysgerminoma 95%
 Immature teratoma 70-80%
 Endodermal sinus 60-70%
Malignant neoplasms of the
fallopian tube
 Etiology : 0.3%
 Clinical presentation: sixth decade,
Latzko’s sign – watery vaginal
discharge and palpable adnexal
mass.
 Histopathology: papillary carcinoma
(95%), bilateral in45%, fusiform or
sausage-shaped
 Treatment: same with epithelial.
 Prognosis: 5-yrs survival 50%.