Ovarian Carsinoma

Divisi Onkologi Ginekologi

Bagian Obstetri & Ginekologi
FK - USU
 Definition
Malignancy primary originated from ovarian
tissue
Epithelial originated: are most common
(90%)
Non epithelial originated:
Germ cell
Sex cord - stromal
 Etiology: ?
Factors important in the carsinogenesis:
Endocrine factor
Environmental factors
genetic factors
Risk factors:
Nulliparity
Family history
Early menarche and late menopause
White race
Increasing age
 Etiology : ?

Variety of epidemiologic variables

Low parity and infertility
Talc use :
Tubal ligation :
Oral contraceptive 5 years :
Genetic ( 5 10% )
Early menarche and late menopause
 Prevention
Oral contraception (women with hereditary
BRCA 1 and BRCA2 mutation)
Tubal ligation
Prophylactic oophorectomy
Screening: (not cost effective)
Tumor marker
Ultrasonography (transvaginal)
Gynecologic examination
 Diagnosis

Requires an exploratory laparotomy

Frozen section
Paraffin block
75%-85% diagnosed: has spread through
peritoneal cavity
Early stage : during routine pelvic
examination
Differential diagnosis

Benign neoplasm
Functional cyst
Non gynecologic
 Staging

I Tumor confined to the ovaries

IA tumor limited to one ovary, capsule intact . No tumor
on ovarian surface. No malignant cells in the ascites or
peritoneal washing.
IB tumor limited to the both ovaries, capsule intact. No
tumor on ovarian surface. No malignant cells in the
ascites or peritoneal washing.
IC tumor limited to one or both ovaries, with any of
following: capsule rupture, tumor on ovarian surface,
positive malignant cells in the ascites or peritoneal
washing.
II Tumor involves one or both ovaries with pelvic extension.
IIA extension and/or implants in uterus and/or tubes. No
malignant cells in the ascites or peritoneal washing.
IIB extension to other pelvic organ. No malignant cells in
the ascites or peritoneal washing.
IIC IIA/B with positive malignant cells in the ascites or
peritoneal washing
 Staging

III Tumor involves one or both ovaries with

microscopically confirmed peritoneal metastasis outside
the pelvic and /or regional lymph node metastasis
IIIA microscopic peritoneal metastasis beyond the pelvis
IIIB macroscopic peritoneal metastasis beyond the pelvis
2cm or less in greatest dimension
IIIC peritoneal metastasis beyond pelvis more than 2 cm in
greatest dimension and/or regional lymph node
metastasis
IV Distant metastasis beyond the peritoneal cavity
 Surgery
Staging
Fluid : cytologic examination
Peritoneal washing
Systematic abdominal exploration
Biopsy at any suspicious areas
Omentum resection (infracolic omentectomy)
Lymph node evaluation / selected lymphadenectomy
TAH + BSO
Appendectomy for mucinous tumor
Conservative : I A + preserve fertility
Debulking or cytoreductive surgery
Rationale for cytoreductive

Physiologic benefit
Improve tumor perfusion
Increase growth fraction
Enhance immunologic
 Physiologic benefit

Reduce ascites volume

Alleviate nausea and satiety
Restore intestinal function
Improve nutritional status
 Tumor perfusion

Bulky tumor : poor vascularisation

Chemotherapy concentration
Poorly oxygenated
 Growth fraction

Non dividing / resting phase (G0)

Resistant to the therapy
Fractional cell kill hypothesis
 Immunologic

Large mass immunosuppressive

Host defense mechanism
Cytotoxic lymphocyte
Adjuvant therapy

No adjuvant
Chemotherapy
Radiation
Hormonal
Immunotherapy
 No adjuvant

Stage I A grade 1
Stage I A I B grade 1 & 2
Non high risk
 Chemotherapy
High risk
Combination
Cisplatin base
Cisplatin + paclitaxel
Intravenous
Intraperitoneal : ?
Neoadjuvant
Interval debulking
 Radiation

Whole abdomen
Some institution in Canada
Not been tested against chemotherapy
 Hormonal

Not appropriate as primary therapy

Progestional agent
Recurrent case
For : well differentiated endometrioid
(+) ve estrogen receptor
 Immunotherapy
Various trial
Corynebacterium parvum
Bacillus Calmette Guerin (BCG)
Conjunction with cytotoxic chemotherapy
Benefit : ?
Cytokine, interferon, interleukin
Monoclonal directed antibody
Herceptin : HER 2 / neu