Ovarian Cancer: Zhai Jianjun Department of Obstetric & Gynecolgy Beijing Tongren Hospital

Ovarian Cancer
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
Differentiation Treatment Prognosis

 Germ cell origin(10%~15%)
Teratoma
Dysgerminoma
Endodermal sinus tumor
Embryonal sinus tumor
Choriocarcinoma
Gonadoblastoma
Mixed germ cell tumors

 Specialized gonadal-stromal origin(3%~5%)
Granulosa-theca cell tumors
Sertoli-Leydig tumors
Gynandroblastoma
Lipid cell tumors

 Nonspecific mesenchymal origin(fewer than 1
%)
Fibroma, hemangioma, leiomyoma, lipoma
Lymphoma
Sarcoma

Overview to ovarian cancer
 Risk of ovary cancer
 The patient characteristics found to be assoc
iated with an increased risk for epithelial ova
rian cancer include white race,late age at me
nopause,family history of cancer of the ovary
,breast or bowel,and prolonged intervals of o
vulation uninterrupted by pregnancy.
 High risk of ovarian caner in nulliparous wom
en and those who have been infertile.
Benign or malignant ?
 1,age
 2,history
 3,sign
 4,B scan
 5,CA125,HE4,199,153,CEA,AFP,HCG
 LDH,
Divided into 3 referred to cell differentiation
 Differentiation 1:highly differentiated

 Differentiation 2:moderate differentiated
 Differentiation 3:low differentiated

Clinical manifestations
Early-stage ovarian cancer

 Vague abdominal pain or bloating
 Symptom of a mass compressing the blad
der or rectum:urinary frequency or constip
ation
 Menstrual irregularity

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

Rupture: spontaneous or external force
 Rupture because of torsion

Metastasis of ovarian cancer
 Directly spread and peritoneal metastasis

 Lymph node metastasis
1, Along the ovarian vessels

2, Along ovarian lymphatic door to iliac int
ernal and external lymph nodes
3,Along round ligament to iliac external a
nd inguinal lymph nodes

Aortic lymph nodes
Common iliac lymph nodes

Iliac internal lymph nodes
Inguinal lymph nodes


Clinical stage of ovarian cancer
 Phase I: Growth limited to ovaries

Ia: Growth limited to one ovary; no ascites. No tumor
on the external surface; capsule intact
Ib: Growth limited to both ovaries; no ascites. No tu
mor on the external surfaces; capsule intacts
Ic: Tumor either stage Ia or Ib but with tumor on the
surface of one or both ovaries or with capsule ruptured o
r with ascites present containing malignant cells or with p
ositive peritoneal washings

Clinical stage of ovarian cancer
 Phase II: Growth involving one or both ovaries

with pelvic extension
II a: Extension or metastases, or both, to the uterus o
r tubes, or both
II b: Extension to other pelvic tissues
II c: Tumor either stage IIa or IIb but with tumor on th
e surface of one or both ovaries or with capsule or capsu
les ruptured or with ascites present containing malignant
cells or with positive peritoneal washings

Clinical stage of ovarian tumors
 Phase III: Tumor involving one or both ovaries wi

th peritoneal implants outside the pelvis or positi
ve retroperitoneal or inguinal nodes, or both. Su
peficial liver metastasis equals stage III. Tumor i
s limited to the true pelvis, but with histologically
proven malignant extension to small bowel or o
mentum

IIIa: Tumor grossly limited to the true pelvis with nega

tive nodes but with histologically confirmed microscopic s
eeding of abdominal peritoneal surfaces
IIIb: Tumor of one or both ovaries with histologically
confirmed implants of abdominal peritoneal surfaces, no
ne exceeding 2 cm in diameter. Nodes negative for disea
se
IIIc: Abdominal implants >2 cm in diameter or positiv
e retroperitoneal or inguinal nodes, or both

Clinical stage of ovarian tumors
 Phase IV: Growth involving one or both ovaries

with distant metastasis. If pleural effusion is pres
ent, there must be positive cytologic test results t
o allot a case to stage IV. Parenchymal liver met
astasis equals to stage IV.

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

Differentiation of benign and malignant o

varian tumors
 Age
 Course of disease
 Nature and location of mass
 Ascites
 B-mode ultrasound
 Tumor markers:CA-125,CA199,CEA,AFP,HCG

Benign, borderline and malignant giant c

heck to identify
benign borderline malignant
Papillae （乳 Less,Small or Lot, Film-like Lot, Rough, cauliflower-

头） verrucous hairy like （菜花）
（疣）
Solid area no yes 2 / 3 semi-qualitative
Capsule rupture no yes beyond 51%
Peritoneal no yes more
Hemorrhage No, clear liquid yes more

and necrosis

Benign, borderline and malignant microscopic identification

benign borderline malignant
Cell arrangement neat little loss of loss of polarity

polarity
Cell proliferation single layer 2-3 layers Above 4 layers

Cilia （纤毛） yes Can be no sometimes
Mitotic( 有丝分裂 ) no less(<1/HP) more(> 1/HP)
back to back of the no yes The phenomenon

gland of wall
New glands No or less More, more cribriform
interstitial cavities
Interstitial infiltration no no yes

Differential diagnosis of benign ovarian tumor

s
 Ovarian tumor-like lesion
 Tubal ovarian cyst
 Uterine myoma
 Pregnant uterus
 Ascites

Differential diagnosis of malignant ovaria

n tumors
 Endometriosis
 Pelvic connective tissue inflammation
 Tuberculous peritonitis
 Tumors outside the reproductive tract
 Metastatic ovarian tumors

 Uterine myoma
Tubal ovarian cyst

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

Treatment of benign tumors
 Age
 Propertys and range of lesions
 Fertility requirements
 Surgery,espescialy micro-invasive operati
on,such as laparoscopy

Treatment of malignant tumors
 Surgery:
 Chemical treatment
 Radiation therapy
 Immunotherapy
 Thermal treatment

Prognosis



Follow-up and monitoring
 Time:After operation: monthly

After the second year: once every 3 months
After the third year: once every 6 months
More than three years: once a year
 Content:Clinical symptoms, signs,
Systemic and pelvic examination
B ultrasound, CT, MRI
PET-CT,
Tumor markers

prevention
 Prevention of risk factors

 To carry out survey :
 Early detection and treatment:B mode ultr
asound,

Epithelial ovarian carcinomas Germ cell tumors Specialized gonadal-stromal tumors
Epithelial ovarian tumur overvie

w
 The most common ovarian tumors
 Age of onset is 30 to 60 years old
 Benign, borderline and malignant
metastatic cancers
Epithelial ovarian carcinomas Germ cell tumors Specialized gonadal-stromal tumors
Disease risk factors

 Genetic and familial factors:Pass breast - ovarian cance
r syndrome: BRCA1 BRCA2; site - specific ovarian canc
er syndrome: familial; II type Lynch syndrome: endometr
ial, breast, ovarian, colon; autosomal dominant feature
 Environmental factors and lifestyle:Asbestos, talc, high d
oses of lactose, animal fat, whole milk powder, coffee, lo
w-iodine
 Endocrinefactors:Hormone,Menstrual,Marriag,Fertility,Br
east-feeding,Contraceptives
 Continued ovulation:Application of ovulation induction dr
ugs
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
Borderline serous cystadenoma
 Medium size, mostly bil

ateral. Intracystic papill
ary growth in the less.
 Microscope, no more th
an three-stratified epith
elium, no Interstitial infil
tration
 5-year survival rate of 9
0%
metastatic cancers
Serous cystadenocarcinoma
 The most common ov

arian cancer
 Mostly bilateral, larger,
semi-substantial.
 Multi-room section, ca
vity filled nipple.
 Significant cellular aty
pia, and to interstitial i
nfiltration.
 5-year survival rate of
20 to 30%
metastatic cancers
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
Borderline mucinous cystadenoma
 Section wall thickening, parenchyma and

nipple shape, nipple is small and soft.
 Microscopically, the epithelium is not mor
e than three cells with mild atypia
 No Interstitial infiltration
metastatic cancers
Mucinous cystadenocarcinoma
 Nipple visible wall o

r parenchyma, cut h
alf-solid half-sac
 Significantly abnor
mal cells, and inters
titial infiltration
 5-year survival rate
of 40 to 50%
metastatic cancers
Endometrioid ovarian tumors
 Rare benign tumor.

 Malignant:Mostly uni
lateral, of moderate
size, cystic or solid,
with nipple growth.
 5-year survival rate
of 40 to 50%
metastatic cancers
treatment
 Early stage tumors ： the standard operation is t

otal abdominal hysterectomy, bilateral salpingo-o
ophorectomy, infracolic omentectomy, and thoro
ugh surgical staging.
 People who wish to preserve fertility may have a
unilateral salpingo-oophorectomy
 No further treatment is necessary in patients wit
h grade 1 or 2 tumors confined to one or both ov
aries after surgical stage
 Patients with grade 3 tumors are subsequently tr
eated with systemic chemotherapy
metastatic cancers
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
treatment
 Combination chemotherapy after cytoredu

ctive surgery—most commonly intravenou
s carboplatin and paclitaxel, or intraperiton
eal cisplatin and paclitaxel.
 Single-agent therapy with paclitaxel, or car
boplatin, is only for frail or elder people.
metastatic cancers
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
Prognosis
 Almost all patient with stage Ia grade Ⅰare

cured surgically.
 5-year survival rate for poor differentiated
bilateral lesions of stage Ia is 75%
 5-year survival rate for stage II is 65%
 5-year survival rate for stage III is 20%
 A prolonged survial is expected in patients
of borderline ovarian tumors
metastatic cancers
Ovarian germ cell tumors

 Mature teratoma (benign):Ca
vity full of grease and hair, te
eth and bones are sometimes
visible.
Ovarian goiter - thyroid horm
one secretion – hyperthyroidi
sm
 Immature teratoma(malignan
t)
:Mainly the original nerve tiss
ue
metastatic cancers
 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
 Endodermal sinus t
umor
 Rare, highly malignant
 More common in childre

n and young women
 Mostly unilateral, large T
umors, round or oval
metastatic cancers
Ovarian 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
Ovarian 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
Metastatic ovarian tumors
 Breast, bowel, stomach,

reproductive tract, urinar
y tract
 Krukenberg tumor:
The primary site i
s gastrointestinal tract,
bilateral, multi-ascites, s
howing signet-ring cell
metastatic cancers
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

Ovarian Cancer: Zhai Jianjun Department of Obstetric & Gynecolgy Beijing Tongren Hospital

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Ovarian Cancer: Zhai Jianjun Department of Obstetric & Gynecolgy Beijing Tongren Hospital

Hochgeladen von

Copyright:

Verfügbare Formate

Ovarian Cancer

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Divided into 3 referred to cell differentiation

 Differentiation 1:highly differentiated

Differentiation Treatment Prognosis

Early-stage ovarian cancer

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Rupture: spontaneous or external force

 Rupture because of torsion

Differentiation Treatment Prognosis

Metastasis of ovarian cancer

 Directly spread and peritoneal metastasis

1, Along the ovarian vessels

Differentiation Treatment Prognosis

Aortic lymph nodes

Common iliac lymph nodes

Inguinal lymph nodes

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Clinical stage of ovarian cancer

 Phase I: Growth limited to ovaries

Differentiation Treatment Prognosis

Clinical stage of ovarian cancer

 Phase II: Growth involving one or both ovaries

Differentiation Treatment Prognosis

Clinical stage of ovarian tumors

 Phase III: Tumor involving one or both ovaries wi

Differentiation Treatment Prognosis

IIIa: Tumor grossly limited to the true pelvis with nega

Differentiation Treatment Prognosis

Clinical stage of ovarian tumors

 Phase IV: Growth involving one or both ovaries

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis

Differentiation of benign and malignant o

Differentiation Treatment Prognosis

Benign, borderline and malignant giant c

Papillae （乳 Less,Small or Lot, Film-like Lot, Rough, cauliflower-

Capsule rupture no yes beyond 51%

Peritoneal no yes more

Hemorrhage No, clear liquid yes more

Differentiation Treatment Prognosis

Benign, borderline and malignant microscopic identification

Cell arrangement neat little loss of loss of polarity

Cell proliferation single layer 2-3 layers Above 4 layers

back to back of the no yes The phenomenon

Differentiation Treatment Prognosis

Differential diagnosis of benign ovarian tumor

Differentiation Treatment Prognosis

Differential diagnosis of malignant ovaria

Differentiation Treatment Prognosis

Tubal ovarian cyst

Differentiation Treatment Prognosis

Differentiation Treatment Prognosis