Ovarian Cancer

Ovarian Cancer 

            Any of the conditions we just talked about:

            Ovarian neoplasms

-          Epithelial 75%

-          Germ Cell 20%

-          Stromal 5% 

-          Screening – none; the methods we have are not good for screening everybody.

-          Exam – may not be able to detect anything until it’s too late

-          Ultrasound – not financial feasible to ultrasound everybody.

-          CA-125 – this is a protein that can be found in the blood; it is elevated in ovarian cancer as well as in other conditions, such as inflammation.

-          Symptoms – often none or nonspecific until an advanced stage.

o        – the patient may present with fullness, bloating, constipation.

-          Simplified staging

o        Stage I – Ovaries

o        Stage II – Pelvic extension

o        Stage III – Peritoneal implants/regional nodes

o        Stage IV – Distant metastasis 

Etiology 

-          Unknown

-          Genetics – involved in a small % of cases

-          “Incessant ovulation” – a theory from the 1920s regarding trauma and ovulation and germinal inclusion cysts. But no one knows for sure.

-          Increased risk with nulliparity (having never been pregnant)

-          Decreased risk with oral contraceptives
 

Metastatic Tumors to the Ovary 

-          Krukenberg tumor – metastatic signet ring tumor of the ovaries

o        Origin: GI, breast

o        Keep the shape of the ovary

o        Histological feature – signet ring cell – mucinous material pushing the nucleus over to the edge of the cell. 

As an aside, four organs get metastases from everywhere in the body: The liver, the lungs, the brain, and the ovaries. Bilateral symptoms would make you think metastases.

Evaluating an Ovarian Mass 

-          Examination – the bimanual exam

-          Ultrasound – more often trans-vaginal rather than abdominal.

-          CA-125

-          Laparoscopy

-          Laparotomy

-          Role of Frozen sections: intra-operative consultation –  performed to plan the operation. This is basically a rush order for a slide during surgery while the patient is on the table.

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