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