Ovarian Tumors genera characteristics, classification Flashcards
General characteristics of ovarian Tumours
Peak incidence of 60-70 years Early presentation (20-30) usually has genetic link
Classified according to ovarian site of origin
- surface epithelial cells
- germ cell
- sex chord
- metastatic
Risk factors for ovarian Tumours
1)Genetic predisposition
BRCA1/BRCA2 mutation
-history of breast cancer or early age breast cancer increases risk
HNPCC/Lynch syndrome
2)Hormonal imbalance and freq menstrual cycle
Elevated number of lifetime ovulations (contraceptive pill has a protective effect)
Infertility/low number of pregnancies
Early menarche and late menopause
PCOS
What is lynch syndrome/ HNPCC ( Lynch your EGO lose your RECTUM)
Hereditary non polyploid colon cancer
familial cancer syndrome caused by an autosomal dominant mutation in DNA mismatch repair (MMR) genes.
Patients develop a small number of adenomas that can rapidly progress to colorectal cancer (CRC), resulting in earlier presentation compared to sporadic colorectal cancer.
HNPCC causes increased risk of other forms of cancer
endometrial, gastric, and ovarian cancer.
The patients are asymptomatic until presenting with symptoms of advanced cancer.
What is PCOS
disorder characterized by 1.hyperandrogenism 2.oligoovulation/anovulation 3.polycystic ovaries
dg of exclusion of disorders with a similar clinical picture (!!congenital adrenal hyperplasia!!!) long term hypothyroidism,
50% of PCOS patients have metabolic syndrome, associated with; obesity, insulin resistance, hypercholesterolemia, and an increased risk for endometrial cancer.
Sx of PCOS hirsutism, acne, and virilization.
Diagnostic methods include a pelvic exam, blood tests for specific hormones( androstenedione, LH high,FSH low, thyroid hormones normal) and ultrasound.
Management consists of
weight loss via lifestyle changes
oral contraception pills in women who do not wish to conceive.
The aim of treatment in women who desire to conceive is to normalize ovarian function and stimulate follicular growth
Classification of ovarian Tumours
Epithelial Tumours (3)
- CYSTADENOMA/CARCINOMA
- ENDOMETROID CARCINOMA
- CLEAR CELL
germ cell Tumours
- TERATOMA
- DYSGERMINOMA
- YOLK SAC TUMOUR
- NON GESTATIONAL CHORIOCARCINOMA
sex cord Tumours
-oestrogen producing
1)GRANULOSA CELL TUMOUR
2THECA CELL TUMOUR
-androgen producing
SERTOLI LEYDIG CELL TUMOUR
OVARIAN FIBROMA
Metastasis
- KRUKENBURG
- endometrium
- breast
Epithelial Tumours (3)
65–75% of all ovarian tumors;
70% of all malignant ovarian tumors
- CYSTADENOMA/CARCINOMA
- serous- cystsdenoma most common. Usually MG
- mucinous- 2nd most common
- ENDOMETROID CARCINOMA
- usually mg
- assoc w/ endometriosis and endometrial cancer
-CLEAR CELL
germ cell Tumours (4)
- TERATOMA: develop from all three embryological germ layers
- mature
- immature
-DYSGERMINOMA: most common malignant ovarian tumor in young women (20–30 years); female histological equivalent to the male seminoma
- YOLK SAC TUMOUR
- Usually MG
- common in childhood or teenagers
- NON GESTATIONAL CHORIOCARCINOMA
- super rare
- produce BHCG
sex cord stromal Tumours 2 types according to hormone production
- oestrogen producing
1) GRANULOSA CELL TUMOUR(mg)
2THECA CELL TUMOUR( benign)
Androgen producing: sertoli leydig cell tumour
Ovarian fibroma
Benign, although may cause Meigs’ syndrome
Metastatic ovarian Tumours
GI
BREAST
ENDOMETRIAL
KRUKENBURG: bilateral ovarian metastases from an undifferentiated gastric carcinoma (mucin-secreting, signet ring cell carcinoma)
Differentiation
GX Differentiation cannot be assessed • GB Borderline tumor • G1 Well differentiated • G2 Moderately differentiated • G3 Poorly differentiated • G4 Undifferentiated
Patterns of Spread
- Local spread: retroperitoneally by cells’ exfoliation in pelvis
- Peritoneal carcinosis: intraperitoneal spread after rupture of the ovarian capsule
- Lymphatic metastasis: para-aortic lymph nodes, in rare cases retrograde invasion of inguinal / femoral lymph nodes
- Hematogenous metastasis to liver, lung, CNS, in rare cases bone involvement
T 1classification
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor limited to ovaries A: limited to one ovary, capsule intact B: limited to both ovaries, capsule intact C: rupture of capsule, tumor cells on ovarian surface
T2 Tumor extending into the pelvis
A: invasion of the uterus and/or the fallopian tubes
B: invasion of other pelvic organs
C: tumor cells in ascites / peritoneal lavage
T3 Metastasis beyond the pelvis, peritoneal involvement
A: microscopic detection
B: tumor size ≤ 2 cm
C: tumor size > 2 cm
Figo staging
FIGO stage TNM stage
T N M Stage I T1 N0 Mo Stage II T2 N0 M0 Stage III T3 N0 M0 Stage IV Any T any N M1
