Ovarian Tumours Flashcards
Tumor marker CA125 increased in:
90% of epithelial tumours
Tumour marker HCG increased in:
Choriocarcinoma
Alpha-feto protein increased in:
Endodermal sinus tumours
carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 increased in:
Mucinous tumours
Lactate dehydrogenase increased in:
Dysgerminoma
Functional non neoplastic tumors:
Follicular cyst : <3cm
Luteal cyst:
1. Corpus luteal cyst: hge into cyst
2. Theca luteal cyst: +HCG, a/w hydatidiform mole, chorioca-clomid or gonadotropine therapy
Pathological non-neoplastic tumors:
Ovarian Endometriotic cyst
PCOS
Benign tumors:
Epithelial tumors
Benign germ cells tumors
Sex cord stromal tumors
Benign Epithelial tumors
Serous cyst adenoma
Mucinous cyst adenoma
Brenner tumor
Benign germ cells
Mature teratoma or dermoid cyst
Benign sex cord stromal tumors;
Fibroma
Sertoli-leydig cell
Thecoma
Lipoma
Neoplastic tumors:
Surface epithelium
Serous cyst adenoma : CA125
Mucinous cyst adenoma: CEA&C19, 9
Clear cell tumor: worst prog, hobnail cells
Endometrioid: a/w EC
Brenner: most are benign
Germ cell tumors embryonic
- Teratoma: adolsencenc, unilateral symptomless unless ruptured
- Dysgerminoma (common form of malignancy in germ cells): phenotypic femal, bilateral, radiosensitive (good prog) ++LDH
- Extra embryonic: Endodermal sinus tumor: secrete AFP and non-gestational chorio carcinoma secrete HCG
4.Gonado plastima - 2ry tumors from metastasis (krukenberg) : bilateral? Signal ring cells
Sex cord tumors(stromal tumors):
Granulosa &theca cell tumor
Sertoli-leydig cells (androblastoma or arrhenoblastima)
Gynandroblastoma
Fibroma
It may produces estrogen, cause precocious puberty and postmenopausal bleeding
Granulosa & theca cell tumor
It secrets androgen musculining tumour amd causes virilisarion
Sertoli-leydig cells
It secretes androgen at its sex cord tumor and contains male and female cell type
Gynandroblastoma
Lobulated bilateral, it causes Meig’s syndrome (ascitis+hydrothorax)it is a non-secreting tumor
Fibroma
Clinical presentation:
Usually asymptomatic unless if rupture or torsion causes pain
Abdominal fullness
Irregular P/V bleeding-loss of weight
urinary symptoms if press bladder
precocious puberty if secreting estrogen
On examination :
–weight
Respiratory exam (Pleural effusion? Ascitis, mass)
PV Bimanual examination
Pulge mass> solid or soft regular or iiregular if cystic if fixed or not & if there is nodular suggesting endometriosis
D/D
Pregnancy
Ascitis
Bladder
Ectopic pregnancy
Hydronephrosis
Pelvic kidney
Fibroid
Tubo ovarian abscess
Investigations
Tumor markers:
CA125 ++ in 90% of epith. Tumor
CEA, CA19-9 + in mucinous tumor
AFP + in endometrial sinus tumors
LDH> in dysgerminoma
Other investigation
CBP: U&E , LFT, especially Albumin
USS
Doppler; for tumor that may show ++ vascularity
MRI & CT
IV Pyelography : suspect renal involvement
Barium enema if rectal involvement
Treatment of benign:
Cystectomy: wish to preserve fertility
Ovarectomy : if large tumor
Hyst.BSO: if her family completed
Treatment of malignancy:
staging laparatomy through mid line incision:
Hyst
BSO
Omentectomy
Lymph node sampling
Pertoneal biopsies -Scrubbing of diaphram
Pelvic washing or ascitis sampling
Treatment of malignancy
If tumor is advanced:
Debulking or cytoreductive surgery: The aim is to remove as much tumor as possible
Treatment of malignancy
Germ cell tumor confined to single ovary
Unilateral slpingeo-oophorectomy & preserve contralateral ovary, and it may need chemotherapy
Chemotherapy
Ised after surgery
Examples of chemotherapy that used in ovarian tumours with S/E
Platinum:
Cisplatinum: nephrotoxic, neurotoxicity peripheral neuropathy auto toxicity
Carboplatin: thrombocytopenia &leukopenia
Taxol:
Paclitaxel: hypersensitivity reaction, mucositis-neutropenia-alopecia, BM- depression, arrhythmia and heart attack
