The Ovaries and Oviducts

8/14/2019 The Ovaries and Oviducts

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Ovaries andOvaries and

oviductsoviducts


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General introductionGeneral introduction

The fifth mostThe fifth most

common cancer incommon cancer in

womenwomen

1/70 of newborn1/70 of newborngirls will developgirls will develop

ovarian cancer.ovarian cancer.


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EtiologyEtiology

UnknownUnknown

Repeated ovulationRepeated ovulation

Infertility treatmentInfertility treatment

Polycystic ovarian syndrome ( PCOS )Polycystic ovarian syndrome ( PCOS )

Chromosomal abnormal: TurnersChromosomal abnormal: Turners

syndrome ( 45,XO )syndrome ( 45,XO )

Hereditary : ( BOC breast and ovarianHereditary : ( BOC breast and ovariancancer syndrome )cancer syndrome )

P53 geneP53 gene


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HistopathologyHistopathology

Epithelial neoplasmsEpithelial neoplasms

Germ cell neoplasmsGerm cell neoplasms

Sex cord-stromal tumors of the ovarySex cord-stromal tumors of the ovary Neoplasms metastatic to the ovaryNeoplasms metastatic to the ovary


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Epithelial neoplasms (overEpithelial neoplasms (over

60% of all; over 90% of60% of all; over 90% of

malignant)malignant) Serous neoplasms: ovarian serousSerous neoplasms: ovarian serouscystadenocarcinoma common one,cystadenocarcinoma common one,

bilateral in 50%,bilateral in 50%,

Mucinous neoplasms:Mucinous neoplasms:

Endometrioid neoplasms: bilateral inEndometrioid neoplasms: bilateral in

40%.40%.

Clear cell carcinoma: hypercalcemia,Clear cell carcinoma: hypercalcemia,

hyperpyrexia, cystic and solid, clearhyperpyrexia, cystic and solid, clear

cell and hobnail cell.cell and hobnail cell.


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Germ cell neoplasmsGerm cell neoplasms

( 20-30+years, better( 20-30+years, better

prognosis )prognosis ) Dysgerminoma : unilateral in 90%,Dysgerminoma : unilateral in 90%,solid, malignantsolid, malignant

Endodermal sinus tumor: ( yolk sacEndodermal sinus tumor: ( yolk sac

tumor ), acute abdomen alpha-tumor ), acute abdomen alpha-

fetoprotein (AFP),malignantfetoprotein (AFP),malignant

Immature teratomas: malignant, AFPImmature teratomas: malignant, AFP

Mature teratomas: 2% malignant inMature teratomas: 2% malignant in

40years.40years.

Embryomal carcimoma: malignant,Embryomal carcimoma: malignant,hCG AFP


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Sex cord-stromal tumors ofSex cord-stromal tumors of

the ovarythe ovary

Granulosa cell tumors: malignant,Granulosa cell tumors: malignant,

hyperestrogenism, precocioushyperestrogenism, precocious

puberty,puberty,

Ovarian thecoma: benignOvarian thecoma: benign

Ovarian fibroma: Mergs syndrome Ovarian fibroma: Mergs syndrome

the occurrence of an ovarianthe occurrence of an ovarian

fibroma, ascites, and pleural effusion,fibroma, ascites, and pleural effusion,

which collectively mimic thewhich collectively mimic the

presentation of ovarian cancer.presentation of ovarian cancer.

Sertoli-stromal cell tumors:Sertoli-stromal cell tumors:


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StagingStaging

Stage I: limited to the ovaries. a oneStage I: limited to the ovaries. a one

ovary; b both; c-- rupture, ascites(+),ovary; b both; c-- rupture, ascites(+),

peritoneal cytology (+)peritoneal cytology (+)

Stage II: extension to pelvic. a uterus orStage II: extension to pelvic. a uterus ortube; b others; c a or b rupture,tube; b others; c a or b rupture,

ascites(+), peritoneal cytology (+)ascites(+), peritoneal cytology (+)

Stage III: abdominal cavity. a microscopicStage III: abdominal cavity. a microscopic

metastases; b-- 2cm, inguinalmetastases; b-- 2cm, inguinal

lymph node(+), liver surface.lymph node(+), liver surface.

Stage IV: distant.Stage IV: distant.


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Surgical treatment ofSurgical treatment of

epithelial ovarian cancerepithelial ovarian cancer

Surgery is cornerstone, over 70% ofSurgery is cornerstone, over 70% of

patients have metastases beyond thepatients have metastases beyond the

pelvis.pelvis.

Fluid or peritoneal washings shouldFluid or peritoneal washings should

be obtained.be obtained.

Bilateral adnexectomy;Bilateral adnexectomy;

hysterectomy; infracolichysterectomy; infracolic

omentectomy ( omentum );omentectomy ( omentum );

cytoreductive surgery.cytoreductive surgery.


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Surgical treatment of germSurgical treatment of germ

cell neoplasmscell neoplasms

Young patients: removal of theYoung patients: removal of the

involved adnexainvolved adnexa

Contralateral ovary biopsy is notContralateral ovary biopsy is not

recommended.recommended.


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Chemotherapy ofChemotherapy of

epithelialepithelial Stage Ia and grade I no needStage Ia and grade I no need

chemotherapy.chemotherapy.

Others undergo systemicOthers undergo systemic

chemotherapychemotherapy

Cisplatin, carboplatin,Cisplatin, carboplatin,

cyclophosphamide, paclitaxelcyclophosphamide, paclitaxel

Paclitaxel 175mg/m2+ cisplatinPaclitaxel 175mg/m2+ cisplatin

75mg/m2or carboplatin prefer. 675mg/m2or carboplatin prefer. 6

cycles at 3-week intervals.cycles at 3-week intervals.


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Chemotherapy of germChemotherapy of germ

cellcell Dysgerminoma radiation-sensitive.Dysgerminoma radiation-sensitive.

CurableCurable


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Complications ofComplications of

chemotherapychemotherapy Cisplatin : nephrotoxicity, neurotoxicity,Cisplatin : nephrotoxicity, neurotoxicity,

ototoxicityototoxicity Carboplatin: thrombocytopenia, neutropeniaCarboplatin: thrombocytopenia, neutropenia Cyclophosphamide: hemorrhagic cystitis,Cyclophosphamide: hemorrhagic cystitis,

pulmonary fibrosispulmonary fibrosis Paclitaxel: myelosuppressionPaclitaxel: myelosuppression Altretamine: peripheral neuropathyAltretamine: peripheral neuropathy Etoposide: myelosuppressionEtoposide: myelosuppression Bleomycin: pulmonary fibrosisBleomycin: pulmonary fibrosis Doxorubicin: cardiac toxicityDoxorubicin: cardiac toxicity Vincristine: neuropathyVincristine: neuropathy

Ifosfamide: hemorrhagic cystitis, centralIfosfamide: hemorrhagic cystitis, centralneurotoxicitneurotoxicit


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Radiation therapyRadiation therapy

DysgerminomaDysgerminoma


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PrognosisPrognosis

5-yrs survival epithelial stage I 76-5-yrs survival epithelial stage I 76-

93%93%

Stage II 60-74%Stage II 60-74%

Stage III 23-41%Stage III 23-41%

Stage IV 11%Stage IV 11%

Dysgerminoma 95%Dysgerminoma 95% Immature teratoma 70-80%Immature teratoma 70-80%

Endodermal sinus 60-70%Endodermal sinus 60-70%


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Malignant neoplasms of theMalignant neoplasms of the

fallopian tubefallopian tube

Etiology : 0.3%Etiology : 0.3%

Clinical presentation: sixth decade,Clinical presentation: sixth decade,

Latzkos sign watery vaginalLatzkos sign watery vaginal

discharge and palpable adnexaldischarge and palpable adnexal

mass.mass.

Histopathology: papillary carcinomaHistopathology: papillary carcinoma

(95%), bilateral in45%, fusiform or(95%), bilateral in45%, fusiform or

sausage-shapedsausage-shaped

Treatment: same with epithelial.Treatment: same with epithelial.

Pro nosis: 5 rs survival 50%

The Ovaries and Oviducts

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