科室培训 妇产科 Ovarian Cancer课件.ppt

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1、Ovarian Tumor,Deprt. of OB/GYN, Institute of OB/GYN,Ovarian tumor,2,Ovarian cancer is the most lethal gynecological cancer, ranking ninth in incidence, but fifth in lethality, among women in the USAMain presentation with advanced-stage disease due to late symptoms and the lack of effective screening

2、 for early disease, as well asTreated by cytoreduction and chemotherapy with combination taxanes and platinum, prolongs survival even in the presence of stage IV diseaseDue to chemoresistance along with tumor progression; the 5-year survival rate of patients with advanced-stage has remained 30%-40%,

3、Classification of Ovarian tumor,3,Epithelial Ovarian tumors,4,Germ cell tumor,5,Dysgerminoma Yolk sac tumor Embryonal carcinoma Polyembryoma Non-gestational Choriocarcinoma Teratoma Mature: Solid, Cystic (dermoid cyst) Immature Monodermal (e.g. struma ovarii, carcinoid) Mixed,Sex cord-stromal tumors

4、,6,Granulosa-stromal cell tumors: Granulosa cell tumors Thecomas FibromasSertoli-leydig cell tumors (androblastoma)Mixed or unclassified sex cord-stromal tumors,Clinical manifestation,7,The most common symptoms include: bloating pelvic or abdominal pain trouble eating or feeling full quickly urinary

5、 symptoms such as urgency or frequencyThese symptoms are also commonly caused by benign diseases and by cancers of other organs. They occur more often or are more severe.,Clinical manifestation,8,Women who have these symptoms almost daily for more than a few weeks should see the doctor.preferably a

6、gynecologist. Others symptoms of ovarian cancer can include: fatigue upset stomach back pain pain during sex constipation menstrual changes,Complication,Torsion of pedicleRuptureInfectionCanceration,Diagnosis,10,Imaging studies Ultrasonography, Abdominal X-ray, CT, MRI, PETBlood tumor marker CA-125,

7、 AFP, HCGBiopsyIt can be done during the laparoscopy procedure. Usually, a biopsy is done at the time of surgery.Ascites aspiration for cytology,Differential Diagnosis,11,Differential Diagnosis,12,METASTASIS,13,14,Surgical Staging (FIGO 2000),15,16,Surgical Staging (FIGO 2000),17,Epithelial Ovarian

8、tumor,INTRODUCTION,Epithelial ovarian tumor (EOC) is the most common ovarian tumor. Malignant EOC account for about 90% of malignant ovarian tumorsIt includes benign, borderline and malignant tumorMajority occurs between 3060 years old,Risk Factors,20,Inherited Genetic Factors : 5%-10% HBOC: Heredit

9、ary breast-ovarian carcinomaHSSOC: Hereditary site-specific ovarian cancer syndromeHNPCC: hereditary nonpolyposis colorectal cancerBreast/ovarian familial cancer syndrome (BRCA1, BRCA2)Persistant ovulationPredisposing factors: Nulliparity, Primary infertilityProtective factors: Multiple pregnancy, L

10、actation, OCTEnvironmental factors and others or ingredient Industrial chemical products, diet habit,Epithelial Ovarian Tumors - Benign,Benign epithelial ovarian tumorsMost epithelial ovarian tumors are benign, do not spread, and usually do not lead to serious illness. There are several types of ben

11、ign epithelial tumors:Serous AdenomasMucinous AdenomasBrenner Tumors,Serous & Mucinous cystadenoma,Serous cystadenoma,Mucinous cystadenoma,Epithelial Ovarian Tumors - Borderline,Borderlin epithelial ovarian tumorsBorderline epithelial ovarian cancer do not clearly appear to be cancerous (low maligna

12、nt potential)These differ from typical ovarian cancers in that they do not grow into the ovarian stroma.Likewise, if they spread outside the ovary (e.g. into the abdominal cavity), they do not usually grow into the lining of the abdomen.,Epithelial Ovarian Tumors - Carcinoma,About 85% to 90% of ovar

13、ian cancers are EOC. Epithelial ovarian carcinoma cells have several features which are used to classify epithelial ovarian carcinomas intoSerousMucinousEndometrioidClear cell typesUndifferentiated epithelial ovarian carcinomas,TREATMENT,Surgical staging,Systematic exploration of intra-abdominal sur

14、faces and viscera Cytologic evaluation: hemidiaphargm, pelvic cul-de-sac, peritoneal washings, Infracolic omentectomy: omentum resected from the transverse colonSelective lymphadenectomy: pelvic randomized biospy of tissues from the peritoneum of the pelvic cul-de-sac, paracolic gutters, over the bl

15、adder, intestinal mesentaryHysterectomy & bilateral salpingo-oophorectomyAppendectomy should be performed for mucinous carcinoma,TREATMENT-Malignant EOC,TREATMENT-Malignant EOC,TREATMENT-SURGERY,The resection of the pelvic tumor may include removal of the uterus, tubes, and ovaries, as well as porti

16、ons of the lower intestinal tract,Separation of the omentum from stomach and transverse colon,Survival by Stage,Germ Cell Tumor,INTRODUCTION,Derived from the primordial germ cell of the ovary.Incidence secondary to EOC, are the most common ovarian cancers in women younger than 20 years.Most germ cel

17、l tumors are benign, although some are cancerous and may be life threatening. The most common germ cell tumors areTeratomaDysgerminomaYolk sac tumor ( Endodermal sinus tumor )Choriocarcinoma,TERATOMA,TERATOMA,Mature Teratoma,Immature Teratoma,DYSGERMINOMA,Mild malignant , the most common malignant g

18、erm cell tumor, accounting for 30%-40% of all ovarian cancers of germ cell origin; 75% occur between 10-30ylarge round, ovoid, solid, often unilateral (right-ovary involvement), moderate size, eraser-like texture, smooth surface or lobular appearanceHighly sensitive to radiation therapy with 90% of

19、5 year survival rate; Poor prognosis if presented with mixed type,YOLK SAC TUMOR,Endodermal sinus tumors( EST), derived from the primitive yolk sac.Malignant, the third most frequent malignant germ cells of the ovary. Median age of occurrence is 16-18yunilateral, relatively large, round or elliptic

20、; Section: partial cystic,brittle, bleeding , necrosisMost secrete AFP- useful tumor markerRapid development and early metastasis, poor prognosis,Rare Germ cell tumors of the ovary,DIAGNOSIS,Clinical characteristicsyoung patientslarge tumor size high risk of ascites development rapid progressionPosi

21、tive tumor marker: AFP，hHCGDynamic level is correlated with the progression of disease Monitoring the recurrence or response to the treatmentDefinitive diagnosis is made through the pathological examination,TREATMENT,Sex cord stromal Tumor,INTRODUCTION,Derived from the sex cords and the ovarian stro

22、ma or mesenchymeAccount for about 5%-8% of all ovarian malignanciesFunctioning tumors an unusual group of tumors characterized by hormone productionComposed of various combinations of elements, including ： “female” cells (i.e., granulosa and theca cells) “male” cells (i.e., Sertoli and Leygid cells)

23、,CLASSIFICATION,TREATMENT,Metastatic Carcinoma in the Ovary,Krukenberg tumor of the ovary metastatic from a gastric carcinoma: Macroscope: Bilateral, middle size, kidney-shape apperance, smooth surface, Microscope: Malignant cells have discrete vacuoles that push nuclei eccentrically, giving a signe

24、t-ring appearance,Fallopian Tube Cancer,INTRODUCTION,Carcinoma of the fallopian tube accounted for 0.3% of all cancers of the female genital tract, seen most frequently in the fifth and sixth decades with a mean age of 52-57ySimilar to ovarian cancer regarding histologic features and behavior.The fa

25、llopian tubes frequently are involved secondarily from other primary sites, most often the ovaries.Almost all cancers are of epithelial origin, frequently of serous histology. Rarely, sarcomas are reported.,Clinical manifestation,47,Classic triad of symptoms and signs (noted 15% of patients)Prominen

26、t watery vaginal dischargePelvic painPelvic massVaginal bleeding is documented in 62% of patientsOn examination, pelvic mass is present in about 60% of patientsAscites may be present if advanced disease existsOthers: abdominal bloating, frequency, urgency, cachexia,SIMILAR TO EOC,48,Spread pattern Principally by the transcoelomic exfoliation Lymphatic channelsStagingTreatment Surgery combined with platinum and taxane-based chemotherapy,Thanks for Your Attention!,