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Ovarian cancer: Difference between revisions
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<section begin="oncology" />'''Ovarian cancer''' is the second most common gynaecological cancer (after endometrial), but the most common cause of gynaecological cancer death due to its poor prognosis. It has no early symptoms, it has potential to grow very large, and it has aggressive behaviour. There is no effective screening for it in the general population. The most common type is the epithelial type (90% of cases), which has the worst prognosis. It is mostly a disease of postmenopausal women in the 55 – 65 age group. The 5-year survival is 30 – 35%. 70% of cases are stage III or IV at the time of diagnosis. The only real opportunity for survival is early diagnosis with complete surgical excision. | <section begin="gynaecology intro" /><section begin="oncology" />'''Ovarian cancer''' is the second most common gynaecological cancer (after endometrial), but the most common cause of gynaecological cancer death due to its poor prognosis. It has no early symptoms, it has potential to grow very large, and it has aggressive behaviour. There is no effective screening for it in the general population. The most common type is the epithelial type (90% of cases), which has the worst prognosis. It is mostly a disease of postmenopausal women in the 55 – 65 age group. The 5-year survival is 30 – 35%. 70% of cases are stage III or IV at the time of diagnosis. The only real opportunity for survival is early diagnosis with complete surgical excision. | ||
Ovarian germ cell tumours (like teratoma) account for < 3% of ovarian cancers. They mostly affect younger women, rarely affecting those over 30. They’re most commonly benign. Most are diagnosed at an early stage and are highly curable (5-year survival > 95%). | Ovarian germ cell tumours (like teratoma) account for < 3% of ovarian cancers. They mostly affect younger women, rarely affecting those over 30. They’re most commonly benign. Most are diagnosed at an early stage and are highly curable (5-year survival > 95%). | ||
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The FIGO classification is used for staging. | The FIGO classification is used for staging. | ||
<section end="oncology" /> | |||
=== Borderline ovarian tumour === | === Borderline ovarian tumour === | ||
Borderline ovarian tumours are epithelial ovarian tumours of low-grade malignant potential. They are characterised by atypical growth but no stromal invasion. They sometimes have intraperitoneal spread. | Borderline ovarian tumours are epithelial ovarian tumours of low-grade malignant potential. They are characterised by atypical growth but no stromal invasion. They sometimes have intraperitoneal spread. | ||
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==== Classification ==== | ==== Classification ==== | ||
* Teratoma | * Teratoma | ||
** Dermoid cyst (mature teratoma) | ** Dermoid cyst (mature teratoma) | ||
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Fibroma is the most common benign SCST, while granulosa cell tumour is the most common malignant SCST. | Fibroma is the most common benign SCST, while granulosa cell tumour is the most common malignant SCST. | ||
<section begin="oncology" /> | <section begin="oncology" /><section begin="gynaecology intro" /> | ||
== Clinical features == | == Clinical features == | ||
Ovarian cancer is characteristically asymptomatic until the late stages, which is part of the reason for the poor prognosis. | Ovarian cancer is characteristically asymptomatic until the late stages, which is part of the reason for the poor prognosis. | ||
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** Haemorrhage – abdominal pain and haemorrhagic shock | ** Haemorrhage – abdominal pain and haemorrhagic shock | ||
Some present with an asymptomatic adnexal mass which is discovered on bimanual examination or on ultrasound. Germ cell tumours grow quickly and therefore often cause pelvic pain or symptoms of bladder or bowel compression.<section end="oncology" /> | Some present with an asymptomatic adnexal mass which is discovered on bimanual examination or on ultrasound. Germ cell tumours grow quickly and therefore often cause pelvic pain or symptoms of bladder or bowel compression.<section end="oncology" /><section end="gynaecology intro" /> | ||
=== Features of SCSTs === | === Features of SCSTs === | ||
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Sertoli-Leydig cell tumours produce androgens, which may cause virilisation, hirsutism, acne, etc. | Sertoli-Leydig cell tumours produce androgens, which may cause virilisation, hirsutism, acne, etc. | ||
<section begin="oncology" /> | <section begin="oncology" /><section begin="gynaecology intro" /> | ||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Physical examination should be performed for an adnexal mass as well as inguinal and cervical lymphadenopathy. Ultrasound (usually transvaginal) of the adnexal mass can reveal features suspicious for malignancy (solid mass, irregularity, papillary structures, etc.) and ascites. Chest, abdominal, and pelvic CT or MRI are used to look for ascites and disease spread. [[FNAB]] is never performed as it may cause spreading. | Physical examination should be performed for an adnexal mass as well as inguinal and cervical lymphadenopathy. Ultrasound (usually transvaginal) of the adnexal mass can reveal features suspicious for malignancy (solid mass, irregularity, papillary structures, etc.) and ascites. Chest, abdominal, and pelvic CT or MRI are used to look for ascites and disease spread. [[FNAB]] is never performed as it may cause spreading. | ||
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The definite diagnosis of ovarian cancer, as well as determination of its histological type, requires histology. Biopsy causes tumour seeding and is not performed. All cases of suspected ovarian cancer undergo complete surgical staging, involving total hysterectomy with bilateral salpingo-oophorectomy with pelvic and paraaortic lymph node dissection and omentectomy. Peritoneal cytology is also acquired by peritoneal washing. Only after histological evaluation of these samples can the diagnosis be made. | The definite diagnosis of ovarian cancer, as well as determination of its histological type, requires histology. Biopsy causes tumour seeding and is not performed. All cases of suspected ovarian cancer undergo complete surgical staging, involving total hysterectomy with bilateral salpingo-oophorectomy with pelvic and paraaortic lymph node dissection and omentectomy. Peritoneal cytology is also acquired by peritoneal washing. Only after histological evaluation of these samples can the diagnosis be made. | ||
It’s important to distinguish germ cell tumours from other ovarian tumours during the diagnostic evaluation, as the treatment is different. Germ cell tumours are more often solid on ultrasound than epithelial tumours. Because germ cell tumours frequently are bilateral, both sides must be examined (bilateral examination is performed routinely in all cases anyway). If germ cell tumour is suspected in a young girl, we may perform karyotyping (as the probability of intersex disorder is high). Ovarian germ cell tumours often produce tumour markers, especially hCG, AFP, and lactate dehydrogenase (LDH). | It’s important to distinguish germ cell tumours from other ovarian tumours during the diagnostic evaluation, as the treatment is different. Germ cell tumours are more often solid on ultrasound than epithelial tumours. Because germ cell tumours frequently are bilateral, both sides must be examined (bilateral examination is performed routinely in all cases anyway). If germ cell tumour is suspected in a young girl, we may perform karyotyping (as the probability of intersex disorder is high). Ovarian germ cell tumours often produce tumour markers, especially hCG, AFP, and lactate dehydrogenase (LDH).<section end="gynaecology intro" /> | ||
=== Tumour markers of malignant ovarian cancer === | === Tumour markers of malignant ovarian cancer === | ||