OVARIAN TUMOUR - an

overview
Sachin Maiti
MD,MRCOG,DFFP
Research Registrar
Wirral Hospital NHS Trust,UK

Epithelial Ovarian Tumour

Most

common gynaecological
Malignancy in developed countries
15/100,000
4000 deaths/year
2/3 present in advanced stage
Life time risk of ov ca = 1.5%, dying 1%
90% of ovarian tumours are epithelial
origin

Epithelial Ovarian Tumour

90% derived from
coelomic epithelium
75-80% serous
10% mucinous
10% endometriod
1% Brenner,
undifferentiated,
clear cell

Epithelial Ovarian Tumour

Age 56
80-90 > 40 years, 30-40% >60 years
1 in 10 of ovarian tumour malignant <40 y
1 in 3 of ovarian tumour malignant >40 y
1% of ovarian tumours <20 y, 2/3 Germ CT
30% of ovarian tumours malignant in
postmenopausal women

Epithelial Ovarian Tumour

Prevention: Pregnancy (RR 0.3-0.4)
OCP (RR 0.5)
2 Children and OCP (RR 0.3)
Oophorectomy

Epithelial Ovarian Tumour

SCREENING: TVS (1 in 10)
Doppler US
CA125
TVS+CA125 (1 in 4 laparotomy)

Hereditary Ovarian CA
5-10%
BRCA1

& BRCA2

HNPCC
AD,

mutations
Risk of ovarian ca 10years earlier
35-40% risk

Impact of BRCA-1

Differential Diagnosis
Benign

cyst
Endometriosis
PID
Fibroids
Pelvic Kidney
Retroperitoneal tumours

Risk of Malignancy Index

(RMI)
USS
Menopausal

status

CA125
RMI

= UxMxCA125
High index of suspicion = RMI> 200

Investigations
History/Examination
FBC,

LFT, CA125 (CEA)

USS/CT
Chest X-ray
Barium/Gastroscopy (if bowel
symptoms)
Endometrial sample (PMB)

CA125
Secreted

by Mullarian & Coelomic

epithelium
>30 ku/l in PMW, risk of ov ca 36 fold
>96ku/l in PMW, PPV 96%
Stage 1- 50%
Stage 2- 60%

Poor prognostic factors

High grade
Aneuploidy
Serous vs Mucinous
Lymphatic invasion, Ascitis, positive cyto
Clear cell histology
Poor performance status
Poor biochemical/haematological status

Borderline tumours
Low

malignant potential
Confined to one ovary for long time
Good prognosis, 86-90%
Age 30-50years
Metastatic implants can occur
Late recurrence

Aim of Surgery
Establish diagnosis
Staging
Primary Cytoreduction
Interval/ Secondary cytoreduction
Palliative & salvage surgery

Laparoscopy/Aspiration NOT recommended

Treatment
Surgery-

cytoreduction <1-2cms
TAH+BSO+Omental Biopsy+washings
Bowel resection if impending
obstruction
Chemotherapy
Stage >1C (>2A)
Carboplatin +Taxol

Survival
Stage

1 76-93%
Stage 2 60-74%
Stage 3A
40%
Stage 3B
25%
Stage 3C
23%
Stage 4 11%
Increased grade - decreased survival

Non Epithelial Ovarian

Tumour
Uncommon,

10% of all ovarian ca

Germ Cell Tumours
Sex Cord Tumours
Metastatic Tumours
Rare- Sarcomas, Lipoid cell tumours
Tumour markers- AFP, HCG, PALP,
LDH

Germ Cell Tumours

Arise

from primordial germ cell

1/10 as common as testicular tumours
Most arise from undifferentiated germ
cell in ovary
20-30% of all ovarian neoplasia
3% malignant, rapidly growing
<20years, 70% Germ CT, 1/3 malignant

Germ cell tumours

Dysgerminomas

30-40%
Teratomas (Immature/Mature)
Monodermal
Endodermal Sinus tumour (YST)
Embryonal carcinomas
Choriocarcinoma
Mixed form

Dysgerminoma

Most common GCT

75% -10-30years, 5%
<10years
20-30% of tumours in
pregnancy
5% abnormal gonads
85% stage 1
10-15% bilateral
95% secrete PALP,
LDH, 3% HCG

Dysgerminomas
Treatment

- Surgery+ Chemotherapy
Staging, USO
Fertility preservation
Stage 1A -surgery alone
Stage 1B or higher - surgery+chemo
BEP chemo
Prognosis- 90-100%,

Immature Teratomas

10-20% of ov tumours in
<20years
50% occur 10-20years
Malignant transformation- .
5-2% in PMW
Tumour markers negative
Diagnosis- USS/ Histology
Surgery- Staging +USO,
Chemo - BEP >1A
Survival - 70-80%

Endodermal Sinus tumours

(Yolk sac tumours)

1/3 present before

menarche
median age 18years
10% mass
75% pelvic pain
Secrete AFP
Surgery +
chemotherapy in all
patients
Response rate 60%

Sex cord-stromal tumours

5-8% of all ovarian
malignancy
Granulosa-stromal
cell tumour
Androblastroma
Gynandroblastoma (
attached slide)
unclassified

Granulosa cell tumour

Low grade malignancy

2% Bilateral
Reproductive age, 5%
prepubertal
25-50% endometrial
hyperplasia
5% endometrial
carcinoma
10% ascitis
Mostly stage 1

GCT
Recurrence 5-30years
Haematogenous spread
Secrete Inhibin
Treatment-Surgery- USO/TAHBSO
Chemotherapy no benefit
recurrence BEP
90% 10 year survival, 75% 20 year survival

Sertoli-Leydig Tumour

3-4 decade
75% <40 years
Low grade malignancy
Produce androgens
70-85% - clinical
virilization
Surgery USO/TAH+BSO, No
chemo
Survival 70-90%

Metastatic Tumours
5-6%

of ovarian tumours
Breast, GIT
Tubal 13%
Endometrial 5%
Breast 24%
Krukenburg 30-40% of metastatic ov ca
(primary- stomach, colon, breast, biliary
T)

Thank you