The Ovaries And Oviducts

Ovaries and oviducts

General introduction 



The fifth most common cancer in women 1/70 of newborn girls will develop ovarian cancer.

Etiology     





Unknown Repeated ovulation Infertility treatment Polycystic ovarian syndrome ( PCOS ) Chromosomal abnormal: Turner’s syndrome ( 45,XO ) Hereditary : ( BOC –breast and ovarian cancer syndrome ) P53 gene

Histopathology    

Epithelial neoplasms Germ cell neoplasms Sex cord-stromal tumors of the ovary Neoplasms metastatic to the ovary

Epithelial neoplasms (over 60% of all; over 90% of malignant) 

 



Serous neoplasms: ovarian serous cystadenocarcinoma – common one, bilateral in 50%, Mucinous neoplasms: Endometrioid neoplasms: bilateral in 40%. Clear cell carcinoma: hypercalcemia, hyperpyrexia, cystic and solid, clear cell and hobnail cell.

Germ cell neoplasms ( 20-30+years, better prognosis ) 



 



Dysgerminoma : unilateral in 90%, solid, malignant Endodermal sinus tumor: ( yolk sac tumor ), acute abdomen alphafetoprotein (AFP),malignant Immature teratomas: malignant, AFP Mature teratomas: 2% malignant in 40years. Embryomal carcimoma: malignant, hCG/AFP

Sex cord-stromal tumors of the ovary 

 



Granulosa cell tumors: malignant, hyperestrogenism, precocious puberty, Ovarian thecoma: benign Ovarian fibroma: Merg’s syndrome – the occurrence of an ovarian fibroma, ascites, and pleural effusion, which collectively mimic the presentation of ovarian cancer. Sertoli-stromal cell tumors:

Neoplasms metastatic to the ovary   



25% of all malignant. Bilateral From: breast, stomach, colon, endometrium Krukenberg tumors: (from stomach)

Diagnosis 

 

 

Gastrointestinal complaints: nausea, dyspepsia Distention: ascites, constipation Pain, urinary retention, rectal discomfort, obstruction Menstrual abnormal Examination \ ultrasound\ CA125.

Staging 







Stage I: limited to the ovaries. a– one ovary; b– both; c-- rupture, ascites(+), peritoneal cytology (+) Stage II: extension to pelvic. a– uterus or tube; b– others; c– a or b rupture, ascites(+), peritoneal cytology (+) Stage III: abdominal cavity. a– microscopic metastases; b-- <2cm; c-- >2cm, inguinal lymph node(+), liver surface. Stage IV: distant.

Surgical treatment of epithelial ovarian cancer 





Surgery is cornerstone, over 70% of patients have metastases beyond the pelvis. Fluid or peritoneal washings should be obtained. Bilateral adnexectomy; hysterectomy; infracolic omentectomy ( omentum ); cytoreductive surgery.

Surgical treatment of germ cell neoplasms 



Young patients: removal of the involved adnexa Contralateral ovary biopsy is not recommended.

Chemotherapy of epithelial 







Stage Ia and grade I no need chemotherapy. Others –undergo systemic chemotherapy Cisplatin, carboplatin, cyclophosphamide, paclitaxel Paclitaxel 175mg/m2+ cisplatin 75mg/m2or carboplatin – prefer. 6 cycles at 3-week intervals.

Chemotherapy of germ cell  

Dysgerminoma – radiation-sensitive. Curable

Complications of chemotherapy          

Cisplatin : nephrotoxicity, neurotoxicity, ototoxicity Carboplatin: thrombocytopenia, neutropenia Cyclophosphamide: hemorrhagic cystitis, pulmonary fibrosis Paclitaxel: myelosuppression Altretamine: peripheral neuropathy Etoposide: myelosuppression Bleomycin: pulmonary fibrosis Doxorubicin: cardiac toxicity Vincristine: neuropathy Ifosfamide: hemorrhagic cystitis, central neurotoxicity

Radiation therapy 

Dysgerminoma

Prognosis 

     

5-yrs survival epithelial stage I 7693% Stage II 60-74% Stage III 23-41% Stage IV 11% Dysgerminoma 95% Immature teratoma 70-80% Endodermal sinus 60-70%

Malignant neoplasms of the fallopian tube  



 

Etiology : 0.3% Clinical presentation: sixth decade, Latzko’s sign – watery vaginal discharge and palpable adnexal mass. Histopathology: papillary carcinoma (95%), bilateral in45%, fusiform or sausage-shaped Treatment: same with epithelial. Prognosis: 5-yrs survival 50%.