Ovarian Cancer

 'Ovarian cancer'  are  superficial epithelial  tumors (90%). From the group of  germinal cell tumors'  (2-3% of cancers), the most common cancer is'  dysgerminoma  '. Other cancers are from the group of tumors' 'of stromal cells and' 'germline' ''. The ovaries metastasize Uterine tumors,  Mamma carcinoma,  Malignant lymphomas and GIT tumors ( Krukenberg's tumor).

Epithelial tumors spread mainly  'by implantation'  and lymphogenically. Dysgerminomas metastasize mainly  lymphogenically , rarely by implantation.

Epidemiology
Ovarian malignancies have an annual incidence of about 11 / 100,000 women.

Diagnostics
Epithelial tumors are usually asymptomatic and occur as an accidental ultrasound scan. Biochemical examination of the tumor marker CA-125 is also important. In the late stages, they may present with tactile resistance,  ' ascites' , cachexia (facies ovarica), cycle disorders, and bleeding are present. There may be painful torsion of the ovary to infarction or subtotal cyst.

In germ cell tumors, detection of α-fetoprotein (AFP), hCG and carcinoembryonic antigen (CEA) is possible.

Sertoli-Leydig tumor (androblastoma) produces androgens, which corresponds to the clinical manifestations. Estrogenically active granulosa tumor may manifest as premature pseudopuberty, irregular menstrual bleeding, and under [estrogenic influence] may develop endometrial cancer with its manifestations.

The basis is ultrasound examination, biochemical examination  tumor markers , diagnostic and surgical laparoscopy with prevention of malignant spread after the peritoneum ( endo-bag ) and subsequent histological examination.

Metastasis

 * lymphogenically: pelvic and paraaortic lymph nodes,
 * hematogenously: lungs, liver, bones, CNS.

Staging
The TNM classification or the FIGO classification is used for staging:
 * T1, FIGO I - tumor bounded to the ovary ( 1a  one ovary,  1b  both ovaries,  1c  rupture of the capsule and malignant cells in ascites / cytology of the peritoneum) ,
 * T2, FIGO II - pelvic tumor only ( 2a  uterus / tube,  2b  other tissues,  2c  malignant cells in ascites / cytology of the peritoneum),
 * T3, FIGO III - tumor outside the pelvis, metastases on the peritoneum ( N1  lymph nodes,  3a  micrometastases,  3b  meta <2 cm,  3c  meta> 2 cm),
 * M1, FIGO IV - distant metastases.

Treatment
Treatment varies according to the histological type. Epithelial and non-epithelial tumors, with the exception of dysgerminoma, are treated "surgically", often with very extensive procedures to achieve zero macroscopic residue (R0).  'Chemotherapy'  is used adjuvantly (epithelial tumors paclitaxel + carboplatin 6-8 cycles with an interval of 21 days between cycles).

Radiotherapy is not used in epithelial tumors.

Dysgerminomas are very chemosensitive and radiosensitive. Bleomycin, etoposide, cisplatin (BEP) chemotherapy is preferred for minor late complications.

Related Articles

 * Ovarian tumors
 * Gynecological malignancies