Ovarian cancer is a malignant tumor Tumor Inflammation arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria cord-stromal tumors (SCSTs). By far, EOCs are the most common, tend to present in postmenopausal women with advanced disease, and carry a poor prognosis Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas. On the other hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy, OGCTs and SCSTs frequently affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment younger women, tend to present earlier, and carry a better prognosis Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas. Affected individuals are frequently asymptomatic, although they may present with nonspecific symptoms such as fatigue Fatigue The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. Fibromyalgia, increasing abdominal girth, GI symptoms, and pelvic pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways. Moreover, if the tumor Tumor Inflammation secretes hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview and Types, abnormal bleeding may be a presenting symptom. Diagnosis is suspected based on imaging studies and confirmed with histologic examination. Treatment is primarily surgical and often with adjuvant Adjuvant Substances that augment, stimulate, activate, potentiate, or modulate the immune response at either the cellular or humoral level. The classical agents (freund's adjuvant, bcg, corynebacterium parvum, et al.) contain bacterial antigens. Some are endogenous (e.g., histamine, interferon, transfer factor, tuftsin, interleukin-1). Their mode of action is either non-specific, resulting in increased immune responsiveness to a wide variety of antigens, or antigen-specific, i.e., affecting a restricted type of immune response to a narrow group of antigens. The therapeutic efficacy of many biological response modifiers is related to their antigen-specific immunoadjuvanticity. Vaccination chemotherapy Chemotherapy Osteosarcoma.
Last updated: 29 Sep, 2021
Ovarian cancer is a malignant tumor Tumor Inflammation arising from the ovarian tissues.
Several common factors significantly reduce the risk of ovarian cancer, including:
Proportion of primary malignant ovarian tumors | Commonly affected age group | Major types | |
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Epithelial tumors | 90% | Postmenopausal women |
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Germ cell tumors | 5% | 10‒30 years |
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Sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria cord-stroma | 5% | Perimenopausal women |
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Metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis to ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy | – | Variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables | From:
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Epithelial ovarian carcinomas (EOCs) originate from surface epithelial cells and account for 90%‒95% of ovarian malignancies. Major types of EOCs include:
Psammoma bodies Psammoma Bodies Cellular Accumulations in an ovarian adenocarcinoma
Image: “Moderately differentiated ovarian adenocarcinoma” by Pusiol T, Parolari AM, Piscioli I, Morelli L, Del Nonno F, Licci S. License: CC BY 2.0, cropped by Lecturio.Ovarian germ cell tumors (OGCTs) originate from primordial germ cells Germ Cells The reproductive cells in multicellular organisms at various stages during gametogenesis. Gametogenesis (i.e., primordial oocytes Oocytes Female germ cells derived from oogonia and termed oocytes when they enter meiosis. The primary oocytes begin meiosis but are arrested at the diplotene state until ovulation at puberty to give rise to haploid secondary oocytes or ova (ovum). Ovaries: Anatomy).
Histologic types of malignant OGCTs:
Mature
cystic
Cystic
Fibrocystic Change
teratoma
Teratoma
A true neoplasm composed of a number of different types of tissue, none of which is native to the area in which it occurs. It is composed of tissues that are derived from three germinal layers, the endoderm, mesoderm, and ectoderm. They are classified histologically as mature (benign) or immature (malignant).
Imaging of the Mediastinum (
benign
Benign
Fibroadenoma ovarian germ cell
tumor
Tumor
Inflammation (OGCT)):
Note the hair, sebaceous material, and tooth. Mature
cystic
Cystic
Fibrocystic Change teratomas are the most common type of
benign
Benign
Fibroadenoma OGCTs and can undergo malignant
transformation
Transformation
Change brought about to an organism’s genetic composition by unidirectional transfer (transfection; transduction, genetic; conjugation, genetic, etc.) and incorporation of foreign DNA into prokaryotic or eukaryotic cells by recombination of part or all of that DNA into the cell’s genome.
Bacteriology into immature teratomas.
Ovarian SCSTs originate from sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria cord cells, stromal cells, or both.
Histologic types of SCSTs:
Some mutations are commonly associated with ovarian cancers, including:
Ovarian cancers spread via:
Women with early disease (especially EOCs) tend to be asymptomatic or present with vague, nonspecific complaints. Most women with EOCs especially tend to present later with signs/symptoms associated with metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis.
The diagnosis of ovarian cancer relies upon tissue biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma. The initial detection of cancer is based on physical examination and imaging techniques, including ultrasound.
Imaging is typically ordered 1st if signs/symptoms suggestive of a pelvic mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast are present. Discovery of concerning masses is often 1st identified on imaging and can help narrow differential diagnoses, assess the extent of disease, and assist in treatment planning. Modalities include:
Preoperative transvaginal ultrasonography (a) showing an isoechoic Isoechoic A structure that produces an echo of a very similar amplitude to its environment and is very difficult to distinguish Ultrasound (Sonography) solid mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in the right pelvic cavity (approximately 10 cm in size) with an ill-defined boundary between the lesion and the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy, and T2-weighted MRI of the ovarian tumor Tumor Inflammation in (b) the horizontal and (c) sagittal Sagittal Computed Tomography (CT) planes. The mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast was later identified as a fibroma.
Image: “Preoperative transvaginal ultrasonography” by Diagnostic Pathology. License: CC BY 4.0MRI of a mucinous cystadenomcarcinoma demonstrating a classically large multiloculated
cystic
Cystic
Fibrocystic Change
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast:
a: T2- weighted image; after administration of contrast material, we can see some small solid parts along the septa enhanced by contrast material (arrow heads).
b:
sagittal
Sagittal
Computed Tomography (CT) T1-weighted image
c: contrast-enhanced and fat saturated T1-weighted image
Tumor Tumor Inflammation markers are generally nonspecific but can aid in diagnosis and assessing treatment response if imaging is suggestive of ovarian cancer. Commonly obtained serum tumor Tumor Inflammation markers include:
Histopathologic evaluation is ultimately required for diagnosis (gold standard).
Ovarian cancer is staged surgically. There are 4 primary stages (each also contains several substages, which are beyond the scope required for medical school).
Staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis procedures:
Since staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis depends on the extent of disease and presence of metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis, staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis procedures involve evaluation of:
Ovarian cancer stages:
Individuals are staged based on their “highest” findings. For example, an individual with a tumor Tumor Inflammation confined to the ovary but with positive para-aortic lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy is classified as stage III.
Stage | Extent of tumor Tumor Inflammation invasion into surrounding tissue | Distant metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis |
---|---|---|
I | Tumor Tumor Inflammation is confined to the ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy (may be bilateral). | None |
II | Direct
tumor
Tumor
Inflammation invasion into other tissues within the pelvic cavity (i.e., below the pelvic brim), which typically includes:
|
None |
III |
Tumor
Tumor
Inflammation invades outside the
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy/
peritoneal cavity
Peritoneal Cavity
The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of winslow, or epiploic foramen.
Peritoneum: Anatomy, potentially including:
|
Metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis to regional lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy: para-aortic or pelvic nodes |
IV | Tumor Tumor Inflammation invasion into the hepatic or splenic parenchyma |
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The primary treatment for ovarian cancer is surgery; however, specific treatment depends upon the stage of cancer. Other treatment modalities include chemotherapy Chemotherapy Osteosarcoma and immunotherapy.
The prognosis Prognosis A prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas depends primarily on the stage at diagnosis and the specific histology. General 5-year survival rates are noted in the table.
Stage | Epithelial ovarian carcinomas | Ovarian germ cell tumors | Sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria cord-stromal tumors |
---|---|---|---|
Stage I | Approximately 85% | Approximately 100% | Approximately 90%‒100% |
Stage II | Approximately 70% | Approximately 85% | Approximately 55%‒75% |
Stage III | Approximately 40% | Approximately 80% | Approximately 25%‒50% (combined data) |
Stage IV | Approximately 20% | Approximately 70% |
The differential diagnosis of a pelvic mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast includes: