Cancer of Ovary and Fallopian Tube

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Cancer of Ovary and Fallopian Tube

Classification: mainly these are of 4 types as follow:-

1. Epithelial ovarian cancers (85-90%)
2. Germ cell Ovarian cancers (10-15%)
3. Sex-cord stromal tumors
4. Kruckenberg or other metastatic or others rare tumors

Incidence: women have 1.4% lifetime risk of developing it and around 1 in 108 women will develop ovarian cancer during their lifetime

Staging of Ovarian Cancer

Stage I : cancer is limited to the ovaries

Stage II : cancer is involving one or both ovaries, but extends to pelvis

Stage III : cancer is microscopically or gross spread outside the true pelvis into the abdomen; on omentum, liver surface, small or large bowel or peritoneum

Stage IV : cancer spread to distant sites, including pleural effusion with positive cytologic test or parenchymal liver metastasis equals stage IV

Etiopathogenesis

1. Exact causative agent and etio-pathogenesis is still not known
2. Certain women are high risk due genetic predisposition. History of ovarian, breast or colon in more than one, 1st or 2nd degree blood relatives on maternal or paternal side predisposes for it( HBOS,HNPCC/LynchII)

Sign & Symptoms

Early stage

Asymptomatic except some vague complaints of dyspepsia or feeling of fullness in lower abdomen

Late stages

may manifest with following sign or symptoms:

• Pain in abdomen
• Weight loss
• Loss of appetite, early satiety, difficulty to eat, dyspepsia, bloating sensation or fullness of abdomen
• frequency of urination
• In advanced metastatic stage its signs like abdominal distension, pain in abdomen, hard mass in pelvis or abdomen, ascites , pleural effusion etc

Diagnosis

For early detection of ovarian cancers

• Annual pelvic or vaginal examination by Gynecologist
• Annual pelvic Sonography

To confirm the diagnosis

1. Sonography or CT Scans
2. various tumor markers in blood:CA125,CEA, BHCG,AFP,LDH
3. fine needle aspiration cytology (advanced stages)

Treatment

• Ovarian cancers are mainly treated with surgery with adjuvant chemotherapy.
• Role of surgery: to diagnose and to stage (staging laparotomy) in early stages (I&II); while in late stages(III &IV), it is done to de-bulk the tumor load followed by tumor left over cells to be taken care of by chemotherapy drugs.
• In few selected cases, where upfront surgery can not be done for various reasons, chemotherapy (neo-adjuvant) is given to decrease the tumor load followed by surgery
• Fertility Preservation surgeries are done in suitable localized tumors, if women is desirous for it with due risk of recurrence explained to them. They are kept under close observation till the time completion of surgery is done

Prognosis in ovarian cancers:

• Epithelial ovarian cancers: early stages : around 90%
• Overall prognosis: around 50%
• Germ cell tumors are generally associated with high cure rate and good survival
• Sex cord tumors though have good prognosis , but known for late recurrences