Treatment

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Surgery

The initial treatment for all suitable patients is a staging laparotomy which includes total abdominal hysterectomy and bilateral salpingo-oophorectomy, infra-colic omentectomy, cytological analysis of ascites and peritoneal washings, biopsies of peritoneum and diaphragm and selective pelvic and para-aortic lymph node sampling. The aim is to remove all macroscopic tumour and is usually possible in Stage I and early Stage II disease. In more advanced disease the aim is for optimal cytoreduction, that is residual tumour deposits less than 1.5 to 2.0cm in diameter. Patients with unresectable disease benefit from chemotherapy followed by surgical debulking. Some of the less aggressive germ cell tumours and sex cord stromal tumours, which occur in younger patients, can be treated with limited surgery to preserve fertility.

Table 6.1. Epithelial tumours: make up 60-90% of all ovarian tumours; make up 90% of all malignant ovarian tumours

Serous

Mucinous

Endometrioid

Clear cell

Brenner

Incidence

20-50% of malignant tumours

10% of malignant tumours

20% of malignant tumours

6% of malignant tumours

1-2% of malignant tumours

Aggression

Benign 60% Malignant 25%

Benign 80% Malignant 10%

Almost always malignant

Almost always malignant but 75% Stage 1

Rarely malignant

Bilateral

25% of benign 65% of malignant

5% of benign 20% of malignant

40%

40%

6%

Age

Post-menopausal

Po st-menopausal

Post-menopausal

Post-menopausal

Any age, 50% over 50 yrs

Solid and homogenous. Occasionally cystic Usually small (1.0-2.0 cm). Extensive calcification

Typical features

Predominantly cystic. Malignant lesions have more solid components. Psammoma bodies in 30%

Multilocular cysts containing haemorrhage or cellular debris

Variable cystic/solid components. Associated with endometrial hyperplasia and carcinoma

Usually unilocular cyst with few mural nodules protruding into the lumen

Table 6.2. Sex cord stromal tumours: 5% of all ovarian malignanctes; 85-90% synthesise steroid

Fibroma

Thecoma

Granulosa cell

Sertoli-Leydig cell

Incidence

Rare

Commonest

5-10% of all ovarian malignancies

Less than 0.2% of all ovarian malignancies

Aggression

Benign

Benign

Malignant potential increases with size. 5yr survival is 90%

Aggressiveness depends on degree of differentiation. 5yr survival is 70%

Bilateral

Unilateral

Unilateral

Unilateral in >95%

Unilateral

Age

4th and 5th decades

Reproductive years

Any age but commonest in post-menopausal years

Reproductive years

Typical features

Solid. Associated with pleural effusion (Meigs syndrome)

Solid. Produces oestrogen and associated with abnormal vaginal bleeding, endometrial hyperplasia and carcinoma

Multi-cystic. May be haemorrhagic or necrotic. Can secrete oestrogen and is associated with abnormal vaginal bleeding, hyperplasia and carcinoma

Can be solid or cystic. Synthesise androgens resulting in masculinisation.

approximately 90% of patients doubling or halving of the CA-125 correlates with disease progression or regression respectively. In patients with treated early stage disease a rising CA-125 is predictive of recurrence regardless of imaging features. However, if the CA-125 falls to normal following treatment, this may not indicate complete response and up to 50% of patients will have residual disease discovered at laparotomy.

It is important to note that CA-125 is not exclusive to ovarian cancer and is also elevated in 40% of patients with advanced non-ovarian intra-abdominal malignancy, as well as other abdomino-pelvic conditions such as liver cirrhosis, pancreatitis, endometriosis, pelvic inflammatory disease, pregnancy and also in 1 % of healthy individuals.

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Natural Cures For Menopause

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