Ovarian tumors can be primary (arise in the ovary) or secondary (spread from other sites). The most common primary ovarian tumor is epithelial ovarian cancer, which arises from ovarian surface cells. Germ cell tumors arise from egg-producing cells and are more common in children/teens. Stromal tumors produce hormones. Risk factors include nulliparity, family history of breast/ovarian cancer, and hereditary conditions. Epithelial tumors are classified as malignant, borderline, or benign. Staging involves assessing spread from ovaries to other pelvic/abdominal sites or distant metastasis. Treatment depends on stage but may include surgery and chemotherapy.

1. OVARIAN TUMORS
Fahad zakwan

3. Introduction
• Ovarian cancer is a cancerous growth arising from the ovary.
• Symptoms are frequently very subtle early on and this makes
their diagnosis often delayed
• They are grouped as:
Primary: arise denovo in the ovary
Secondary (metastatic): results from spread from other sites of
the body e.g the breast

4. PRIMARY OVARIAN TUMORS
• Epithelial ovarian tumors are derived from the cells on the surface
of the ovary. This is the most common form of ovarian cancer
and occurs primarily in adults.
• Germ cell ovarian tumors are derived from the egg producing cells
within the body of the ovary. This occurs primarily in children and
teens.
• Stromal ovarian tumors are also rare in comparison to epithelial
tumors and this class of tumors often produces steroid hormones.

6. Risk factors for developing ovarian tumors
• Parity (Nuliparous and low parity women are at an
increased risk
• Family history of breast cancer
• Hereditary ovarian cancer.
Breast/ovarian cancer syndrome
Lynch II/ HNPCC (hereditary nonpolyposis colorectal
cancer) syndrome

7. Classifying epithelial tumors
1. Malignant
2. Borderline
3. Benign

8. 1. Serous adenocarcinoma
2. Mucinous tumors
Adenocarcinoma
Pseudomyxoma peritonei
3. Endometrioid Tumors
Adenocarcinoma
Malignant mixed müllerian tumor

9. 4. Clear cell adenocarcinoma
5. Transitional cell tumors
Malignant Brenner tumor
Transitional cell carcinoma
6. Squamous cell carcinoma
7. Mixed carcinoma
8. Undifferentiated carcinoma
9. Small cell carcinoma

10. Pathology
Risk Factors for Developing Epithelial Ovarian Cancer
1. Nulliparity
2. Early menarche
3. Late menopause
4. White race
5. Increasing age
6. Family history

11. Signs and Symptoms
• Ovarian cancer typically is portrayed as a "silent killer"
without appreciable signs or symptoms until advanced
disease is obvious clinically.
• Actually, patients are often symptomatic for several months
before the diagnosis, even with early-stage disease
The difficulty is in distinguishing these symptoms from those
that occur normally in women or other diseases makes the
diagnosis challenging

12. • Commonly they present with:
1. increased abdominal size,
2. bloating,
3. urinary urgency, and pelvic pain are reported.
4. Additionally, fatigue, indigestion, inability to eat normally,
constipation, and back pain may be noted
5. Abnormal vaginal bleeding occurs rarely.
Unfortunately, many women and clinicians are quick to
attribute such symptoms to menopause, aging, dietary changes,
stress, depression, or functional bowel problems. As a result,
weeks or months often pass before medical advice is sought or
diagnostic studies are performed.

13. Physical Examination
• A pelvic or pelvic-abdominal mass is palpable in most patients with
ovarian cancer.
• In general, malignant tumors tend to be solid, nodular, and fixed, but
there are no pathognomonic findings that distinguish these growths from
benign tumors.
• Paradoxically, a huge mass filling the pelvis and abdomen more often
represents a benign tumor or low-grade malignancy.
 To aid surgical planning, a rectovaginal examination also should be
performed.
 In advanced ovarian cancers wasting is always present coupled with
features of metastasis to other sites

14. • The presence of a fluid wave or less commonly, flank
bulging suggests the presence of significant ascites.
 In a woman with a pelvic mass and ascites,
the diagnosis is ovarian cancer until proven
otherwise.
However, ascites without an identifiable pelvic mass
suggests the possibility of cirrhosis or other primary
malignancies such as gastric or pancreatic cancers.

15. In advanced disease, examination of the upper
abdomen usually reveals a central mass signifying
omental caking.
• Auscultation of the chest is also important because
patients with malignant pleural effusions may not
be overtly symptomatic. The remainder of the
examination should include palpation of the
peripheral nodes in addition to a general physical
assessment.

16. Laboratory Testing
• A routine complete blood count and metabolic panel/blood
chemistry often demonstrate a few characteristic features
• The serum CA125 test is integral to management of epithelial
ovarian cancer.
• With mucinous tumors, the serum tumor markers cancer
antigen 19-9 (CA-19-9) and carcinoembryonic antigen (CEA)
may be better indicators of disease than CA125

17. Sonography/USS
• In general, malignant tumors are multiloculated, solid or
echogenic, large (>5 cm), and have thick septa with areas of
nodularity
• Other features may include papillary projections or
neovascularization—demonstrated by Doppler flow
Although several presumptive models have been described in
an attempt to distinguish benign masses from ovarian cancers
preoperatively, none has been implemented universally

18. Radiography
• Every patient with suspected ovarian cancer should
have a chest radiograph to detect pulmonary effusions
or infrequently, pulmonary metastases.
• Rarely, a barium enema is helpful clinically in excluding
diverticular disease or colon cancer or in identifying
involvement of the rectosigmoid by ovarian cancer.

19. Computed-Tomography Scanning (CT scan)
• The main advantage of computed tomography (CT) scanning is in
treatment planning of women with advanced ovarian cancer.
Preoperatively, it may detect disease in the liver, retroperitoneum,
omentum, or elsewhere in the abdomen and thereby guide surgical
• However, CT scanning is not particularly reliable in detecting
intraperitoneal disease smaller than 1 to 2 cm in diameter.
 Moreover, the accuracy of CT scanning is poor for differentiating a
benign ovarian mass from a malignant tumor when disease is limited to
the pelvis. In these cases, transvaginal sonography is superior.

20. Paracentesis
• A woman with a pelvic mass and ascites can be assumed to have
ovarian cancer until proven otherwise surgically.
Thus few patients require a diagnostic paracentesis to guide
treatment. Moreover, this procedure typically is avoided
diagnostically because cytologic results usually are nonspecific,
and abdominal wall metastases may form at the needle entry site
However, paracentesis may be indicated for patients with ascites
and the absence of a pelvic mass.

23. Staging ovarian cancers
IA
• Growth limited to one ovary
IB
• Growth limited to both ovaries
IC
• Tumor limited to one or both ovaries, but with disease on the
surface of one or both ovaries; or with capsule(s) ruptured; or
with malignant ascites or positive peritoneal washings

28. IIA
• Extension and/or metastases to the uterus and/or tubes
IIB
• Extension to other pelvic tissues
IIC
• Tumor limited to the genital tract or other pelvic tissues,
but with disease on the surface of one or both ovaries; or
with capsule(s) ruptured; or with malignant ascites or
positive peritoneal washings

33. IIIA
• The cancer is present in one or both of the ovaries, and cancer
cells are also present in small ranges in parts of the abdomen with
this stage without nodular involvement.
IIIB
• On this particular stage, the cancer is present in one or both of
the ovaries, and cancer cells are also present in amounts less than
2 cm or 3/4″ in parts of the abdomen.
IIIC
• Abdominal implants at least 2 cm in diameter and/or positive
pelvic, para-aortic, or inguinal nodes

38. IV
•Distant metastases, including
malignant pleural effusion or
parenchymal liver metastases

40. Management of Early-Stage Ovarian Cancer
• When a malignancy appears clinically confined to the ovary,
surgical removal and comprehensive staging should be
performed
• Fertility-Sparing Management :may be an option in selected
patients when disease appears confined to one ovary in
younger patients
• Adjuvant Chemotherapy: In general, patients with stage IA or
IB, tumors should be treated with three to six cycles of
platinum based-combinations

41. • multimodality therapy is particularly
important to achieve the most successful
outcome
Primary Cytoreductive Surgery
Primary Chemotherapy

42. PROGNOSTIC FACTORS
1. Pathological factors.
• Morphology (granulose tumors have the best
prognosis)
• Histological(Clear cell carcinoma have the best
prognosis)
• Degree of differentiation of the tumor. ( unclassified
and undifferentiated tumors have the worst prognosis)

43. 2. Biological factors
• Patients with diploid tumors have a significant longer median
survival than those with aneuploid tumors.
3. Clinical factors.
• Volume of ascites
• Patients age
• Extent of residual tumor after primary surgery
• Stage of the disease
• Performance status

44. SEX CORD-STROMAL TUMOR
• This group of tumors includes all those that contain
the granulosa cell, theca cells, sertoli cells or leydig
cells either singly or in combination.
• Accounts for 5-8% 0f all ovarian malignancies.
• They commonly secrete hormones and therefore
endocrinological features may be more common than
other physical signs

45. GERM CELL TUMORS
• They are derived from he primordial germ cell of the ovary
• Both alpha-fetal proteins and hCG are secreted by some germ cell
tumors, therefore the presence of circulating hormones can be
clinically useful in the diagnosis of a pelvic mass as well as in
monitoring the course of the patient after surgery.
• Placental alkaline phosphatase and lactate dehydrogenase are
commonly produced by dysgeminomas and may be useful in
monitoring the disease.

46. • In the first 2 decades of life almost 70% of
ovarian tumors are of germ cell origin and
one-third of these are malignant. Germ cell
malignancies expand rapidly and often
characterized by subacute pelvic pain related
to capsular ditension, hemorrhage or
necrosis.