OVARIAN TUMORS-

CLINICAL ASPECTS
PFI WHITE, MD

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

MEDICAL FACULTY OF UNIVERSITAS TADULAKO – TADULAKO EDUCATIONAL
HOSPITAL
2019
GENERAL CHARACTERISTICS
• One in 70 women will develop ovarian cancer in their
lifetime. In 2013, 22,240 new cases are approximated, and
14,030 deaths. Ovarian cancer is most commonly found at
Stage III and most women die from bowel obstruction.
• Symptoms include abdominal fullness, dyspepsia,
constipation, tenesmus, pelvic fullness or pressure,
bloating, anorexia, and electrolyte abnormalities
(hypercalcemia).
• The route of spread for ovarian cancer is primarily
transcoelomic. Cancer cells flake off the ovarian surface and
implant throughout the abdomen and pelvis. Other routes
of spread are lymphatic and hematogenous.
GENERAL WORKUP

• The pretreatment workup includes a history and physical

examination, lymph node (LN) survey, laboratory tests
including a CBC, CMP, coagulation profile, CA-125, and other
indicated tumor markers.
• A chest x-ray is recommended in addition to abdominal/pelvic
imaging (CT/MRI). Colonoscopy and esophagoduodenoscopy
can be considered based on symptoms.
GENERAL TREATMENT

• Surgery usually consists of an exploratory laparotomy,

abdominal cytology, hysterectomy, bilateral
salpingooophorectomy, omentectomy, and cytoreduction.
• Patients with evidence of up to Stage IIIB cancer should be
surgically staged to include peritoneal biopsies and a pelvic
and paraaortic LN dissection. Three-fourths of advanced-
stage cancers will have positive retroperitoneal LN.
• LN drainage tends to follow the ovarian vessels.
• Dissection around the high precaval and para-aortic regions
is important.
GENERAL TREATMENT

• The definition of complete debulking is removal of all

gross tumor to no residual visible disease (microscopic
status). Optimal debulking is removal of all gross tumor to
less than 1 cm visible macroscopic disease. Suboptimal
resection is defined as remaining visible tumor with a
diameter greater than 1 cm.
• Surgical staging is often inadequate when performed by
general surgeons (68%) or general gynecologists (48%),
compared to gynecologic oncologists (3%).
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EPITHELIAL
• Serous is the most common type of epithelial ovarian cancer. Serous cancers are
graded in a 2-tiered fashion: low grade and high grade.
• Clear cell carcinoma: These tumors are difficult to treat; 63% are refractory to
primary platinum chemotherapy. There is an increased risk of DVT: 42% vs. 18%
compared to serous histologies. The OS is approximately 12 months for patients
with advanced-stage disease.
• Mucinous tumors are often large and the serum CEA can be positive. They have a
higher rate of discordance between frozen and final pathology at 34%: 11% were
downgraded and 23% were upgraded. This is due in part to their larger size. LN
metastases are rare in apparent Stage I cancers and an LND can potentially be
omitted in these cases without adverse effect on PFS or OS. Appendectomy is still
recommended to ensure primary tumor site identification.
• The ovaries are “fertile soil” for metastatic disease. Metastatic disease can be
distinguished from a primary ovarian tumor by the following: Metastatic tumors to
the ovaries are bilateral in 77% of cases, and often smaller in size. Primary tumors
are commonly larger than 17 cm and usually unilateral (bilateral only in 13%).
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THANK YOU

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