CA OVARY

Alfiya Mulla
3rd BHMS
03
SPREAD
• Natural path of spread:- spread along the peritoneal surface
to involve ovarian, parietal and intestinal peritoneal surfaces
as well as diaphragm particularly right side.
• Modes of spread:-
1. Transcelomic
2. Lymphatic
3. Direct
4. Hematogenous
• Transcelomic spread
Implantation of malignant cells occurs by:
• Direct exfoliation of cells as in papillary cyst
adenocarcinoma
• Penetration of tumor capsule
• Rupture of the capsule.
Lymphatics:-
• It is to the draining lymph nodes namely paraaortic
and superior gastric nodes.
• Left supraclavicular nodes are enlarged due to
obstruction of efferent lymphatic channel of nodes by
tumor emboli.
• Lateral lymphatic spread through broad ligament to
pelvic nodes occur.
• Retrograde lymphatic spread in advance disease occur
to inguinal nodes through round ligament.
• Direct
After capsule is broken, spread occurs directly to the
adjacent organs like tubes, broad ligament, intestine,
omentum and uterus.
• Hematogenous
The blood stream metastasis lately and involve organs
such as lungs, liver parenchyma, brain and Bones, etc.
Clinical features
• Although there is no immune to ovarian malignancy
but about 60% in postmenopausal and 20% in
premenopausal women are malignant.
• Increased association of nulliparity and with a family
history.
SYMPTOMS
Early stage- asymptomatic.
Presenting complaints – short duration and insidious
onset.
Feeling of abdominal distension and vague
discomfort.
Dyspepsia, flatulence, eructation and pelvic pain.
Loss of appetite with sensation of bloating after
meals.
In pre existing tumor-
1. dull aching pain and tenderness at one area.
2. rapid enlargement of tumor.
Later stages
Abdominal swelling –maybe rapid
Dull abdominal pain.
Sudden loss of weight.
Respiratory distress – due to ascites or pleural effusion.
SIGNS:-
General examination:
Pallor, jaundice present
Left supraclavicular lymph gland enlarged.
Edema leg.
Per abdomen:
Liver enlarged, firm and nodular.
Mass felt in hypogastrium, Which can be
solid or heterogeneous, mobile or restricted, tenderness present.
On percussion – dull sound over tumor.
Per vaginum:
Uterus may be separated from mass felt at abdomen.
Nodules may b felt through post. Fornix.
If it is > 1 cm , diagnosis of malignancy is almost certain.
Reference
DC Dutta’s textbook of Gynecology
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