Cancer of the ovary are the second most common gynecologic malignancy. In 1999, 25200 new cases are expected in the United States, with 14500 deaths. The mean age at onset is 62 years. Late menarche, early meonpause, pregnancy, and oral contraception all appear to confer a protective effect by effecting ovulation suppression. Hereditary disorders, diet, environmental factors, viral infectioin, and irradiation have been implicated in the etiology.
Ovarian cancer is classified histologically into epithelial, gonadal stromal, and germ cell turmors. Of the malignant tumors, 40% to 45% are serous, 5% to 10% are mucinous, 15% to 20% are endometrioid, and 4% to 6% are clear cell. Epithelial adenocarcinomas are further differentiated into borderline and malignant types. Borderline growths display nuclear abnormalities and cellular stratification but lack stromal invasion. Conadal stromal tumors (eg granulosa cell,
Sertoli-Leydig cell) constitute 5% to 10% of ovarian cancer. Of the gem cell tumors, dysgerminoma (1%~2%), embryonel carcinoma (1% ~2%), and immature teratoma (1%~2%) are the most common. Metastatic tumors (4% ~8%) are generally derived from the bowel, endometrium, breast, or thyroid. Spread takes place over the surface of the peritoneum and the bowel and then extends to the upper abdomen. If there is modal involvement, it usually affects the retropenitoneal nodes of the upper aldomen. Iliac nodes are involved about a fourth as often as in cervical cancer. Hematogenous spread is rarely seen clinically, but transdiaphragmatic dispersion is common.
Staging of ovarian cancer is based on the findings at laparotomy. In stage IA , growth is limited to one ovary; in stage IB , both ovaries are involved. Stage IC is either stage IA or IB , but tumor is also on the surface of the ovary, the capsule is ruptured, ascites is present, or the cytologic analysis of peritoneal washings yields positive findings. Stage II disease involves one or both ovaries and there is pelvic extension. Stage IIA involves extension or metastases to the uterus
or tubes; stage IIB involves extension to other pelvic tissues; and stage IIC is stage IIA of B, plus there is ascites or positive washings, a ruptured capsule, or tumor on the ovarian surface. In stage II,tumor growth extends outside the pelvis, with peritoneal implants or positive retroperitoneal or inguinal nodes, or both. Superficial liver metastases are considered stage III, and this stage is further divided into IIIA through IIIC. Stage IV represents distant metastasis and includes pleural effusions with positive cytology and parenchymal liver metastasis.
The detection of a pelvic mass is often the first indication of an ovarian tunor, although many patients experience vague gastrointestinal symptoms for several months before the mass is discovered. Rarely, endocrine activity of the tumor may lead to menstrual abnormality. Although pelvic findings can be inconclusive, palpation of an irregular, nodular ( "a handful of knuckles"), insensitive, bilateral mass in the pelvis strongly suggests the presence of an ovarian tumor. The
discase is bilateral in 70% of cases of ovarian carcinomas, compared with 5% for benign lesions. Ascites and a right-sided pleural effusion are common findings in advanced disease. Imaging techniques such as computed tomography, magnetic resonance imaging , and sonography are more useful for monitoring the course of the disease than for making an early diagnosis.
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