Ovarian Cancer Pathophysiology PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Copyright © 2017 Wolters Klu...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Ovarian Cancer Ovarian Cancer Australia https://ovariancancer.net.au/ http://www.ocrf.com.au/ https://acrf.com.au/ Cancer of the female reproductive tract Neoplasia can occur anywhere throughout the reproductive tract Uncommon: vulva, vagina More common: cervix, uterus, ovaries Endometrial cancer of the uterus: most common invasive cancer in reproductive tract Epithelial carcinoma of the ovary: second most common genitourinary cancer fifth most frequent cause of death in women >48% of all cases occur in women over the age of 65 Silent disease with poor prognosis  Ovarian Cancer Pathophysiology Approximately 5% to 10% of ovarian cancers: inherited BRCA-1 and BRCA-2 tumor suppressor genes implicated, 3 patterns of inheritance 1. ovarian cancer alone 2. ovarian-breast cancer 3. ovarian-colon cancer most important risk factor is a family history of a first-degree relative (mother, daughter, or sister) with the disease risk increases in women with two or more first-degree relatives with ovarian cancer other risk factors: increased ovarian trauma due to monthly ovulation ovulation: ovum breaks through the epithelial surface of the ovary injury, inflammatory response and tissue repair over time with repeated ovulation, the risk for ovarian cancer increases pregnancy, the use of contraceptives, and other events that suppress ovulation may have a protective effect post menopausal use of hormone therapy  Ovarian Cancer Pathophysiology Several types and variations Epithelial tumors: arise from the surface of the ovary most common type: serous adenocarcinoma epithelial tumor that resembles the epithelial tissue of the fallopian tube Germ cell tumors: comprise 25% of ovarian tumors are mostly benign in adult women more often malignant in children and young adults development is similar to that of testicular cancer Sex cord tumors: comprise 10% of ovarian tumors arise from primitive sex cord or connective tissue of the developing ovary Porth C. Pathophysiology : concepts of altered health states. 7th ed. Philadelphia, Lippincott Williams & Wilkins; 2005.  Ovarian Cancer Pathophysiology spread of ovarian cancer: distinctive pattern over surface of peritoneum local shedding into the peritoneal cavity with seeding and implantation on the peritoneum followed by local invasion of the bowel and bladder infiltration of the pelvic lymph nodes is common (incidence increases with greater severity of disease) staged on a I to IV scale at the time of diagnosis : I. Limited to one or both ovaries II. Extends into pelvis III. Metastases in peritoneum outside the pelvis IV. Distant metastases metastases can relocate in the ovaries from a primary tumor that originates elsewhere Craft AJ, Gordon C, Tiziani A. Understanding pathophysiology. 1st ed. Chatswood, Mosby; 2011  Ovarian Cancer Pathophysiology Ovarian cancer is curable in a high percentage of patients if detected in the early stages Unfortunately, at the time of diagnosis: 3/4 women have local spread to the pelvis or distant metastases most lethal female reproductive cancers >50% of these individuals are at stage III or greater at diagnosis stage III or IV tumors that cannot be removed adequately via surgery: the 5-year survival rate is less than 10%. The composite 5-year survival rate for all patients diagnosed with ovarian cancer is 35% More favorable prognosis: younger age at diagnosis cell type other than mucinous or clear cell lower stage, greater cell differentiation, small size of tumor absence of ascites (fluid accumulation in the peritoneum) adequate response to surgery, radiation, chemotherapy Craft AJ, Gordon C, Tiziani A. Understanding pathophysiology. 1st ed. Chatswood, Mosby;2011  Ovarian Cancer Clinical Manifestations Often absent in early stages Vague abdominal bloating Peritoneum allows for growth without immediate obstruction Time of diagnosis: widespread disease Large tumors may manifest as abdominal distention, pressure, pain Gastrointestinal symptoms, vomiting, alterations in bowel habits Craft AJ, Gordon C, Tiziani A. Understanding pathophysiology. 1st ed. Chatswood, Mosby; 2011  Ovarian Cancer Diagnostic Criteria Patient history Physical examination Bimanual palpation of ovaries Transvaginal ultrasound Laparoscopic or other surgical exploration of the peritoneal cavity Cytologic examination of ovarian epithelial cells and surrounding peritoneal tissues, lymph nodes with laparotomy Serum tumor marker levels: C-125 Value of monitoring treatment efficacy Recurrence of disease  Ovarian Cancer Treatment Goal of therapy is removal of neoplastic cells and complete remission treatment is based on tumor stage stage I or II, well differentiated or moderately well differentiated: surgery surgical removal of the uterus, both ovaries, and surrounding omentum diaphragm is biopsied along with multiple lymph nodes to detect spread considering childbearing: removal of reproductive organs may be limited to the affected ovary and fallopian tube less differentiated tumor and greater spread: combination surgery as above adjuvant extensive internal and external radiation therapy adjuvant local and systemic combination chemotherapy