Histogenetic classification of ovarian neoplasm
I. Neoplasms derived from coelomic epithelium
A. Serous tumor
B. Mucinous tumor
C. Endometriod tumor
D. Mesonephroid (clear cell) tumor
E. Brenner tumor
F. Undifferentiated carcinoma
G. Carcinosarcoma and mixed mesodermal tumor
II. Neoplasms derived from germ cells
A. Teratoma
1. Mature teratoma
a. Solid adult teratoma
b. Dermoid cyst
c. Struma ovarii
d. Malignant neoplasms secondarily arising from mature cystic teratoma
2. Immature teratoma (partially differentiated teratoma)
B. Dysgerminoma
C. Embryonal carcinoma
D. Endodermal sinus tumor
E. Choriocarcinoma
F. Gonadoblastoma
III. Neoplasms derived from specialized gonadal stroma
A. Granulosa-theca cell tumors
1. Granulosa tumor
2. Thecoma
B. Sertoli-Leydig tumors
1. Arrhenoblastoma
2. Sertoli tumor
C. Gynandroblastoma
D. Lipid cell tumors
IV. Neoplasms derived from nonspecific mesenchyme
A. Fibroma, hemangioma, leiomyoma, lipoma
B. Lymphoma
C. Sarcoma
V. Neoplasms metastatic to the ovary
A. Gastrointestinal tract (Krukenberg)
B. Breast
C. Endometrium
D. Lymphoma
Stage of ovarian cancer
Stage I Growth limited to the ovaries
Stage Ia Growth limited to one ovary; no ascites present
containing malignant cells; no tumor on the external surfaces; capsule
intact
Stage Ib Growth limited to both ovaries; no ascites present
containing malignant cells; no tumor on the external surfaces; capsules
intact
Stage Ic Tumor either stage Ia or stage Ib but with tumor on the
surface of one or both ovaries; or with capsule ruptured; or with
ascites present containing malignant cells or with positive
peritoneal washings
Stage II Growth involving one or both ovaries with pelvic
extension
Stage IIa Extension and/or metastases to the uterus and/or tubes
Stage IIb Extension to other pelvic tissues
Stage IIc Tumor either stage IIa or stag IIb but with tumor on
the surface of one or both ovaries; or with capsule(s) ruptured; or with
ascites present containing malignant cells or with positive peitoneal
washings
Stage III Tumor involving one or both ovaries with peritoneal
implants outside the pelvis and/or positive retroperitoneal or inguinal
nodes; superficial liver metastasis equals stage III; tumor is limited
to the true pelvis but with histologically verified malignant
extension to small bowel or omentum
Stage IIIa Tumor grossly limited to the true pelvis with negative
nodes but with histologically confirmed microscopic seeding of abdominal
peritoneal surfaces
Stage IIIb Tumor of one or both ovaries; histologically confirmed
implants of abdominal peritoneal surfaces, none exceeding 2 cm in
diameter; nodes negative
Stage IIIc Abdominal implants 2 cm in diameter and/or positive
retroperitoneal or inguinal nodes
Stage IV Growth involving one or both ovaries with distant
metastasis; if pleural effusion is present, there must be positive
cytologic test results to allot a case to stage IV; parenchymal liver
metastasis equals stage IV
Pre-operative survey
1. Tumor markers: CA-125, AFP, CEA, β-HCG, LDH, CA19-9 (for mucinous
tumors)
2. Lower GI series survey
3. Panendoscope
4. Fr D&C + cervical biopsy
5. Breast exam (and/or mammography)
Surgical therapy in ovarian cancer
1. Peritoneal washing cytology
2. Determination of extent of disease
a. pelvis
b. peritoneal surface
c. diaphragms
d. omentum
e. lymph node
3. Remove all tumors possibly plus pelvic, para-aortic lymph node
sampling and omentectomy
Adjuvant therapy
1. Chemotherapy as ovarian cancer protocol.
Requirements for conservative management in epithelial ovarian cancer
1. Stage Ia
2. Well differentiated
3. Young woman of low parity
4. Otherwise normal pelvis
5. encapsulated and free of adhesions
6. No invasion of capsule, lymphatics, or mesovarium
7. Peritoneal washings negative
8. Adequate evaluaiton of opposite ovary and omental biopsy negative
9. Close follow-up probable
10. Excision of residual ovary after completion of childbearing
(optional)
