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Malignant Epithelial Ovarian Tumours

Kushtagi, Pralhad (2010) Malignant Epithelial Ovarian Tumours. In: Obstetrics and Gynaecology for Postgraduates. Universities Press (India) Pvt Ltd, Hyderabad , Hyderabad, pp. 354-370. ISBN 978-81-7371-691-1

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Abstract

Attempt has been made to apply WHO screening criteria to ovarian cancer to assess the potential for early detection of the disease. Sequential multimodal screening (CA 125 estimation and transvaginal sonography) has superior specificity and positive predictive value. Presence of normal ovarian tissue (‘Ovarian Crescent Sign’) and low score from any of the risk of malignancy indices will help to differentiate adnexal masses. Surgery is the cornerstone in all treatment modalities employed for ovarian cancers. The concept of cytoreductive surgery or debulking surgery is applicable in management of ovarian cancer. In adequately staged patients with Stage IA and Stage IB Grade I disease adjuvant chemotherapy would not provide further benefits. In the absence of high risk features the fertility sparing surgery may be an option for stage IA disease. Surgical resection of the primary tumour is the principal treatment of borderline tumours and there is no evidence that either subsequent chemotherapy or radiation therapy would improve survival. Epithelial ovarian tumours do not infiltrate the peritoneum or lumina of intestine and bladder deeply. Primary debulking surgery remains the cornerstone of treatment of epithelial ovarian carcinoma, survival of patients with an optimal primary cytoreductive surgery (taken as < 5 to 15 mm of residual disease) being superior. All cases of advanced ovarian carcinoma should receive adjuvant chemotherapy which has platinum based combination. Induction chemotherapy can be considered in patients in whom optimal cytoreduction at primary laparotomy is considered to be impossible. Interval debulking in advanced ovarian cancer significantly increases the survival and progression free interval. The ‘second look’ operation helps in documenting response to therapy in those patients with ovarian cancer who are clinically free of disease. But, negative second look is, unfortunately, no guarantee that the lesion will not recur. The role of the laparoscopy in the management of patients with ovarian cancer is somewhat limited to either for second look or in advanced cases where surgery is not feasible, to avoid laparotomy. The treatment of an asymptomatic patient with recurrent disease based on tumour marker alone is difficult. Patients with relapse are managed based on disease free interval after primary platinum based chemotherapy.

Item Type: Book Section
Uncontrolled Keywords: Epithelial ovarian tumor; screening; staging; fertility sparing surgery;
Subjects: Medicine > KMC Mangalore > Obstetrics & Gynaecology
Depositing User: KMCMLR User
Date Deposited: 24 Mar 2012 09:39
Last Modified: 24 Mar 2012 09:39
URI: http://eprints.manipal.edu/id/eprint/3645

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