Carcinoma of the ovary and Fallopian tube doc

c It a pi e r

Carcinoma of the ovary and

Fallopian tube

CanDEr of Ihe ovary 143 Cance<ofrliG Fallopian lube 152

OVERVIE W

of tha ovary is mosl common ii1

the 'ijeamiyridtirjri:.c-t 111 fc world There die lustundsr 6000 case!, each ysar in Ibs UK

Wb ilfl ffiB incidence of ovarian cancer is si mi l&r to thai of endometri urn aridcf cervix, more women die from ovar&n cancer than

fro-;1

^drtinnma nl fl>E.cerm anfl body of fbe ut?rue combined.

Most wanan temours are ol epithelial (irigm. Tlie&E jre Mre befure Hit age of 35'years buttle incider-DE increases i<iitb age

IG a peak in tbe 5Q-7Q-ypar-i;ld aae gmup (Fig. 13.1 j. Mo^tspltlieli?! amours art not discovered until they hava spread widely

Some at fiiesE "nvariai'' lumouis prnoabiy arise frnm the fallopian ^bo.tumnurF of whmh arn .Dually racogriized only v/tien at a

relatively early ^tage Surely and rjhemufherapy. mdirily v<A\\ carboplafir, DI cisplalm and paciilaxel, form lire mapnsfay nf iiBaf￾DnJv 3 pEri:Hnln;nvanan cjnggrs are seen mwnm fin you ngerthan 35 yea rs and most of these are non ^jjltnelial cancers

a& yerm ^11 luinuurs ^n conlrasf To epithelial fumpurs. germ DE!! lumouis can be Ireaterjvpry successfully 'Vifh

Ferlilitycanoffen bu^jnaerved

CANCER OF THE OVARY

Aeliology "

Incessant uunlation' theory

Epithelial liimaura arc mosl trcqucntlv

wilb nulli|iari[y, jr) t&tly rncnjrdic, ^ late age at

menopju*,e and j high esrimjTeJ number of vewri

ol o^iiliition. Grill contraceptive use reduces the rkk

iouifuld (The Cancer and Steroid Hormont Sludy,

1997). lk>ive\er, even without urdl Lonlidceplives,

inciej<.ingage at first birtli reduces tht risk of ovarian

cancer. This and other anomialici ca^ldcubt upon the

'incessant ovulalicii* theor,1

.

Suhfertititylreatmenr

Subfertiliry, especially when il is unexplained, isasso￾aaccd with buth ovarian and cnddmdrial canitr.

r, 1,-ist-coiii rolled Siiudies have sujy>eMed

1 1 Carcinoma of the ovary antf Fallopian lube

UL>-

Cn

sc. 4C —

& 3D

6

1 20-

O

10

n-

,»"» • "--• \

/ \

pf

•

/

y

'

.....

10-14 25-33 40-44 55-74 >94

.Age iy£arsj

Figure 13.1 The Incidence D! ovarian cancers England anO

Wales iQffice of Population Censuses and Surveys, 1985|.

there might possibly bed link between ovarian cancer

and prolonged attempts at induction of ovulalion

(VenneraL,

Genetic factors

F3inilial ovarian cancer

• Familial ovarian cancer is rarfl -5-10%

• Suggflstive history

• fttlea5tt'"ofir&t-rtogree relatives mill u.'diidn

or ti)loretlal carcmama

• Casss usually diaynoaed before 50 vFarsotagH

» Defective genss include 0flC4f and 8RCA2

t Th* risk of ovarian cancfii 1.40%) in Ihese lamilles is

less than the r&k of breast cancer {80%|

» Genetic testing cannot guarantee to defect all

genes

Familial ovarian cancer

There is a family hinor? in between 5 and HI per cent

of ^omtn ivith epithelial nvarian tantcrs -

serous adenocardoornas (Kafipr/^k ul jl.t

Av-umaii with one affectf d dose relati\r

e has a lifetime

ctsk of 2-5 per cent, twice tht ribk in the general

popuklion. With two affected clost reldLivt^ lhiL

lite￾time risk increases to 30-10 per cent iPonder, 19y4|.

A partieular feature of familial unciT:> is the i elativelv

early age dl ™hich thcv occur

Most of these families rtl>o have ia&C;> of breast or

(.olorectal cancer in the family. 'Itie defective gt;ne

in (he breast/ovary families is most commonly the

luinoiir-s.uppn:$ior gene BRCAl (#1 pei cent).

BRCA2 is defective in aboiil 14 ntr^unl. Families Wffl

i.olorettal cancer have defects in the J3NA repair genes

but this is seldom found m association with tamilial

ovarian cancer (Kaflpr/ak el al., 1999). A woman

who has inheuied a detective RK.CA1 gene hi a weJl￾ducumenlctl [dmilv ha;> a 60 per cent risk of breast

cancer by .'ill years nl a^ and an &0 pel cent lifetime

risk. However, the risk of ovarian earlier is much

lower, he ing nearer JO per cent

Management ot women with a family

history of Dvarian cancer

Genetic testing for BKCAl is. now pos&iblc bill is

impracticable and unreliable because mutations are

found far lesi often than expected, even in

with a strong family bislorv. There jre very

able problems in interpreting the resulis in

with only one or li^o aftected relatives There maybe

a spectrum of inulaliyrii, isith verv different lei'els of

risk. Ei'en a negative test resnlr nid\ nol provide ihe

expflded reassurance.

Once idenlilied vvilh the help or a clinical geneticist,

women with a hiph ri^k of ovarian and" bica&t cancer

arc difiitult to advise. The main risk is bre&sl i-uiLerh

but prophyldclk, bilalcral mastectoniy ifl a very drastic

s^tep for any 'voilian 10 Lake. None of the available

&tre.emng tests for ovarian cancer is vurv effective, and

false-positive result* can result in unnecessary surgery.

Annual ovarian ullrasonography with colour-flow

Doppler studies and serum CA 1Z5 estimation evert

6-12 months are recommended, bui it is unierlaJB

how much pro Let Lion this offei^. Prophylactic hilat

eral oopho recto in y, iiiually combined v-nth hv^iterec￾lomy, i> recommended for dejrh ilelinuil h^h-rnt

women aflcr Completion of their family at aN«*]

45 years of age (K,ii|ir^Hk ul al., 1999). This does, nol

recnyvt the nsi; entirely, as c.lrcillonn of the pcrfl

toneum has occurred after this procedure.

Class if i callon of nujrian tumouis

Ovarian inmoiirb lan be solid or cystic. They nuyhf

benign r>r ma%nanl antl [n addition there are thc«

that, while having

lack am' evidence ol

called borderline lurai

ovarian |lin

orig

coid gonadal tyj>e laiso

Oi sex cord me.senchyi

«A cord iTie^nchmal

Simplified hi stole

ovarian tumours

I Connirnii apfilielial hi

A Serous rumour

B MuGifious tumour

C. EniJumetmid lumui

D Clear cell

f U ill 'fferpniiated care

II Sex cord stromal turn

A Grgnulo&dsn'niiac

fl Andrablas'Oma: SH

III Germ cell

A Dy&ngrniincma

C Embiyonalcelltumi

E. Teratuma

F Mlx

IV MaiasiaLc

Pathology of ep it he

cpid

ofteji rfM^i

ihe dfgr.ee of dif

vival, fflfLt-pt in the mo

mniuui-3 tend [o be a^s<i

and a bedii progrn

Hin'rv^l between differa

• .c i n on i and

ajsociated with an