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GYNECOLOGICAL ONCOLOGY . . . CONT.

• sex cord-stromal tumours • granulosa cell tumours - estrogen-producing • associated with endometrial cancer in adult, pseudoprecocious puberty in child • Call-Exner bodies - histological hallmark • Sertoli-Leydig tumours - androgen-producing • metastatic ovarian tumours • 4-8 % of ovarian malignancies • from GI tract, breast, endometrium, lymphoma • Krukenberg tumour = metastatic tumour from GI tract with “signet-ring” cells • most of these tumours originate from stomach • often bilateral

Table 11. FIGO Staging for Primary Carcinoma of the Ovary (Surgical Staging)

Stage I Stage IA Stage IB Stage IC

Growth limited to the ovaries 1 ovary 2 ovaries 1 or 2 ovaries with ascites

Stage II Stage IIA Stage IIB

Growth involving one or both ovaries with pelvic extension Extension to uterus/tubes Extension to other pelvic structures

Stage III

Tumour involving one or both ovaries with peritoneal implants outside the pelvis and/or

positive retroperitoneal or inguinal nodes Superficial liver metastasis equals stage III Tumour is limited to the true pelvis, but with histologically proven

malignant extension to small bowel or omentum

Stage IV

Distant metastasis

Notes

Table 12. Treatment According to Stage

Stage IA & B surgical

TAH-BSO (consider alternatives if wish to child-bear) • peritoneal washings

• staging laparotomy

Stage IC & II surgical

TAH-BSO • pertioneal washings • staging laparotomy + adjuvant therapy • radiotherapy • limited to small subset of patients without evidence of residual disease • effectiveness is controversial • chemotherapy

• cisplatinum • carboplatinum • cyclophosphamide • follow-up with serial US and CA-125

Stage III, IV surgical

TAH-BSO • peritoneal washings • staging laparotomy with omentectomy • debulking + chemotherapy 3-6 months

prognosis • 5-year survival • Stage I: 80-90% • Stage II: 60-70% • Stage III: 15-30% • Stage IV: 5-15% • overall 5 year survival: 30-35% • majority present late as Stage III • death from ovarian cancer usually results from progressive encasement of abdominal organs (i.e. bowel obstruction)

FALLOPIAN TUBES

least common site for carcinoma of female genitalia usually adenocarcinoma more common at extremes of age, < 20 or > 40 80% are benign

Gynecology 48

MCCQE 2000 Review Notes and Lecture Series

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