Carcinoma of the ovary is one of the leading causes of death in women. It usually affects the elderly women during 60 to 80 years of age. Carcinoma of the ovary has a higher incidence in industrialised nations. The exact cause is not fully understood, but it appears that hormones play an important role in genesis of the ovarian carcinoma. Studies have shown that the risk of ovarian carcinoma is reduced to 50 per cent during pregnancy due to hormonal factors. The use of contraceptive pills also lowers the risk of ovarian carcinoma because it creates a hormonal balance in the body that is similar to the pregnancy. Studies have revealed that the nulliparous women are more likely to develop the ovarian carcinoma. Those women, who had suffered from cancer of the breast, intestine or the rectum, also have a higher risk of the ovarian carcinoma. It has been observed that those women, who had a positive family history of the breast or the ovarian cancer, have a higher risk of the ovarian carcinoma. Exposure to radiation and asbestos are the other risk factors. About 85 per cent of the ovarian tumours are carcinomas, which include mucinous cystadenocarcinoma, serous cystadenocarcinoma, clear cell cystadenocarcinoma, endometrioid adenocarcinoma and undifferentiated carcinoma. The remaining 15 per cent of the ovarian tumours are germ cell tumours, stromal tumours and the borderline tumours.
Carcinoma of the ovary usually remains asymptomatic during initial stages of the disease. As the disease advances, non-specific gastrointestinal symptoms appear, which include nausea, vomiting, diarrhoea and constipation. The major symptoms of ovarian carcinoma include palpable abdominal mass, ascites and weight loss. In advanced stages, there may be pelvic pressure, vaginal bleeding and abdominal pain or distension. Carcinoma of the ovary usually spreads to peritoneum, omentum and the pouch of Douglas.
Staging of carcinoma of the ovary is done as follows:
Procedures used in diagnosis and evaluation of the ovarian carcinoma include pelvic examination, X-rays, ultrasound, CT scan, IVP, exploratory laparotomy and biopsy. The estimation of CA 125 and CEA is important in the follow-up of ovarian carcinoma patients. The raised level of CA 125 indicates presence of the ovarian carcinoma in the body, whereas the raised level of CEA indicates advanced stage of the ovarian carcinoma.
Ovarian germ cell tumours and stromal tumours constitute about 10 per cent of the ovarian tumours. Germ cell ovarian tumour arises from the germ cells (the cells that give rise to ovaries during the foetal development). The germ cell tumours include dysgerminoma, endodermal sinus tumour, embryonal carcinoma, malignant teratoma and choriocarcinoma. The stromal tumours include granulosa cell tumour and Sertoli-Leydig tumour. Ovarian germ cell tumours and stromal tumours affect young women usually below 20 years of age.
Ovarian germ cell tumours and stromal tumours remain asymptomatic during initial stages of the disease. Common presenting symptoms of the ovarian germ cell tumours and stromal tumours include mass in the abdomen and vaginal bleeding.
Staging of ovarian germ cell tumours and stromal tumours are done as follows:
Procedures used in the diagnosis and evaluation of a germ cell ovarian tumour include pelvic examination, ultrasound, CT scan and biopsy.
Krukenberg's tumour is a secondary ovarian tumour that has been metastasised usually from a primary carcinoma of the stomach, large intestine or the breast. The Krukenberg's tumour has a smooth surface, does not form adhesions and moves freely in the pelvis. Krukenberg's tumour usually affects both the ovaries.
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