A 25 year old married nullipara undergoes laproscopic cystectomy for ovarian cyst which on histopath reveals ovarian serous cisadenocarcinoma. What should be the next management?
Ans. is 'c' i.e., Unilateral salpingooophorectomy Cystadenocarcinoma is an epithelial ovarian carcinoma.All patients with epithelial ovarian carcinoma require surgery i.e., B/L salpingooophorectomy with hysterectomy.But the patient in question is quite young and nulliparous. She needs fertility sparing surgery.There haven't been enough successful trials on fertility sparing surgery in ovarian carcinoma.Currently two surgical options are available in patients with epithelial ovarian carcinoma who desires to retain the fertility.Simple unilateral salpingooophorectomyStaging procedure (unilateral salpingooophorectomy, bilateral pelvic and paraaortic lymphadenectomy and multiple biopsies).Simple unilateral salpingooophorectomy is done in patients with early stage disease whereas staging procedure is done in patients with advanced disease.Stage of the cancer is not mentioned in the question. But, staging procedure is not mentioned as an option. Thus, the answer is obvious i.e., unilateral salpingooophorectomy.Management of epithelial ovarian tumour.The initial management of patient with epithelial ovarian tumour is surgery.* Surgery is almost always performed in women suspected of epithelial ovarian cancer. The procedure is necessary to: -Obtain tissue at diagnosisAssess the extent of the diseaseAttempt optimal cyto reduction which is crucial for successful treatment.Treatment in patients with early stage diseasePatients with stage I or II disease (Tumour confined to the ovary and pelvis).These patients require -B/L salpingooophorectomy with hysterectomy.For management purpose early stage disease can be divided into two categories: - Patients with low risk.Patients with early stage disease and well differentiated encapsulated tumour - - They don't need any further t/t after surgery.Patients with high riskPatients with early stage disease with poorly differentiated tumours, those with pelvic extension, capsular rupture or involvement ascites or high grade lesions.These patients require Surgery with postoperative chemotherapyPatients with advanced disease (stage III or IV) (Distant metastasis, peritoneal implants).In these patients surgery is not enough. But still they need surgery for debulking of the tumour.They require postoperative chemotherapy (Platinum based chemotherapy).
Serial Ca 125 measurement and follow up
Hysterectomy and bilaterals alpingoophorectomy
Unilateral salpingoophorectomy
Radiotherapy
Ovary