A 60 yr old woman came to OPD with distended abdomen and postmenopausal bleeding. Imaging suggests bilateral ovarian complex masses with a CA 125 value of 1500. A comprehensive surgical staging is planned. Per operatively, bilateral ovarian masses are seen with surface involvement and ascites. There is no pelvic or extrapelvic extension of tumor or lymph node involvement. What is the appropriate treatment?
Diagnosis here is Stage 1C ovarian cancer, according to FIGO staging The tumour is limited to one or both ovaries, with any of the following: The ovary capsule is ruptured The tumour is detected on the ovary surface Positive malignant cells are detected in the ascites or peritoneal washings Treatment of Stage 1C (HIGH RISK STAGE 1 Disease) is adjuvant chemotherapy following Comprehensive surgical staging (involves hysterectomy + BSO) MANAGEMENT OF OVARIAN EPITHELIAL CANCER EARLY Low risk Stage 1A, 1B, low grade Surgical staging High risk Stage 1C, high grade Surgical staging + adjuvant chemotherapy ADVANCED Stage II, III, IV Maximal cytoreduction + adjuvant chemotherapy STEPS OF COMPREHENSIVE SURGICAL STAGING Veical midline incision Ascitic fluid for cytology If no ascites : take peritoneal washings Biopsy of suspicious lesions and diaphragm Supracolic omentectomy Retroperitoneal lymph node evaluation IMPOANT POINTS Maximal cytoreduction: means removal of entire pelvic tumor + resection of metastasis Optimal debulking: less than 1 cm of residual lesion Feility sparing surgery (unilateral salpingo-oophorectomy): Stage 1A with low grade, Bordeline tumors Neo adjuvant chemotherapy: Stage III and IV with massive ascites, massive pleural effusion, unresectable tumor. iT increases chances of optimal debulking
Maximal cytoreduction surgery
Hysterectomy + Bilateral salpingo-oophorectomy
Proceed with surgical staging with hysterectomy + Bilateral salpingo-oophorectomy followed by adjuvant chemotherapy
Bilateral salpingo-oophorectomy followed by adjuvant chemoradiation
Ovarian Tumors and Vulvar cancer