Ovarian low malignant potential tumor
Overview
Ovarian low malignant potential tumor is a disease in which abnormal cells form in the tissue covering the ovary. Ovarian low malignant potential tumors have abnormal cells that may become cancer, but usually do not. This disease usually remains in the ovary. When disease is found in one ovary, the other ovary should also be checked carefully for signs of disease.
Symptoms
* Small bowel obstruction * Asymptomatic
Causes
Exactly what causes ovarian cancer isn't known, but the greatest number of cases occurs in the fifth decade of life. However, it can occur during childhood. Other contributing factors include infertility; nulliparity; familial tendency; ovarian dysfunction; irregular menses; and possible exposure to asbestos, talc, and industrial pollutants. Primary epithelial tumors arise in the ovarian surface epithelium; germ cell tumors, in the ovum itself; and sex cord tumors, in the ovarian stroma. Ovarian tumors spread rapidly intraperitoneally by local extension or surface seeding and, occasionally, through the lymphatics and the bloodstream. Generally, extraperitoneal spread is through the diaphragm into the chest cavity, which may cause pleural effusions. Other metastasis is rare.
Diagnosis
Diagnosis of ovarian cancer requires clinical evaluation, complete patient history, surgical exploration, and histologic studies. Preoperative evaluation includes a complete physical examination, including pelvic examination with Papanicolaou smear (positive in only a small number of women with ovarian cancer) and the following special tests: ❑abdominal ultrasonography, computed tomography scan, or X-ray (may delineate tumor size) ❑ complete blood count, blood chemistries, and electrocardiogram ❑ excretory urography for information on renal function and possible urinary tract anomalies or obstruction ❑ chest X-ray for distant metastasis and pleural effusions ❑ barium enema (especially in patients with GI symptoms) to reveal obstruction and size of tumor ❑ lymphangiography to show lymph node involvement ❑ mammography to rule out primary breast cancer ❑ liver function studies or a liver scan in patients with ascites ❑ ascites fluid aspiration for identification of typical cells by cytology ❑ laboratory tumor marker studies, such as Ca-125, carcinoembryonic antigen, and human chorionic gonadotropin. Despite extensive testing, accurate diagnosis and staging are impossible without exploratory laparotomy, including lymph node evaluation and tumor resection.
Treatment
According to the staging of the disease and the patient's age, treatment of ovarian cancer requires varying combinations of surgery, chemotherapy and, in some cases, radiation. Occasionally, in girls or young women with a unilateral encapsulated tumor who wish to maintain fertility, the following conservative approach may be appropriate: ❑resection of the involved ovary ❑biopsies of the omentum and the uninvolved ovary ❑peritoneal washings for cytologic examination of pelvic fluid ❑careful follow-up, including periodic chest X-rays to rule out lung metastasis. Ovarian cancer usually requires more aggressive treatment, including total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, lymph node biopsies with lymphadenectomy, tissue biopsies, and peritoneal washings. Complete tumor resection is impossible if the tumor has matted around other organs or if it involves organs that can't be resected. Bilateral salpingo-oophorectomy in a prepubertal girl necessitates hormone replacement therapy, beginning at puberty, to induce the development of secondary sex characteristics. Chemotherapy extends survival time in most ovarian cancer patients, but it's largely palliative in advanced disease. However, prolonged remissions are being achieved in some patients. Chemotherapeutic drugs useful in ovarian cancer include carboplatin, docetaxel, cyclophosphamide, doxorubicin, paclitaxel, cisplatin, and topotecan. These drugs are usually given in combination and they may be administered intraperitoneally. Radiation therapy generally isn't used for ovarian cancer because the resulting myelosuppression would limit the effectiveness of chemotherapy. Radioisotopes have been used as adjuvant therapy, but they cause small-bowel obstructions and stenosis.