- Epithelial ovarian cancer: refers to malignancy involving ovary, fallopian tube and peritoneum
epithelium. Abnormality can begin at any of these sites presents with hallmark large ovarian mass,
and widespread pelvic and abdominal mets regardless of primary origin
- Risk factors: Postmenopausal women, FH of ovarian and breast cancer (e.g. BRCA carriers), nulliparity,
use of fertility drugs
- Usually presents with advanced dis. as early symptoms are non-specific
- PE: may present with firm, non-mobile pelvic mass with nodularity—concerning for EOC extension
beyond adnexa. Ascites – due to peritoneal spread ↑ capillary permeability and ↓ intravascular
oncotic pressure
- CA-125: little specificity in premenopausal women—can be ↑ from many benign conditions like
endometriosis, leiomyomata and lupus. Mainly useful in post-menopausal women. Can also be used to
monitor recurrence of proven malignancy after treatment
- Exploratory laparotomy with cancer resection, staging and inspection of entire abdominal cavity, esp. in
acute presentation, is definitive rx. During surgery, ovaries, uterus, omentum and any visually apparent
cancerous lesion will be removed and pelvic and paraaortic LN dissected
- Chemotherapy with platinum based agents—initiated after cancer is removed
- Image guided biopsy is CONTRAINDICATED can cause spread of cancerous cells to entire abdominal
cavity
GRANULOSA CELL TUMOR
- Occurs in post-menopausal and rarely in prepubertal girls
- Tumor secretes estrogen breast tenderness, endometrial CA (other feature in table)
- Thickened endometrium on USG requires immediate evaluation for concomitant endometrial
malignancy with endometrial biopsy—gold standard to obtain endometrial sample
- Rx: surgical excision
35
Page
, CONTRACEPTION
- Fertilization is possible 24 hours after ovulation takes 6-12 days to implant
36
Page
,EMERGENCY CONTRACEPTION OPTIONS
More effective than
levonorgestrel but
less readily available
COPPER IUD
- MOST EFFECTIVE emergency and long-term contraception
- Needs a professional to insert
- Hormone free method so can be used in breast cancer pts undergoing treatment for long term
contraception and to avoid hormonal effects of OCPS
- Can be placed for a max. of 10 years
- Levonorgestrel IUD can be used too for long-term (can be placed for 5 years) but NOT emergency
contraception
- Age and parity are not contraindications. Acute cervicitis and PID are contraindications.
- Use in conjunction with condoms to prevent STDs
37
Page
, ORAL LEVONORGESTREL
- Also known as plan B—most readily available emergency contraception
- Ulipristil and levonorgestrel are more are more effective before ovulation has occurred as they prevent
oocyte release and delays ovulation
- Ineffective after fertilization
- Efficacy ↓ over course of 72 hours so give asap
OCPS
- For emergency contraception, multiple pills must be taken in 2 doses 12 hours apart to achieve an
effective progestin level
- May be easy to obtain but less effective
ORAL CONTRACEPTIVE PILLS (OCPS)
BENEFITS OF COMBINATION OCPS
38
Page
epithelium. Abnormality can begin at any of these sites presents with hallmark large ovarian mass,
and widespread pelvic and abdominal mets regardless of primary origin
- Risk factors: Postmenopausal women, FH of ovarian and breast cancer (e.g. BRCA carriers), nulliparity,
use of fertility drugs
- Usually presents with advanced dis. as early symptoms are non-specific
- PE: may present with firm, non-mobile pelvic mass with nodularity—concerning for EOC extension
beyond adnexa. Ascites – due to peritoneal spread ↑ capillary permeability and ↓ intravascular
oncotic pressure
- CA-125: little specificity in premenopausal women—can be ↑ from many benign conditions like
endometriosis, leiomyomata and lupus. Mainly useful in post-menopausal women. Can also be used to
monitor recurrence of proven malignancy after treatment
- Exploratory laparotomy with cancer resection, staging and inspection of entire abdominal cavity, esp. in
acute presentation, is definitive rx. During surgery, ovaries, uterus, omentum and any visually apparent
cancerous lesion will be removed and pelvic and paraaortic LN dissected
- Chemotherapy with platinum based agents—initiated after cancer is removed
- Image guided biopsy is CONTRAINDICATED can cause spread of cancerous cells to entire abdominal
cavity
GRANULOSA CELL TUMOR
- Occurs in post-menopausal and rarely in prepubertal girls
- Tumor secretes estrogen breast tenderness, endometrial CA (other feature in table)
- Thickened endometrium on USG requires immediate evaluation for concomitant endometrial
malignancy with endometrial biopsy—gold standard to obtain endometrial sample
- Rx: surgical excision
35
Page
, CONTRACEPTION
- Fertilization is possible 24 hours after ovulation takes 6-12 days to implant
36
Page
,EMERGENCY CONTRACEPTION OPTIONS
More effective than
levonorgestrel but
less readily available
COPPER IUD
- MOST EFFECTIVE emergency and long-term contraception
- Needs a professional to insert
- Hormone free method so can be used in breast cancer pts undergoing treatment for long term
contraception and to avoid hormonal effects of OCPS
- Can be placed for a max. of 10 years
- Levonorgestrel IUD can be used too for long-term (can be placed for 5 years) but NOT emergency
contraception
- Age and parity are not contraindications. Acute cervicitis and PID are contraindications.
- Use in conjunction with condoms to prevent STDs
37
Page
, ORAL LEVONORGESTREL
- Also known as plan B—most readily available emergency contraception
- Ulipristil and levonorgestrel are more are more effective before ovulation has occurred as they prevent
oocyte release and delays ovulation
- Ineffective after fertilization
- Efficacy ↓ over course of 72 hours so give asap
OCPS
- For emergency contraception, multiple pills must be taken in 2 doses 12 hours apart to achieve an
effective progestin level
- May be easy to obtain but less effective
ORAL CONTRACEPTIVE PILLS (OCPS)
BENEFITS OF COMBINATION OCPS
38
Page
