Σταδιοποίηση σε Ca Ωοθηκών

Ca Ωοθηκών

AJCC Stages

Stage

T

N

M

I

T1

N0

M0

IA

T1a

N0

M0

IB

T1b

N0

M0

IC

T1c

N0

M0

II

T2

N0

M0

IIA

T2a

N0

M0

IIB

T2b

N0

M0

IIC

T2c

N0

M0

III

T3

N0

M0

IIIA

T3a

N0

M0

IIIB

T3b

N0

M0

IIIC

T3c

N0

M0

Any T

N1

M0

IV

Any T

Any N

M1

(T) Primary Tumor

TNM

FIGO

Definitions

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

I

Tumor limited to ovaries (1 or both)

T1a

IA

Tumor limited to 1 ovary; capsule intact, no tumor on ovarian surface; no malignant cells in ascites or peritoneal washing

T1b

IB

Tumor limited to both ovaries; capsules intact, no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings

T1c

IC

Tumor limited to 1 or both ovaries with any of the following: Capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings

T2

II

Tumor involves 1 or both ovaries with pelvic extension

T2a

IIA

Extension &/or implants on uterus &/or tube(s); no malignant cells in ascites or peritoneal washings

T2b

IIB

Extension to &/or implants on other pelvic tissues; no malignant cells in ascites or peritoneal washings

T2c

IIC

Pelvic extension &/or implants with malignant cells in ascites or peritoneal washings

T3

III

Tumor involves 1 or both ovaries with peritoneal metastasis outside the pelvis

T3a

IIIA

Microscopic peritoneal metastasis beyond pelvis (no macroscopic tumor)

T3b

IIIB

Macroscopic peritoneal metastasis beyond pelvis ≤ 2 cm in greatest dimension

T3c

IIIC

Peritoneal metastasis beyond pelvis > 2 cm in greatest dimension &/or regional lymph node metastasis

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

IIIC

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

IV

Distant metastasis (excludes peritoneal metastasis)

Χαρακτηριστικά Επέκτασης

Understanding pattern of spread is crucial for adequate radiological and surgical staging

Local spread

• Direct extension to surrounding pelvic structures
  • Commonly fallopian tubes, uterus, and contralateral adnexa
  • Less commonly rectum, bladder, and pelvic sidewall
• Uterine involvement
  • Independent primary tumors of low histologic grade, usually of endometrioid type, with involvement limited to endometrium and ovary
    • Favorable prognosis; often no additional treatment
  • Tumors metastasizing from uterus to ovary or from ovary to uterus
    • Worse prognosis; adjuvant therapy is generally indicated
  • Distinction between primary vs. secondary involvement relies on histological examination

Peritoneal seeding

• Most common mode of tumor spread
• Malignant cells shedding from tumor surface into peritoneal cavity
• Malignant cells are distributed by gravity into cul-de-sac or follow normal routes of peritoneal fluid circulation
  • Preferential flow and seeding along right paracolic gutter, liver capsule, and right hemidiaphragm
• Peritoneal fluid normally drains through rich lymphatic capillary network of diaphragm to supradiaphragmatic lymph nodes
  • Occlusion of these lymphatics by tumor cells blocks absorption of peritoneal fluid
  • Contributes to accumulation of malignant ascites
• Most common sites of peritoneal metastases
  • Cul-de-sac
  • Greater omentum
  • Paracolic gutters
  • Small and large bowel surface
  • Liver surface
  • Subphrenic spaces

• Other potential sites of metastases
  • Porta hepatis
  • Fissure for ligamentum teres
  • Lesser sac
  • Gastrosplenic and gastrohepatic ligaments
  • Splenic hilum
• Primary peritoneal carcinoma
  • Unusual tumor of similar histiogenic origin to primary ovarian carcinoma
  • Primary tumor of peritoneum that diffusely involves peritoneal surface but spares or only superficially involves ovaries
  • Generally diagnosed in state of peritoneal carcinomatosis
  • Poor prognosis
  • Biopsy important to differentiate primary peritoneal carcinoma from peritoneal carcinomatosis (due to other cancers, mesothelioma, lymphomatosis, or tuberculous peritonitis)
• Pseudomyxoma peritonei
  • Growing body of immunohistochemical and molecular genetic studies suggest that majority are actually secondary to appendiceal tumors in both men and women
  • Those that are ovarian in origin probably originated from mucinous tumors arising in teratomas

Lymphatic spread

• 3 primary pathways for lymphatic drainage
  • Main lymphatics follow ovarian veins → paraaortic and aortocaval lymph nodes at level of renal veins
  • Through broad ligament → pelvic lymph nodes, including external iliac, hypogastric, and obturator nodes
  • Along round ligament → inguinal lymph nodes

Hematogenous spread

• Least common mode of spread
• Usually not present at initial diagnosis, can be found at restaging
  • In up to 50% of patients at autopsy

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Primary ovarian Ca are differentiated by cell origin

Epithelial ovarian tumors (EOT): 90% of ovarian Ca

• Serous cystadenocarcinoma (60%)
• Endometrioid carcinoma (10%)
• Clear cell carcinoma (10%)
• Carcinosarcoma (10%)
• Mixed (5%)
• Mucinous cystadenocarcinoma (3%)
  • Less common than initially thought
  • Many mucinous tumors of ovaries are actually metastatic from gastrointestinal primary
• Undifferentiated carcinoma (1%)
• Brenner tumor (< 1%)

Nonepithelial ovarian tumors: 10% of ovarian Ca

• Germ cell tumors
  • Dysgerminoma
  • Embryonal carcinoma
  • Immature teratoma
  • Olyembryoma
  • Choriocarcinoma
  • Mixed tumors
• Tumor of sex cord or stroma
  • Malignant granulosa cell tumor

Nonepithelial primary ovarian cancers may be staged using TNM classification system