Non-epithelial Ovarian Cancers

This blog post is based on the points taken from TOG article Non-epithelial Ovarian Cancers published in July 2021. This article provides a detailed review to understand the classification, diagnosis and management of all NEOCs with focus on MOGCTs and SCSTs. 

I hope you find this post helpful.

To access the original article : Click Here

To access all TOG topics : Click Here 

https://www.rubabk4courses.com/courses/

Introduction

Ovarian Cancer in UK

•   6th commonest cancer in women                     

•   Causes 4000 deaths per annum

Non-epithelial ovarian cancers NEOCs

•   uncommon form of ovarian tumor         

•   10% of all ovarian malignancies

•   NEOCs can present at ANY age

•   Classified into

•   Malignant Ovarian Germ Cell Tumors - MOGCTs

•   Sex Cord-Stromal Tumors - SCSTs

•   Ovarian Sarcoma

•   Small cell carcinoma of the ovary

Pathophysiology

•   Ovaries divided into cortex and medulla

•   Cortex made of ovarian follicles, interstitial gland cells & stroma

•   Surrounded by dense capsule and surface covered with surface epithelium (coelomic)

•   Epithelial ovarian tumors occur due to neomataplasia of surface epithelial cells

•   SCSTs arise from different cell types from primitive sex cords and stromal cells

•   Stromal cells include→ Theca cells, Fibroblasts & Leydig cells

•   Primitive sex cords include→ Granulosa & Sertoli cells

•   Germ cells arise from endodermal layer of the yolk sac

•   Most non-epithelial ovarian tumors arise from these above specific cells (germ cells, granulosa cells, theca cells, stromal fibroblasts and steroid cells)

 

Clinical Presentation

•   The commonest presenting symptoms — persistent abdominal distention, pelvic or abdominal pain, urinary urgency or frequency & menstrual irregularities

•   In female of ANY age presenting with complex ovarian mass — must consider NEOC as differential diagnosis

 

Classification of Non-epithelial Ovarian Cancer

Ref: TOG

MOGCTs    

•   Usually occur in premenopausal women

•   80% of preadolescent ovarian malignancies

•   Incidence    3.7 per 100 000 women per year

SCSTs                          can present at ANY age

•   Adult-type granulosa cell tumors mainly in peri-menopausal & postmenopausal 

•   Sertoli-Leydig cell tumor occur in young

•   Incidence    2.1 per 100 000 women per year

Malignant Germ Cell Tumors 

Surgical Site Infections in Obs & Gynae

The points in this post have been extracted from a TOG article published in April 2021. Surgical site infection poses a challenge for surgery and has huge impact on patient care/safety and healthcare system. It is an important cause of patient morbidity and if severe can even lead to death. 

Different guidelines have been produced to address this issue. This article provides a very good resource of comprehensive information about SSI. 

It is recommended to read the original article to grasp the topic completely. 

I hope you find this post helpful. 

Suggestions to improve future posts are welcome.

Thanks

https://www.rubabk4courses.com/courses/

Introduction

• SSI remains a peri-surgical problem
• May lead to severe morbidity & mortality, prolonged hospitalisation & enormous economic costs

Measure to reduce SSI

• Improved ventilation in OTs
• Equipment sterilisation
• Barrier use during surgery

Factors which increase SSI

• Antibiotic resistant pathogens, chronic disorders like DM, alcoholism, obesity & immunosuppression
• In obstetrics SSI associated with prolonged labour, emergency CS & multiple vaginal examinations
• Common pathogens include gram +ve & -ve organisms such as Staphylococcus aureus & E. Coli

Definition

• Infection of superficial or deep skin incision, or of an organ or space, occurring up to 30 days after surgery if no implant was left behind, or within 1 year if an implant was left in place

Specific Criteria for diagnosis

Superficial wound infection at least one of the following

• Purulent effluent or exudate with organisms identified
• One of following: pain, redness, localized swelling, tenderness or heat
• Diagnosis by surgeon or attending physician

Deep wound infection at least one of the following

• Purulent exudate from deep wound incision
• Spontaneous dehiscence of deep incisional wound or if deliberately opened with temp >30˚C, localized pain or tenderness
• Abscess or infection involving deep wound incisions
• Diagnosis by surgeon or attending physician

Organ or space infection at least one of the following

• Purulent exudate from a drain
• Organism isolated
• Evidence of abscess or infection
• Diagnosis by surgeon or attending physician

Wound Classification

Ref: TOG

Epidemiology

• Incidence 2-6% of surgeries in high-income countries
• UK in 2006 survey
• Incidence of health care-acquired infection 8% out of which 14% were SSI 
• 5% patients having surgery had SSI
• Incidence varies according to the type of surgery
• Highest after bowel surgery 8%
• Lowest after knee replacement 0.5%
• After TAH 1.6%
• After CS 3-15%

Risk factors  

Epilepsy in Pregnancy

Here is video from our recently completed MRCOG Part 2 Course.

This is an extract and covers the Epilepsy in Pregnancy.

Feel free to leave your feedback.

For Further information

MRCOG Part 2 Course September 2021

Cancer Survival Rates

This is a quick post about one a very important frequently tested fact in the exam i.e. five year survival rates of different stages of gynaecology cancers. Recently there have been questions for the one year survival rates as well. I have compiled the rates in the form of tables for quick review.

I hope this is helpful.

Visit cancer research UK for updated information Click Here

Cervical Cancer

Overall 5 year survival 60%

Overall 1 year survival 80%

Stage	5 Yr Survival	1 Yr Survival
I	79%	96%
II	47%	92%
III	22%	75%
IV	7%	50%

Endometrial Cancer

Overall 5 year survival 77%

Overall 1 year survival 89%

Stage	5 Yr Survival	1 Yr Survival
I	76%	99%
II	56%	95%
III	30%	83%
IV	10%	46%

Ovarian Cancer

Overall 5 year survival 43%

Overall 1 year survival 72%

Stage	5 Yr Survival	1 Yr Survival
I	93%	98%
II	67%	89%
III	27%	73%
IV	13%	53%

Vulval Cancer

Overall 5 year survival 65%

Overall 1 year survival 86%

Stage	5 Yr Survival	1 Yr Survival
I	86%	96%
II	74%	89%
III	54%	78%
IV	15%	43%

According to groin node status 5 yrs survival
Groin Node Negative	92%
ipsilateral	75%
bilateral	30%
>2 nodes	25%
>6 nodes	0%

You may also like

Module 17: Gynaecology Oncology

CA-125

Lynch Syndrome

Lynch Syndrome

This post is about one of an important condition, we come across in gynaecology oncology and that is Lynch Syndrome. Recently there has been evidence found for it to be strongly associated with endometrial and ovarian cancer. NICE recommends to screen all women with endometrial cancer for Lynch syndrome. The points are taken from a recently published TOG which is free access.

To download the original article: Click Here

For infographic: Click Here

Introduction

• Lynch syndrome (LS) → an autosomal dominant inherited condition
• Predisposes to cancers which include colorectal, endometrial & ovarian
• Most affected 95% people are unaware of their risk
• Gynecological cancer → often the first cancer diagnosis in women

Epidemiology

• Exact prevalence → unclear 1:278 to 1:440
• LS is the most common inherited cancer predisposition syndrome 
• Around 3% endometrial cancers are due to LS prognosis very good 10-yr survival ≥90%
• Association with ovarian cancer less clear 1-2%
• NICE recommends universal screening of individuals with colorectal cancer and endometrial cancer
• Degree of penetrance, disease spectrum and age of cancer onset variable

Lynch Syndrome

• Arises from inherited mutations in genes encoding proteins of highly conserved DNA mismatch repair (MMR) system MLH1, MSH2, MSH6 & PMS2
• MMR system maintains genomic stability
• Without functioning MMR→ uncorrected mutation rate ↑ by 1000-fold

How does it happen?

• One pathogenic allele of an MMR gene is inherited & once second allele acquires somatic inactivating mutation→ as MMR system is non-functional which leads to widespread genomic instability as errors which occur during replication can not be corrected
• Hypermutation leads to carcinogenesis
• Incidence of endometrial cancer in (MSH6 = MLH1 & MLH2) > PMS2