Malignant ovarian tumour: Management of malignant ovarian tumors depends on age, parity, type of tumour, stage of tumour. 1.Surgical staging
2.Definitive surgery or debulking 3.Chemotherapy
4.Radiotherapy
5.Immunotherapy
6.Hormonal therapy
1.Surgical staging of ovarian tumors:
To do the surgical staging,vertical midline or paramedian incision to be given.
It should be adequate enough to allow excision of primary tumour with its capsule intact.
It can be extended upwards.
It will give adequate access to upper abdomen.
Low transverse incision – In this rectus muscle will be divided or detached from pubic symphisis or can be converted to J shaped incision.
Evacuation of ascites or multiple cytologic washings can be done. Volume of ascitic fluid recorded and submitted (min. 25ml) for cytologic evaluation.
If no free fluid found separate saline washings (50-100ml) from a)pelvic cul-de-sac b)right paracolic space c)left paracolic space d)undersurface of each hemidiaphragm can be taken. Ovarian tumour to be inspected (papillary excrescences, rupture of capsule), removed and sent for frozen section.
Removal of opposite ovary and uterus depending on other factors. Complete abdominal inspection and palpation to be done. Peritoneal surfaces and intraabdominal viscera, the peritoneum of cul-de-sac, small bowel mesentery, ascending colon, liver, omentum, undersurface of right and left hemidiaphgram, stomach, transverse colon, spleen, descending colon, bladder peritoneumin can be examined in a systematic fashion.
All suspicious areas and adhesions to be biopsied.
If no visible disease found, biopsies from cul-de-sac peritoneum, bladder peritoneum, both lateral pelvic walls, paracolic peritoneum bilaterally, undersurface of right hemidiaphgram can be taken. Infracolic omentectomy – to be done for epithelial ovarian ca. Omental wedge biopsy – for germcell or stromal tumours. Appendicectomy - in case of mucinous epithelial ca.
Pelvic and paraaortic lymphnodes explored on both sides.
Frozen section of enlarged lymphnode, formal pelvic lymphadenectomy are to be sent. Careful documentation of the findings to be done.
2.Definitive surgery or debulking 3.Chemotherapy
4.Radiotherapy
5.Immunotherapy
6.Hormonal therapy
1.Surgical staging of ovarian tumors:
To do the surgical staging,vertical midline or paramedian incision to be given.
It should be adequate enough to allow excision of primary tumour with its capsule intact.
It can be extended upwards.
It will give adequate access to upper abdomen.
Low transverse incision – In this rectus muscle will be divided or detached from pubic symphisis or can be converted to J shaped incision.
Evacuation of ascites or multiple cytologic washings can be done. Volume of ascitic fluid recorded and submitted (min. 25ml) for cytologic evaluation.
If no free fluid found separate saline washings (50-100ml) from a)pelvic cul-de-sac b)right paracolic space c)left paracolic space d)undersurface of each hemidiaphragm can be taken. Ovarian tumour to be inspected (papillary excrescences, rupture of capsule), removed and sent for frozen section.
Removal of opposite ovary and uterus depending on other factors. Complete abdominal inspection and palpation to be done. Peritoneal surfaces and intraabdominal viscera, the peritoneum of cul-de-sac, small bowel mesentery, ascending colon, liver, omentum, undersurface of right and left hemidiaphgram, stomach, transverse colon, spleen, descending colon, bladder peritoneumin can be examined in a systematic fashion.
All suspicious areas and adhesions to be biopsied.
If no visible disease found, biopsies from cul-de-sac peritoneum, bladder peritoneum, both lateral pelvic walls, paracolic peritoneum bilaterally, undersurface of right hemidiaphgram can be taken. Infracolic omentectomy – to be done for epithelial ovarian ca. Omental wedge biopsy – for germcell or stromal tumours. Appendicectomy - in case of mucinous epithelial ca.
Pelvic and paraaortic lymphnodes explored on both sides.
Frozen section of enlarged lymphnode, formal pelvic lymphadenectomy are to be sent. Careful documentation of the findings to be done.
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