Treatment Of Ovarian Tumours Biology Essay
Patients AND METHOD: 55 instances of ovarian tumors admitted from 19th July 2003 to 20th July 2005 were analyzed retrospectively.
All patients were given enrollment figure and the medical record was saved in a preformed proforma, informations analysis was done with demographic feature, mark and symptoms, probes, type of surgical intervention, histopathology, chemotherapy, follow up and mortality associated with this disease. SPSS 16 package was used for analysis of descriptive statistical consequences.Consequence: Out of 55 adult females admitted with ovarian tumors 15 ( 27.
27 % ) were malignant across all age group and 40 ( 72.72 % ) were benign. Thus the incidence of ovarian malignance during the survey period was 1.29 % . Average age of adult females with malignant ovarian tumor was 45.83 A± 13.72 old ages, and for benign tumors was 30.
82 A± 10.2 old ages, the commonest tumor was epithelial in beginning, most of patients present in late phase when endurance is limited.Decision: Early sensing, prompt intervention of tumor can cut down morbidity and mortality.
Keywords: Ovarian tumors, incidence and direction of ovarian malignance.Introduction: Of all gynaecological malignant neoplastic disease ovarian malignances represent the greatest challenge. It is the 2nd most normally diagnosed malignance of the female generative system and 5th taking cause of the decease. 1, 2Among gynaecological malignances it is unluckily being progressively encountered in Pakistan. Harmonizing to multicenter survey on the frequence of malignant ovarian tumor supported by Pakistan Medical Research Council ( PMRC ) incidence rate of ovarian malignance found to be 3.37 % in 1973.
2 Contrary to the western surveies and in India, ovarian tumor were more frequent than cervical cancers.3 Early ovarian malignant neoplastic disease mass does non do obvious symptoms, 4 most of the adult females present with advanced phase where the forecast is hapless in malice of intensive and complex therapies, earlier sensing and intervention better the endurance rate. 5, 6The importance of the surveies has increased because ovarian malignant neoplastic disease is a soundless slayer and most of the patients present in an advanced phase due to miss of showing.Aims & A ; Aims: In this survey we wanted to happen out the incidence, early sensing by proper showing when the forecast is good and in advanced phase multidisciplinary attack to patient and direction will guarantee the best consequences to cut down morbidity and mortality.MATERIAL AND METHODS: Retrospectively records of 55 patients admitted from 19th July 2003 to 20th July 2005 were analyzed with respects to incidence, type, clinical image their diagnosing and direction.
History, physical scrutiny, everyday probe, tumor markers, echography and CT scan determination were noted on preformed proforma. Depending on probationary diagnosing, surgical theatrical production was done. Two patients after biopsy were given direct chemotherapy while in the remainder of the instances cystectomy, oophrectomy, entire abdominal hysterectomy ( TAH ) and bilateral salpingo oophrectomy ( BSO ) , omentectomy was done depending on age, household completion and intuition of malignance. Post operative chemotherapy for 4-6 rhythms was given depending on histopathology study.
Consequence: Entire Numberss of gynaecological patients admitted in the period of 2 old ages were 1160 as shown in Table 1. Out of entire 55 adult females admitted with ovarian tumors, 15 ( 27.27 % ) were malignant across all age groups while staying 40 ( 72.72 % ) were benign. Hence incidences of ovarian malignance were 1.29 % .
Ovarian malignant neoplastic disease is unusual earlier age of 40 old ages. Table II showed the peak age scope between 40-45 old ages, 09 ( 54.01 % ) patients were in this age group, while youngest patient recorded with us was 10 old ages of age.
Of all the benign tumor, maximal figure of patients were 28 ( 70 % ) in the age group of 21-40 old ages. Table III showed that 10 ( 68.8 % ) were malignant in multiparous adult females while about half 20 ( 50 % ) were in benign group. In low para 50 % were benign and 5 ( 31.32 % ) were malignant. Table IV showed the mark and symptom of patients in benign tumor, most common presenting ailment was hurting in venters in 100 % patients, and 10 ( 25 % ) had sterility and 20 ( 50 % ) irregular catamenial rhythm while in malignant tumour abdominal dilatation was more common in 10 ( 66.
67 % ) patients.Table V showed on ultrasound bilateral tumor was common in malignant group. In 10 ( 66.67 % ) instances with a size of & gt ; 20 centimeter, solid and cystic in consistence nowadays in 8 ( 53.
33 % ) , while in benign tumour 30 ( 75 % ) had one-sided tumor with a size of 6-10 centimeter in 17 ( 42.5 % ) patients and 30 ( 75 % ) tumor had cystic consistence.CA – 125 was raised in 11 ( 73.
3 % ) in malignant ovarian tumor and merely in 1 ( 25 % ) in benign. CT scan was done in 4 ( 26.67 % ) patients showed advanced malignance. Table VI showed assorted type of operative process. In 30 ( 75 % ) benign instances oophrectomy / cystectomy was done.
Entire abdominal hysterectomy ( TAH ) and bilateral salpingo oophrectomy ( BSO ) done in 10 ( 25 % ) patients. In malignant group 11 ( 82.84 % ) patients had entire abdominal hysterectomy ( TAH ) , bilateral salpingo oophrectomy and omentectomy, while 2 ( 14.
28 % ) had biopsy and debulking, Four ( 28.56 % ) patients received radiotherapy and chemotherapy, while the staying had merely chemotherapy. Three ( 21.42 % ) were present in phase I, they have regular followup and were free of disease, 3 patients ( 21.42 % ) were in phase III, 01 ( 7.
14 % ) patient was lost on followup, and 2 ( 14.28 % ) patients had regular followup. 8 ( 57.14 % ) patients were admitted in phase IV with distant metastasis, among these one patient lost her followup, 6 ( 42.58 % ) patients were expired within six month after surgery during chemotherapy and one patient died before intervention.Discussion: Cancer has over taken bosom disease as a taking cause of decease all over the universe, mortality from the malignant neoplastic disease now accounting for one one-fourth of all decease.
By and large ovarian malignant neoplastic disease is the disease of peri and station menopausal adult females. The hazard of developing ovarian malignant neoplastic disease extremum is the fifth decennary of life 7 which is comparable to our survey. Nulliparity has been considered as important hazard factor, most of the adult females in our survey were parous, this survey was similar to the consequences reported by saeed et al 8 but contradict to western 9 universe where merely 8.2 % 10 were nulliparous and Ahmed-J et Al in Pakistan.11In our survey reported symptoms in malignant instances were abdominal dilatation and GIT disturbance and in benign instances abdominal hurting was the commonest symptom.Abdominal and pelvic ultrasound is the commonest probe done for diagnosing of ovarian instances, this was recommended by National Institute of Health ( NIH ) as a preferable agencies of naming ovarian mass.12 CA-125 was raised in 50 % of the patient this trial is utile in differential diagnosing and in followup of the disease, it is non accepted to observe early disease because of its low sensitivity13 theatrical production and scaling of the tumor has of import predictive value. Surgery remain the gilded criterion treatment.
14 Western surveies coated 36 % adult females present- phase I, 19 % in phase II, 32 % in phase III and 13 % in phase IV. 15 In our survey higher per centum 73.33 % were present in phase III + IV and 3 ( 20 % ) were in phase I. In early phase of the disease the generative potency of a immature adult females is pursued with conservative surgery while in progress disease cytoreductive surgery reduces the tumor majority, so that chemotherapy will exercise a maximal consequence. Follow-up is normally ignored by the patient, among these one patient was followed on a regular basis and one last follow-up, six patients were expired with in 6 months after surgery during chemotherapy this similar form was seen. 16, 17Decision: Ovarian malignant neoplastic disease is the commonest gynecological malignant neoplastic disease second to chest malignant neoplastic disease.
Because of the deficiency of proper testing adult females ever present in the late phase, when there is no constituted intervention, therefore our purpose should be early sensing, thorough intervention and regular followups so to cut down the morbidity and mortality.
Table – 1 INCIDENCE OF OVARIAN MALIGNANCY
Entire figure of Gynecological patient admitted1160Number of patients with ovarian tumours55Number of patients with benign ovarian tumor40Number of patients with malignant ovarian tumor15Incidence of ovarian malignance1.29 %
Table II Age
Percentage ( % )
Percentage ( % )
& lt ; 2016.662521-40533.33287041-60960102561-800000Entire1510040100
Table III Parity
426.6 %1025 %
16.67 %1025 %
1068.8 %2050 %
Table IV Presentation of mark & A ; symptoms
Abdominal distention10 ( 66.67 % )10 ( 25 % )Pain In venters8 ( 53.33 % )40 ( 100 % )Irregular vaginal hemorrhage3 ( 20 % )20 ( 50 % )Anorexia2 ( 13.33 % )
— — — — — –
— — — — –
10 ( 25 % )Precocious pubescence1 ( 6.67 % )
— — — — –
Table – Volt Probes
U/S CT Scan
UnilateralBilateral5 ( 33.33 % )10 ( 66.67 % )30 ( 75 % )10 ( 25 % )
SolidCysticCystic + solid4 ( 26.6 % )3 ( 20 % )8 ( 53 % )030 ( 75 % )10 ( 25 % )
6-10cm11-20cm& gt ; 20cm3 ( 20 % )4 ( 26.67 % )8 ( 53.33 % )17 ( 42.5 % )13 ( 32.5 % )10 ( 25 % )
CA – 125
11 ( 73.3 % )1 ( 2.5 % )
4 ( 26.6 % )0
Table VI – Treatment Modalities
Number of patient.
Type of operation
30 ( 75 % )10 ( 25 % )Oophrectomy/cyctectomyTAH+BSO
SerousMucinousGranulosa cellDysgerminomaAdvance phase disease.4 ( 28.47 % )6 ( 42.85 % )1 ( 7.14 % )2 ( 14.28 % )2 ( 14.28 % )TAH+BSO+OmentectomyTAH+BSO+OmentectomyUnilateral+SalpingooophretomyTAH+BSOBiopsy / debulking46112112
Table VII Out semen of patient with malignant ovarian tumor.
Number of patient.
Lost follow up
IV and Advanced09010206