Rules of making human tumors

Background
Oncogene Proto-oncogene Tumor supressor
RB P53

Attributes of a tumor
Evade apoptosis Own mitotic signal & resist inhab Angiogenesis Immobilization Others
Invade metastasize

Evade apoptosis
P53
Arrest growth Induce apoptosis

RB
Determine when to precede into G1 Present in Cevical ca

Mitotic stimulation
RAS gene Over expression Presence in breast cancer

Angiogenesis
It produces pro-angiogenic factors For supply of the growing tumor cant grow more then 2 mm

imortalization
Telomere
Regulator for replication Prevent fusion of chromosomes

Telomerase

Ovarian Cancer
Staging and managment

 2008 world statistic

 2008 Fiji statistic

Histological
Epithelial Sex cord stromal Germ-cell

Main Stages of Ovarian Cancer

Stage I Tumour confined to the ovaries 1A Tumour limited to one ovary; no tumouron external surface; capsule intact. No malignant cells in ascites or peritoneal washings 1B As above, but tumour limited to both ovaries 1C Tumour limited to one or both ovaries with any of the following:

tumour on external surface; ruptured capsule; malignant cells in ascites or peritoneal

Stage II Tumour involving one or both ovaries with pelvic extension IIA Extension and/or implants in uterus and/or fallopian tubes. No malignant cells in ascites or peritoneal washings IIB Extension to other pelvic organs. No malignant cells in ascites or peritoneal washings IIC Tumour staged either IIA or IIB with malignant cells in ascites or peritoneal washings

Stage III - IV
Stage III Tumour involving one or both ovaries with microscopically confirmed peritoneal metastases outside the pelvis and/or regional lymph node metases. Liver capsule metastasis equals Stage III. IIIA Microscopic peritoneal metastases beyond the pelvis IIIB Macroscopic peritoneal metastasis beyond the pelvis, none exceeding 2cm in diameter IIIC Peritoneal metastases beyond the pelvis greater than 2cm in diameter and/or regional lymph node metastasis Stage IV Distances metastasis

Managment

Generally
All women should have good counseling
Stages and management, also prognosis How to manage the side effects Symptoms and signs of recurrence Should be offered written information

Stage I
lymphadectomy
Perform retroperitoneal lymph node assessment as a optimal staging Systemic block dissection of lymph node from the pelvic side wall to the level of the renal veins

Chemotherapy
Not for women who had optimal staging and are stage Ia or Ib But do offer it to stage Ic Disscus the possibility in suboptimal staging

Stage II to IV
Chemotherapy is offered Surgery
Complete resection of all macroscopic disease

Intra peritoneal chemotherapy

Do not offer