Cancer de líovaire: bilan d'extension - AMC Chirurgie Cancers Pelviens

Titre: AMC Chirurgie Cancers Pelviens - Cancer de líovaire: bilan d'extension
Diagnostic: Cancer de líovaire: bilan d'extension
Auteur: KINKEL Karen
Commentaire: Dfouni Natalia
Hôpital: HUG
Département: Département de Radiologie
Date: 04.04.2003
ID: 3714
Chapitre: Ovaires

Commentaire: Cancer of the ovary The value of sonography for routinescreening
of ovarian cancer has yet to be established. Ovarian masscharacterization by clinical
examination is not reliable.Ultrasound, CT or MR imaging can detect more than 90% of
ovarianlesions, but no imaging technique can reliably predict histology.Morphologic signs
of malignancy that include wall or septathickness greater than 3mm, wall irregularity such
as mural nodulesor papillary projections, a solid mass or hypervascularity
arecommonly-used criteria for characterization of ovarian lesion andapply to all
cross-sectional techniques. Ancillary findings ofpelvic organ and pelvic sidewall invasion,
peritoneal, omental, ormesenteric involvement, ascitis, and lymphadenopathy are
additionalsigns increasing the post-test probability for ovarian cancer.There is no
consensus in the literature whether one technique isbetter than the others in differentiating
benign from malignantmasses. Due to availability, patient comfort, and low
cost,transvaginal ultrasound in combination with transabdominal US isthe best initial
imaging examination in the characterization ofovarian lesions. A major problem of
sonographic evaluation is asignificant number of lesions appearing suspicious
orindeterminate. For example, hemorrhage in a unilocular cyst is afinding typical of benign
lesions. On US, however, a clot canresemble papillary projections and fibrous strands may
be misreadas septa. Further characterization of internal architecture ofthese lesions with
Color-Doppler sonography, contrast-enhanced MRIor CT may be helpful to avoid
unnecessary surgery. Whereas cancerof the cervix or uterus can be diagnosed by biopsy
without generalanesthesia, adequate histological diagnosis of an ovarian massrequires
surgical removal of the entire specimen requiring generalanesthesia. Surgical staging and
treatment of ovarian cancerincludes bilateral oophorectomy, total hysterectomy with pelvic
andaortic lymphadenectomy and omentectomy. In ovarian cancer,information regarding
pretreatment staging may aid in surgicalplanning, and may influence the choice of a
specialist thusresulting in a more complete surgery at the time of diagnosis.Imaging
techniques that combine high performance for lesioncharacterization and staging are
therefore recommended in patientswith higher pre-test probability for ovarian cancer.
Preoperativeknowledge of sigmoid colon or urinary bladder invasion will affectthe duration
of surgery and require special surgical expertise.Although imaging can give important
pre-operative information, itcannot replace surgical staging. Errors in staging by imaging
aredue to missed small implants, peritoneal carcinomatosis, andmisdiagnosis of enlarged
but benign lymph nodes. Detection ofperitoneal implants depends on lesion size, location
and presenceof surrounding ascitis. Peritoneal seeding is always evaluatedduring surgery,
but preoperative knowledge will alert the surgeonto the presence of lesions at specific
sites. Lesions difficult toevaluate during surgery are the retroperitoneum and the
diaphragm.Presence of diaphragmatic implants or liver surface implants mayrequire special
surgical procedures. Imaging is most useful inadvanced cases (stage III and IV) in which
cytoreductivepre-operative chemotherapy or special surgical expertise may beappropriate.
Moreover, when CT detects lesions located above therenal hilum and measuring more
than 2 cm, the tumor can beconsidered as non-resectable in 92%. Patients with
highperioperative morbidity risk should therefore undergocross-sectional imaging prior to
surgery. Both, CT and MRI havesimilar staging accuracy ranging from 70-90%. At present,
due tocost, examination and interpretation time, contrast-enhanced CT isthe primary
imaging modality for ovarian cancer staging. MRI shouldbe reserved for cases in which CT
findings are equivocal, inpregnant patients, or when iodinated contrast material
iscontraindicated. Due to poor sensitivity for the diagnosis ofpelvic and aortic lymph node
metastases, US is not useful forpreoperative staging.
Description: líimage CT montre une anomalie de la structuregraisseuse de
líépiploon qui est devenu plus dense et irrégulier ensíassociant à une importante quantité
díascite. Cet aspect estdénommé "gateau épiploique". Líablation de líépiploon fait
partiedu staging chirurgical systématique du cancer de líovaire.L'utilité du CT consiste à
montrer des lésions abdominales quipourrait poser des difficultés d'ablation lors de la
chirurgie,comme par example des lésions péritonéales du petit épiploon oudans le ligament
gastro-splénique. Dans ce cas une chimiothérapiepré-opératoire pourrait avoir lieu pour
réduire la massetumorale.

Ordre: 108
Dislocation: 0
Polytraumatisé: 0
Ouvert: 0
Pathologic: 0
Opération: 00.00.00
Graft: 0

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