Ovarian Malignancies in Children: A Five Year Review.

Shubha, K (2007) Ovarian Malignancies in Children: A Five Year Review. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Ovarian tumors are rare accounting for 1% of childhood malignancies. Unlike adult tumors, two thirds of the pediatric ovarian malignancies are of germ cell origin. Tumors of epithelial and stromal origin occur less frequently. As with testicular tumors, the incidence of germ cell ovarian tumors parallel gonadotrophin release implicating hormonal factors in the aetiology. The prognosis and the treatment strategies for malignant pediatric tumors have also changed drastically over the last few years. The outlook was dismal in the prechemotherapy era. But with the advent of platinum based chemotherapy in the 1980s, the prognosis for these tumors has altered dramatically. It has also facilitated the redefinition of risk groups. Since then, chemotherapy regimes have been sequentially modified to reduce the toxicity while maintaining survival rates. Surgical approach has also evolved to a more tailored approach. As we move into the future, with higher success rates in the overall survival, the highlight is now on reducing the toxicity of the chemotherapy regimes. Ongoing studies are now evaluating conservative surgeries in the hope of reducing the overall morbidity. An attempt is being made to redefine surgical principles in the hope of improving the quality of life without compromising the overall survival. With more survivors of childhood cancer, interest is now being focused on the delayed effects on treatment and its impact on potential fertility patterns. More stress is now being laid on maintaining the reproductive abilities of these patients and a number of studies are ongoing in this direction. AIMS & OBJECTIVES : To review the presentation, treatment and histology of ovarian tumors in children. To note the accuracy of diagnostic imaging and operative staging. To calculate the survival rates. To assess the effect of chemotherapy on the attainment of menarche in those surviving in the peripubertal age group. MATERIALS AND METHODS : A retrospective review of all ovarian malignancies treated at the Institute of Child Health between January 2001 and January 2006 was done. 48 patients with ovarian malignancies were identified. Defective case records of 5 patients owing to lack of essential data were excluded from the study. A structured proforma was prepared(vide infra). The age at presentation, symptoms and nature of presentation were noted. The efficacy of imaging in pointing at the malignant nature of the lesion was also assessed. The tumor marker elevations vis-à-vis the histopathology was correlated. Intraoperative features of the tumor, capsular integrity and associated anomalies were recorded. Pathological reports on gross and microscopic features of the tumor were compared with the intraoperative findings. CONCLUSIONS : Review of ovarian tumors at our institute showed that germ cell tumors are highly treatable solid malignancies in the prepubertal age group. Most of these tumors present early making local control easy. This is further boosted by effective platinum based chemotherapy. As seen in our study,epithelial ovarian malignancies are rare in children. Ultrasonogram has a fairly good degree of reliability as an indicator of potentially malignant lesions. Nevertheless, it should be used only as an adjunct and not as the primary modality for diagnosis. In the acute setting, to prevent loss of significant information which might affect staging and treatment, it is better to treat all suspicious lesions as potentially malignant, until proved otherwise. The onset of puberty following chemotherapy is comparable with that of age matched controls. With the advent of newer agents and less toxic regimes, further trials are required to assess their impact on fertility. Their effects on the reproductive potential is a critical issue that needs to be addressed in the long run. Till such time that more light is thrown on this ,caution has to be exercised. To quote Larsen et al.,“ though there may exist unknown repair mechanisms after anticancer treatment, the biological age of the ovaries is 10 years ahead of the chronological age.” This important factor is to be stressed in the counseling of these patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ovarian Malignancies ; Children ; Five Year Review.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:58
Last Modified: 28 Jul 2017 02:58
URI: http://repository-tnmgrmu.ac.in/id/eprint/2286

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