الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Ovarian cancer is the fifth leading cause of death from cancer in women and the leading cause of death from gynecological cancer worldwide. Epithelial ovarian cancer accounts for 90 to 95 percent of malignant ovarian tumors. Germ cell and sex cord stromal ovarian cancer account for the remaining 5 to 10 percent. In 2004, in the United States, 25,580 new cases were diagnosed and 16,090 women died of ovarian cancer.
The risk of developing ovarian cancer increases in women with affected first or second degree relative, women with a mutated BRCAl or BRCA2 gene, older women, infertile women, women with endometriosis, women using postmenopausal estrogen replacement therapy, women with early menarche and late menopause and white race women. In contrast, breast feeding has a protective effect perhaps by prolonging amenorrhea. Long-term combined oral contraceptive pills reduce the risk of ovarian cancer by 50 percent and the duration of protection lasts up to 25 years after the last use. Tubal ligation and hysterectomy also reduce the risk of developing ovarian cancer.
Ovarian cancer is staged by FIGO staging system, ovarian cancer at its early stage (I &II) is difficult to diagnose until it spreads and advances to later stage (III &IV). This is because most of the symptoms are non-specific. So, ovarian cancer is a silent killer; however, recent improvement in identification of women at high risk for ovarian cancer, as well as improved imaging technique, increase the likelihood of early detection.
Early ovarian cancer; stage (I &II) account for 20 percent of the cases late ovarian cancer; stage (III &IV) account for the remaining 80 percent.
The vast majority (90%) of ovarian cancer arises from the malignant transformation of the ovarian surface epithelium.
This transformation leads to altered adhesion of transformed cells, which in turn results in the shedding of tumor cells into the peritoneal cavity where they float in the peritoneal fluid or ascites as clumps of aggregated cells or spheroids until they find a secondary attachment site for further growth. So, the attachment of shedded floating spheroids to the peritoneal lining and associated organs in the major route for the dissemination of ovarian carcinoma
The classic approach for early ovarian cancer management is staging laparotomy which includes peritoneal cytology, total-abdominal-hysterectomy, bilateral salpingoopherectomy, omentectomy, pelvic & para aortic lymphadenectomy and peritoneal biopsies including uterovesical, douglas pouch, right and left pelvic, right and left paracolic and diaphragmatic biopsies.
The posterior pelvic peritonectomy represents resection of posterior parietal and visceral peritoneal surfaces (peritoneum of doughlas pouch) . The dissection includes stripping of the posterior pelvic peritoneum and an en bloc removal of all internal female genitalia.
The aim of this work was study microscopic posterior pelvic peritoneal affection in early epithelial ovarian malignancy following posterior pelvic peritonectomy.
The study included 40 women with early stage epithelial ovarian cancer recruited from the gynecological oncology clinic at El- Shatby University Hospital. An informed consent was taken on admission. The demographic and clinical data of the patients was collected and after surgery the Staging laparotomy ,peritoneal wash or sample from the ascitic fluid, total abdominal hysterectomy with bilateral salpingoopherectomy, omentectomy, and posterior pelvic peritonectomy.
Comprehensive histopathological examination of the resected peritoneal elements was performed in addition to full evaluation of surgically removed elements. Pathological assessment of peritoneal affection together with analysis of summited specimens were carried at the pathology department, Faculty of medicine, University of Alexandria. Operative and early post operative complications of the procedure were reported.
In our study the pathological results of multiple random biopsies from douglas pouch showed positivity for malignant cells in 25% of cases (10 cases only), while following posterior pelvic peritonectomy pathological analysis revealed positivity for malignant cells in 75% of cases (30 cases), i.e 20 cases( 50%) were positive for malignant cells, but couldn’t be detected by pathological evaluation of multiple random biopsies from douglas pouch, this means that the sensitivity of the results increased by 50% following posterior pelvic peritonectomy rather than multiple random biopsies from douglas pouch. It was found that all negative cases for malignant cells has normal pelvic ultrasound, while positive cases for malignant cells had positive findings in pelvic ultrasound. The relation between pelvic ultrasound and pathological findings following posterior pelvic preitonectomy it was found that all negative for malignant cells cases had normal pelvic ultrasound evaluation, while positive for malignant cells cases had positive findings in pelvic ultrasound evaluation.
In addition, it was found that there is a relation between grade of disease and pathological findings of following posterior pelvic peritonectomy, in other words all negative cases for malignant cells were in grade I, II. The relation between CA125 level and pathological findings following posterior pelvic peritonectomy CA125 was much higher in positive than negative for malignant cells cases (P< 0.05).