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Gynaecology > 20. Ovarian Carcinoma > Flashcards

20. Ovarian Carcinoma Flashcards

1
Q

Why do more women die from ovarian cancer than any other gynecological cancer?

A

Due to its vague symptomatology, leading to late-stage diagnosis

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2
Q

How does the incidence of ovarian cancer vary globally?

A

Higher in industrialized countries, except Japan (3/100,000). Highest in Scandinavia, Eastern Europe, and Canada (22-24/100,000). Lower in developing countries.

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3
Q

How are ovarian cancers classified?

A

They can be primary or secondary (metastatic).

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4
Q

What are common sources of secondary ovarian cancers?

A

Metastases from the gastrointestinal tract (Krukenberg tumours) or breast cancer.

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5
Q

What are the three most important types of primary ovarian cancers?

A

Epithelial cancers, germ cell tumours (GCTs), and sex cord-stromal tumours.

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6
Q

What percentage of ovarian cancers are epithelial?

A

About 90%.

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7
Q

From which tissue do epithelial ovarian cancers arise?

A

The surface epithelium of the ovary.

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8
Q

What are the subtypes of epithelial ovarian cancer?

A

Serous, mucinous, endometrioid, transitional, and undifferentiated subtypes

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9
Q

Which age group is most commonly affected by epithelial ovarian cancers?

A

Older postmenopausal women.

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10
Q

What is the 5-year survival rate for stage I epithelial ovarian cancer?

A

More than 90%.

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11
Q

What percentage of epithelial ovarian cancers are diagnosed at late stages (II-IV)?

A

About 75-80%.

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12
Q

What percentage of ovarian cancers are germ cell tumours?

A

Approximately 5%.

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13
Q

What is the origin of germ cell tumours?

A

Primordial germ cells of the ovary

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14
Q

What percentage of GCTs are diagnosed in women under 30 years old?

A

About 80%.

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15
Q

What is the most common type of germ cell tumour?

A

Dysgerminoma

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16
Q

Name other types of germ cell tumours besides dysgerminomas.

A

Yolk sac (endodermal sinus) tumours, immature teratomas, embryonal carcinomas, and non-gestational choriocarcinomas.

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17
Q

Do germ cell tumours often contain more than one histological type?

A

Yes

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18
Q

What percentage of ovarian cancers are sex cord-stromal tumours?

A

About 8%.

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19
Q

What is the origin of sex cord-stromal tumours?

A

The stromal connective tissue of the ovary.

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20
Q

Do sex cord-stromal tumours affect all age groups?

A

Yes

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21
Q

What are the most common types of sex cord-stromal tumours?

A

Juvenile granulosa cell tumours, adult granulosa cell tumours, and Sertoli-Leydig cell tumours.

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22
Q

What hormones can sex cord-stromal tumours produce?

A

Oestrogen, inhibin, progesterone, and testosterone.

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23
Q

What symptoms may patients with hormone-secreting sex cord-stromal tumours present with?

A

Abnormal uterine bleeding, pseudoprecocious puberty, endometrial hyperplasia (oestrogen effect), or virilization.

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24
Q

What is the lifetime risk of developing ovarian cancer in the general population?

A

About 1 in 70

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25
Q

What percentage of ovarian cancers are hereditary?

A

About 10%.

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26
Q

When should hereditary ovarian cancer be considered?

A

In cases of:

  • Personal or family history of breast, ovarian, endometrial, prostate, or colon cancer
  • A first-degree relative carrying a BRCA1 or BRCA2 mutation
  • Epithelial ovarian cancer diagnosed in a younger woman
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27
Q

What is the lifetime risk of developing ovarian cancer in women with a BRCA1 or BRCA2 mutation?

A

About 20-50%.

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28
Q

How does uninterrupted ovulation affect ovarian cancer risk?

A

It increases the risk.

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29
Q

Is there a possible link between ovarian cancer and artificial ovulation induction?

A

Yes, but it remains controversial.

30
Q

How does low parity affect ovarian cancer risk?

A

It increases the risk.

31
Q

How does the use of combined oral contraceptives affect ovarian cancer risk?

A

Non-use increases the risk, as combined oral contraceptives provide a protective effect.

32
Q

How does age influence ovarian cancer risk?

A

Increasing age is a significant risk factor.

33
Q

How does diet influence ovarian cancer risk?

A

Diet, particularly in industrialized countries, is a contributing risk factor.

34
Q

Risk factors for ovarian carcinoma

A
  • Uninterrupted ovulation
  • Possible increase in ovarian cancer in women undergo multiple artificial ovulation inductions, although this is controversial
  • Low parity
  • Non-use of combined oral contraception
  • Increasing age
  • Diet (particularly in industrialized countries)
35
Q

Why do ovarian cancers often present late?

A

The ovaries are true intra-peritoneal organs, allowing tumors to grow significantly before becoming clinically evident. The disease also spreads in a creeping fashion rather than directly invading structures.

36
Q

Why are ovarian cancer symptoms referred to as “whispers”?

A

They are vague and non-specific, often mistaken for gastrointestinal or urinary issues.

37
Q

What are some early symptoms of ovarian cancer?

A
  • Unexplained change in bowel or bladder habits
  • Mild dyspepsia
  • Feeling of fullness after meals
  • Abdominal distension
  • Unexplained slow weight loss
38
Q

What are some common late symptoms of ovarian cancer?

A
  • Pelvic pain or discomfort
  • Fatigue
  • Postmenopausal bleeding (in 10% of cases)
  • Abnormal menstrual bleeding in younger women
39
Q

What aspects of history and examination are crucial in diagnosing ovarian cancer?

A

A thorough history and examination focusing on lymph nodes, pleural effusion, ascites, and abdominal/pelvic masses.

40
Q

What lymph node should be palpated in suspected ovarian cancer?

A

The left supraclavicular node (Virchow’s node).

41
Q

Why is it important to check for pleural effusion in suspected ovarian cancer?

A

Ovarian cancer can spread to the pleura, causing malignant effusions.

42
Q

What abdominal findings suggest advanced ovarian cancer?

A
  • Ascites (fluid thrill or shifting dullness)
  • Peri-umbilical nodule (Sister Mary Joseph nodule)
  • Palpable abdominal or pelvic masses
43
Q

Why is a pelvic-rectal examination important in ovarian cancer diagnosis?

A

It helps detect advanced cancers that may not be palpable on abdominal examination alone.

44
Q

Routine investigations for ovarian cancer

A
  • Haemoglobin
  • Pregnancy test in women of reproductive age
  • Urine dipstix
  • Pap smear in all cases of suspected ovarian cancer
  • Endometrial sampling if patient complains of abnormal vaginal bleeding
45
Q

What are the routine blood investigations for suspected ovarian cancer?

A

Haemoglobin levels and a pregnancy test in women of reproductive age.

46
Q

Why is a urine dipstick test performed in suspected ovarian cancer cases?

A

To check for proteinuria, haematuria, or infection that may suggest other differential diagnoses.

47
Q

What gynecological screening tests should be done in suspected ovarian cancer cases?

A

A Pap smear and endometrial sampling if abnormal vaginal bleeding is present.

48
Q

What imaging tests are useful in the metastatic and diagnostic workup of ovarian cancer?

A
  • Chest X-ray
  • Ultrasound and/or CT scan of the abdomen and pelvis
  • Mammogram if indicated
49
Q

Why is an ascitic or pleural tap performed in suspected ovarian cancer

A

For cytology, chemistry (including ADA to rule out abdominal TB), and microbiology.

50
Q

When should bowel investigations like gastroscopy or colonoscopy be performed?

A

If the patient has significant bowel symptoms.

51
Q

What is the significance of CA-125 in ovarian cancer?

A

It is raised in many benign conditions but, if >500/ml, strongly suggests ovarian cancer. It is elevated in over 80% of serous epithelial cancers but only 50% of mucinous carcinomas.

52
Q

Which tumor marker is useful for diagnosing yolk sac (endodermal sinus) tumors?

A

Alpha-fetoprotein (AFP).

53
Q

What tumor marker is commonly elevated in dysgerminomas?

A

Lactate dehydrogenase (LDH).

54
Q

Which tumor marker is raised in non-gestational choriocarcinomas of the ovary?

A

Beta-hCG.

55
Q

How is carcinoembryonic antigen (CEA) useful in distinguishing ovarian cancer from primary bowel cancer?

A

CEA is raised in gastrointestinal tract cancers, helping differentiate them from primary ovarian cancer.

56
Q

What defines Stage I ovarian cancer?

A

The tumor is confined to one or both ovaries

57
Q

What defines Stage II ovarian cancer?

A

The tumor involves one or both ovaries and has extended to other pelvic organs.

58
Q

What defines Stage III ovarian cancer?

A

The tumor has spread to the bowel lining, abdominal peritoneum, or lymph nodes.

59
Q

What defines Stage IV ovarian cancer?

A

The tumor has distant metastases, such as to the liver or chest.

60
Q

What is the gold-standard treatment for ovarian cancer?

A

Surgery

61
Q

What are the three primary goals of surgery in ovarian cancer management?

A
  • To make the diagnosis
  • To stage the disease
  • To remove as much tumor as possible (debulking)
62
Q

Why is a vertical incision preferred in ovarian cancer surgery?

A

It allows for thorough exploration of the entire abdomen.

63
Q

What procedures are involved in staging ovarian cancer if it is confined to the ovaries?

A
  • Peritoneal washings (peritoneal gutters, pouch of Douglas)
  • Diaphragmatic wipes to check for microscopic disease
  • Exploratory laparotomy
64
Q

What are the key surgical components of ovarian cancer treatment?

A
  • Total abdominal hysterectomy (TAH)
  • Bilateral salpingo-oophorectomy (BSO)
  • Infracolic omentectomy
  • Debulking of all macroscopically visible tumors
65
Q

What is the role of surgery in the management of GCTs?

A

Surgery is primarily diagnostic due to the need for fertility preservation and high chemosensitivity.

66
Q

What is the mainstay of treatment for GCTs?

A

Multiple-agent chemotherapy.

67
Q

What is the main treatment for SCSTs (Sex Cord Stromal Tumors) ?

A

Surgery is the primary treatment, with a limited role for chemotherapy.

68
Q

Do most women with EOC (Epithelial Ovarian Cancer) require post-operative chemotherapy?

A

Yes, over 70% of women with EOC require chemotherapy after surgery.

69
Q

What is the 5-year survival rate for early-stage ovarian cancer?

A

Over 90%.

70
Q

What is the 5-year survival rate for Stage III ovarian cancer?

A

Less than 30%.

Gynaecology (25 decks)

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