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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [27] Ovarian Cancer > Flashcards

[27] Ovarian Cancer Flashcards

1
Q

How common is ovarian cancer?

A

It is the fourth most common cancer in the UK

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2
Q

What % of deaths in women aged 40-60 years does ovarian cancer account for?

A

5%

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3
Q

What is the average age of presentation of ovarian cancer?

A

60 years

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4
Q

What other cancers can share histological features with ovarian cancer?

A

Fallopian tube and peritoneal cancer

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5
Q

How is the management of fallopian tube and peritoneal cancer similar to that of ovarian cancer?

A

They are treated with a similar approach

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6
Q

What appears to protect against the development of ovarian cancer?

A

Suppressed ovulation

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7
Q

Give two examples of things that suppress ovulation

A
  • Prolonged breastfeeding

- High-oestrogen OCP

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8
Q

What % of women with ovarian cancer have a positive family history?

A

Up to 7%

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9
Q

What is the risk of ovarian cancer in patients with Peutz-Jeghers syndrome?

A

10%

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10
Q

What are the well recognised familial patterns occur in ovarian cancer?

A
  • Hereditary breast/ovarian cancer families

- Lynch type II families

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11
Q

What mutations do hereditary breast/ovarian cancer families have?

A

BRCA1 or BRCA2

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12
Q

What cancers are lynch type II families at increase risk of of?

A
  • Ovarian
  • Endometrial
  • Colorectal
  • Gastric
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13
Q

What mutations do lynch type II families have?

A

Mutations in mismatch repair enzymes

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14
Q

What kind of cancer is most common in the ovary?

A

Epithelial tumours

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15
Q

What % of ovarian cancers are epithelial tumours?

A

90%

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16
Q

What histological class of cancer do epithelial ovarian tumours include?

A

Adenocarcinomas

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17
Q

What are the potential histological appearances of adenocarcinomas of the ovary?

A
  • Serous
  • Mucinous
  • Endometrioid
  • Clear cell
  • Squamous cell
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18
Q

What are the other, rarer types of ovarian tumours?

A
  • Germ cell tumours
  • Carcinosarcomas
  • Sex cord tumours
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19
Q

In what ways to ovarian germ cell tumours resemble testicular germ cell tumours?

A

In histology and clinical management

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20
Q

What are the features of carcinosarcomas?

A
  • Aggressive

- More susceptible to haematogenous spread

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21
Q

What kinds of tumours does ovarian sex cord tumours include?

A
  • Granulosa cell tumours
  • Thecomas
  • Sertoli-Leydig cell tumours
  • Gonadoblastomas
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22
Q

What do sex cord ovarian tumours occasionally produce?

A
  • Oestrogens

- Androgens

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23
Q

What can oestrogens produced by sex cord ovarian tumours cause?

A
  • Precocious puberty

- Postmenopausal bleeding

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24
Q

What can androgens produced by sex cord ovarian tumours cause?

A

Virilisation

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25
What are the symptoms of early stage ovarian cancer?
Asymptomatic in the majority of cases
26
When do most women with ovarian cancer present?
When they have advanced disease
27
What are the symptoms of advanced ovarian cancer?
- Vague abdominal discomfort - Bloating - Altered bowel habit - Nausea and vomiting - Backache - Weight loss
28
What % of women with ovarian cancer present with advanced disease that is stage 3-4?
70%
29
Can ovarian cancer cause vaginal bleeding?
It is uncommon, and more likely to be Fallopian tube cancer
30
When is it important to consider and exclude ovarian cancer?
In a woman presenting with recent chance in bowel habit, or with vague abdominal symptoms
31
What systemic presentations of ovarian cancer are associated with more advanced disease?
- Pleural effusions - Ascites - Malignant bowel obstruction - Thromboembolic phenomenon
32
How are umbilical peritoneal deposits from ovarian cancer metastasis sometimes seen?
As Sister Mary Joseph nodules
33
What are Sister Mary Joseph nodules?
Palpable nodules bulging from the umbilicus
34
What does the presence of Sister Mary Joseph nodules indicate?
Indicates transcoelomic spread and stage 4 disease
35
What should be looked for on general observation in ovarian cancer?
- Viralisation - Ascites - Cachexia - Signs of dehydration
36
What should be looked for on skin examination in ovarian cancer?
Dermatomyositis
37
What should be looked for on genitourinary examination in ovarian cancer?
- Haematuria | - PV discharge/bleeding
38
What should be looked for on neurological examination in ovarian cancer?
- Focal neurological signs | - Cerebellar dysfunction
39
Are focal neurological signs common in ovarian cancer?
No, they are rare
40
What can cause cerebellar dysfunction in ovarian cancer?
Paraneoplastic syndromes
41
What should be looked for on skeletal examination in ovarian cancer?
Focal bone tenderness
42
What should be looked for on peripheral examination in ovarian cancer?
Calf tenderness
43
What may calf tenderness indicate in ovarian cancer?
DVT
44
What can be used to differentiate between benign ovarian cysts and ovarian malignancy?
- Transvaginal ultrasound - Serum CA125 - Age
45
What is the sensitivity and specificity of investigations to differentiate between benign ovarian cysts and ovarian malignancy?
80-90%
46
What additional use have transvaginal ultrasound and serum CA125 been studied for?
Population screening
47
What might CT imaging be useful for in ovarian cancer?
To detect abdominal spread, including liver, lung, pleura, and lymph node involvementd
48
How is the stage and extent of spread of ovarian cancer determined in ovarian cancer?
Surgery and the FIGO staging system
49
What is the first line intervention for people with ovarian cancer?
Surgery
50
What is the intention of surgery in ovarian cancer?
Debulking the disease
51
What are the potential outcomes of debulking surgery in ovarian cancer?
- Complete - Optimal - Suboptimal
52
What is meant by complete debulking in ovarian cancer?
No macroscopic disease
53
What is meant by optimal debulking in ovarian cancer?
Macroscopic disease <1cm
54
What is meant by suboptimal debulking in ovarian cancer?
Residual disease >1cm
55
What does surgery for ovarian cancer involve?
- Laparotomy - Total hysterectomy - Bilateral salpingo-oophrectomy with omentectomy and lymph node resection
56
What will the majority of women be candidates for after surgery for ovarian cancer?
Adjuvant chemotherapy
57
What is neoadjuvant chemotherapy used for in ovarian cancer?
Patients with extensive disease at presentation
58
What is the aim of neoadjuvant chemotherapy in ovarian cancer?
Shrink disease in order to consider interval debulking
59
What treatment does non-epithelial ovarian cancer require?
Surgery following by chemotherapy
60
What is the agent used for chemotherapy in non-epithelial ovarian cancer based on?
The predominant cell type present
61
What % of patients diagnosed with ovarian cancer achieve remission?
80%
62
What response rate is second-line chemotherapy associated with for relapse of ovarian cancer?
20-40%
63
What are higher response rates to second-line chemotherapy in relapsed ovarian cancer associated with?
Greater treatment-free intervals
64
What can serum CA125 be useful for in ovarian cancer?
- Predicting relapse | - Predicting response to treatment
65
How far ahead can CA125 predict relapse?
4.2 months
66
Does early treatment of ovarian cancer based on CA125 levels alone give a survival advantage?
No
67
What % of patients with ovarian cancer will relapse at some point?
Approx 60%
68
What hormonal agents can be used in ovarian cancer?
- Tamoxifen | - Aromatase inhibitors
69
What is the use of hormonal approaches in ovarian cancer?
They can slow down the rate of progression, and delay onset of symptoms
70
How will advanced ovarian cancer spread?
In a transcoelomic matter
71
What may transcoelomic spread of ovarian cancer produce?
- Ascites | - Subacute or complete bowel obstruction
72
Why may transcoelomic spread of ovarian cancer produce bowel obstruction?
Due to serosal involvement of the bowel
73
What might a pelvic mass caused by ovarian cancer lead to?
Hydronephrosis due to ureteric obstruction
74
What might ascites caused by ovarian cancer require?
Frequent paracentesis
75
What can be used to reduce the recurrence of pleural effusions caused by ovarian cancer?
Talc pleurodesis
76
Why are patients with ovarian cancer at a particularly high risk of thrombosis?
Due to a prothrombotic tendency that correlates with disease activity
77
What does the prognosis of ovarian cancer correlate with?
Stage at diagnosis
78
What is the overall 5 year survival rate of ovarian cancer?
30%
79
What is the 5 year survival rate of stage 1 ovarian cancer?
>90%
80
What is the 5 year survival rate of stage 4 ovarian cancer?
<25%
81
What patients with ovarian cancer have a worse outcome?
- Disease resistant to platinum therapy - Large volume residual disease following debulking - Clear cell histology
82
- Disease resistant to platinum therapy - Large volume residual disease following debulking - Clear cell histology
They are more likely to have visceral metastasis, but are more likely to respond to platinum therapy, and have longer treatment-free interval
83
What is the best predictor outcome of ovarian cancer?
Achieving complete cytoreduction at initial surgery

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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