5 - Gynae - The Ovary and its disorders - Ovarian Cancer Flashcards
silent and presx late giving 5y survival ??
rates incr with? >80% cases in women ?, when is highest incidence? what reduces risk?
<35%
age - >50 (postmenopausal)
80-85
taking COCP
Pathology - 90% are ? carcinomas. Grade of mal vaies from ? to ?
what is rare but most common in <30s?
most common type?
epithelial carcinomas
borderline to high
germ cell tumours
serous cystadenocarcinoma
aetiology - benign cysts can have ? ? RFs relate to ? of ? - therefore early ? and late ? and ? are RF’s , and what 3 things are protective?
ov ca may also be familial - gene muts implicated? what gives risk of 50%?
mal change
no of ovulations
menarche and late menopause and nulliparity
pill, preg, lactation
BRCA1+2 and HNPCC
BRCA1
Screening - what is done? those w genetic muts offered ?? and ? screening, or prophylactic ?
nothing atm - trials ongoing
yearly TVUSS and CA125 screening
prophylx (B)SO
Clinical features - Hx
- Sx often initially ?/?
- 70% presx with stage ?/? disease
- 5 symptoms ?
vague/absent
3-4
bloating, feel full/lost appetite/wt loss, change in bowel habit, pelvic/abdo pain, incr urgency +/ freq
Many Sx are similar to ?, but must exclude ov ca in ? ?
Ask about ? and ? Sx as it may be ? from these sites
Ex - 3 things to look for? v large masses are likely to be ? , what not to forget?
IBS
older women
Breast and GI as it be mets from these sites
cachexia, abdo/pelvic pain, ascites
malignant
palpate breasts also
Signs that ovarian mass is malignant? 6 things
rapid growth, >5cm ascites advanced age bilat masses solid or septate nature on USS incr vascularity
Staging - give general outline of 4 stages
1 - macroscopically confined to the ovaries
2 - beyond ovaries but confined to pelvis
3 - beyond pelvis but confined to abdomen (freq omentum, S Bowel, peritoneum)
4 - beyond abdomen eg lungs/liver parenchyma
Ix - initial detection 1’ care - ? measured in >50 with what? if raised (>?) what is done? what prompts urgent ref to 2’ care?
CA125 measured in women >50 with abo Sx
>35 -> USS abdo+pelvis done
urgent ref if USS/Ex finds ascites/mass
Ix - establishing diagnosis 2’ care.
what done if not done already? what is measured if <40 and why?
what is then calculated? and how/with what? what values are you worried about? who gets ref to MDT?
how is cancer extent assessed? and further staging done?
CA125 and USS
hCG and AFP - raised in germ cell tumours and not epithelial ov ca
RMI - risk of mal index -
RMI = U (USS score) x M (menopause score) x serum CA125
> 200
250 -> specialised MDT
CT of pelvis and abdo for extent and surgery to further stage
MGMT - two key things?
- when is RTx used?
assess fitness for surgery
cross match blood
only for dysgerminomas
Surgical mgmt
? ? allows thorough assessment. total ? with ? and partial ? done, with ? of any peritoneal deposits, random ? biopsies and ? ? assessment.
If suspect stage 1 - retroperitoneal LNs are ?, in stage 2 or more they are all ? by ? ?
if ?/?? and disease is borderline, ? and unaffected ovary may be left but need ?
abdo laparotomy hyst with BSO and partial omentectomy biopsies peritoneal biopsies retroperitoneal LN sampled removed by block dissection young/presering fertility uterus follow up
Chemotherapy.
? ? ? req before CTx. If surgery not done tissue for ? obtained through ? ? ? ? or laparoscopy. ? levels used to monitor CTx response. 2/3ths of women who respond to 1st line chemo relapse within ?
when is chemo not usually given?
confirmed tissue diagnosis histo percutaneous image guided biopsy CA125 2ys v early on (low grade histo stage 1a/b)
F/U.
CA125 levels useful during and after ?
? aids detection of ?/?
interval ? of residual tissue
CTx prolongs ? ? ? and improves ???
CTx
CT residual disease/relapse
debulking
short term survival and improves QOL
Prog. overall 5y survival? why? what is death normally from? poor prog indicators? (4)
<35% - presx at late stage
bowel obstruction/perf
advanced stage, poor diff, clear cell tumours, slow/poor response to chemo
