Clinical Pathology of Ovary

Question 1

How many cases of ovarian cancer are there per year in Scotland?

Answer 1

600

Question 2

How many deaths per year are there due to ovarian cancer in Scotland?

Answer 2

400

23.8 per 100,000 women per year

Question 3

What is the 5 year survival of ovarian cancer at all stages?

Answer 3

30%

Question 4

At what stage do most people with ovarian cancer prevent?

Answer 4

With advanced disease

Question 5

5-10% of cases of ovarian cancer occur in high risk families, what causes this high risk?

Answer 5

HNPCC/Lynch type II familial cancer syndrome
BRAC1
BRAC2

Question 6

What is the lifetime risk of developing ovarian cancer in women with BRAC1 mutation?

Answer 6

30-40%

Question 7

What is the lifetime risk of developing ovarian cancer in women with BRAC2 mutation?

Answer 7

20%

Question 8

If BRAC1/2 are identified in individuals, what can be offered to family members?

Answer 8

Screening

Question 9

What is the effect of the OCP on ovarian cancer?

Answer 9

Protective

Question 10

What are the symptoms of ovarian cancer

Answer 10

Vague - often dismissed/ignored for a while leading to late presentation
Indigestion/early satiety/poor appetite
Altered bowel habit/pain
Bloating, discomfort, weight gain
Pelvic mass - asymptomatic or pressure symptoms

Question 11

How is ovarian cancer diagnosed?

Answer 11

Surgical/pathological diagnosis
US scan abdomen and pelvis
CT chest, abdomen and pelvis
CA 125

Question 12

What is CA 125?

Answer 12

Glycoprotein antigen

Question 13

Why might CA 125 be raised?

Answer 13

Marker of malignancy but non-specific - raised in ovarian, colon, pancreas and breast cancer

Benign conditions - menstruation, endometriosis, PID, liver disease, recent surgery, effusions

Question 14

What percentage of women with ovarian cancer will have a raised CA125?

Answer 14

80%

Question 15

What percentage of women with stage 1 ovarian cancer will have raised CA 125?

Answer 15

50%

Question 16

How is CA 125 used in ovarian cancer?

Answer 16

Used in detecting and monitoring epithelial ovarian tumours

Question 17

In what women is CA 125 a better marker?

Answer 17

Post-menopausal women as it can be a marker of menopause/other benign states in younger women

Question 18

What is the Risk of Malignancy Index used for?

Answer 18

Used to identify women who need further investigation/women with malignancy rather than benign condition

Question 19

How is the Risk of Malignancy Index (RMI) calculated?

Answer 19

RMI = U x M x CA 125

where;
RMI = risk of malignancy 
U = ultrasound score
M = menopause status 
CA 125 = serum levels of CA 125

Question 20

How are ultrasound findings scored for use in calculating RMI?

Answer 20

1 ultrasound finding = 1

2 or more ultrasound finding = 3

Question 21

What are the ultrasound features of ovarian cancer?

Answer 21

Multi-locular 
Solid areas 
Bilateral 
Ascites 
Intra-abdominal

Question 22

What stage of disease do women with ovarian cancer usually present with?

Answer 22

Stage 3

Question 23

How does stage 4 of ovarian cancer present?

Answer 23

With pulmonary metastases/pleural effusion

Question 24

What is stage 1 of ovarian cancer?

Answer 24

Limited to ovaries with capsule intact/negative cytology

Question 25

What is stage 2 of ovarian cancer?

Answer 25

One or both ovaries involved with pelvic extension

Question 26

What is stage 3 of ovarian cancer?

Answer 26

One or both ovaries with peritoneal implants outside pelvis or positive nodes

Question 27

What is stage 4 of ovarian cancer?

Answer 27

Distant metastases

Question 28

What are the treatments for ovarian cancer?

Answer 28

Surgery

Chemotherapy

Question 29

What are the uses of laparotomy in ovarian cancer?

Answer 29

Obtain tissue diagnosis if not already done
Stage disease
Disease clearance - chemotherapy may be done first in order to shrink cancer to a size which can be completely removed
Debulk disease

Question 30

What are the first line chemotherapy agents for ovarian cancer?

Answer 30

Platinum and Taxane (Taxol)

Question 31

When is chemotherapy used to treat ovarian cancer?

Answer 31

Within 6-8 weeks of surgery or to shrink tumour to a removable size before surgery

Question 32

What is the response to chemotherapy in ovarian cancer?

Answer 32

Complete or partial response
Cure unlikely - response and remission followed by recurrence after around 2 years
Average response 2 years

Question 33

What is the cure rate of stage 1 ovarian cancer?

Answer 33

85%

Question 34

What is the cure rate of stage 2 ovarian cancer?

Answer 34

47%

Question 35

What is the cure rate of stage 3 ovarian cancer?

Answer 35

15%

Question 36

What is the cure rate of stage 4 ovarian cancer?

Answer 36

10%

Question 37

What is the treatment for ovarian cancer recurrence?

Answer 37

Chemotherapy
Palliation - symptomatic recurrence
Platinum chemotherapy if > 6 months
Surgery - select cases, single site recurrence
Tamoxifen - generally in older women who are unfit for chemotherapy

Question 38

Why is population screening for ovarian cancer not done?

Answer 38

Pre-malignant stage difficult to detect, screening picks up people early but not early enough to drastically change outcomes
Picks up cancer, not pre-cancer
Limited sensitivity and specificity
FIGO stages of cancer detected

Question 39

What is the management of women at high risk of ovarian cancer?

Answer 39

Cancer gene mutation carriers or with 2 or more affected relatives
Standard management is to offer prophylactic removal of ovaries and Fallopian tubes at around age 40 - hope is that family is complete, risk starts around this age
(Prophylactic salpingo-oophorectomy)

Question 40

What can be done if screening for ovarian cancer?

Answer 40

Pelvic examination
US scanning of ovaries
CA 125

Question 41

What cancer is there a residual risk of following prophylactic salpingo-oophorectomy?

Answer 41

Peritoneal cancer