Clinical Pathology of Ovary Flashcards
How many cases of ovarian cancer are there per year in Scotland?
600
How many deaths per year are there due to ovarian cancer in Scotland?
400
23.8 per 100,000 women per year
What is the 5 year survival of ovarian cancer at all stages?
30%
At what stage do most people with ovarian cancer prevent?
With advanced disease
5-10% of cases of ovarian cancer occur in high risk families, what causes this high risk?
HNPCC/Lynch type II familial cancer syndrome
BRAC1
BRAC2
What is the lifetime risk of developing ovarian cancer in women with BRAC1 mutation?
30-40%
What is the lifetime risk of developing ovarian cancer in women with BRAC2 mutation?
20%
If BRAC1/2 are identified in individuals, what can be offered to family members?
Screening
What is the effect of the OCP on ovarian cancer?
Protective
What are the symptoms of ovarian cancer
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
How is ovarian cancer diagnosed?
Surgical/pathological diagnosis
US scan abdomen and pelvis
CT chest, abdomen and pelvis
CA 125
What is CA 125?
Glycoprotein antigen
Why might CA 125 be raised?
Marker of malignancy but non-specific - raised in ovarian, colon, pancreas and breast cancer
Benign conditions - menstruation, endometriosis, PID, liver disease, recent surgery, effusions
What percentage of women with ovarian cancer will have a raised CA125?
80%
What percentage of women with stage 1 ovarian cancer will have raised CA 125?
50%
How is CA 125 used in ovarian cancer?
Used in detecting and monitoring epithelial ovarian tumours
In what women is CA 125 a better marker?
Post-menopausal women as it can be a marker of menopause/other benign states in younger women
What is the Risk of Malignancy Index used for?
Used to identify women who need further investigation/women with malignancy rather than benign condition
How is the Risk of Malignancy Index (RMI) calculated?
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
How are ultrasound findings scored for use in calculating RMI?
1 ultrasound finding = 1
2 or more ultrasound finding = 3
What are the ultrasound features of ovarian cancer?
Multi-locular Solid areas Bilateral Ascites Intra-abdominal
What stage of disease do women with ovarian cancer usually present with?
Stage 3
How does stage 4 of ovarian cancer present?
With pulmonary metastases/pleural effusion
What is stage 1 of ovarian cancer?
Limited to ovaries with capsule intact/negative cytology
What is stage 2 of ovarian cancer?
One or both ovaries involved with pelvic extension
What is stage 3 of ovarian cancer?
One or both ovaries with peritoneal implants outside pelvis or positive nodes
What is stage 4 of ovarian cancer?
Distant metastases
What are the treatments for ovarian cancer?
Surgery
Chemotherapy
What are the uses of laparotomy in ovarian cancer?
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
What are the first line chemotherapy agents for ovarian cancer?
Platinum and Taxane (Taxol)
When is chemotherapy used to treat ovarian cancer?
Within 6-8 weeks of surgery or to shrink tumour to a removable size before surgery
What is the response to chemotherapy in ovarian cancer?
Complete or partial response
Cure unlikely - response and remission followed by recurrence after around 2 years
Average response 2 years
What is the cure rate of stage 1 ovarian cancer?
85%
What is the cure rate of stage 2 ovarian cancer?
47%
What is the cure rate of stage 3 ovarian cancer?
15%
What is the cure rate of stage 4 ovarian cancer?
10%
What is the treatment for ovarian cancer recurrence?
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
Why is population screening for ovarian cancer not done?
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
What is the management of women at high risk of ovarian cancer?
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)
What can be done if screening for ovarian cancer?
Pelvic examination
US scanning of ovaries
CA 125
What cancer is there a residual risk of following prophylactic salpingo-oophorectomy?
Peritoneal cancer
