Clinical Pathology Ovary Flashcards
Epidemiology of ovarian cancer?
- 600 cases per year in Scotland
- 400 deaths per year in Sco
- 5 year survival all cases 30%
- Most present with advanced cases
What age is it rare to get ovarian cancer?
<30
Which genes predispose people to ovarian cancer? What are features of people who present with genetic predisposed ovarian cancer?
- HNPCC/Lynch type II familial cancer syndrome
- BRCA1
- BRCA2
Likely to present earlier and have good prognosis
What is the reason most women present with advanced stage?
The symptoms of ovarian cancer are VAGUE
What are some of the symptoms of ovarian cancer?
- Indigestion/early satiety/poor appetite
- Altered bowel habit/pain
- Bloating/discomfort/weight gain
- Pelvic mass: however the mass can grow to quite a size without the patient knowing
How is diagnosis normally made for ovarian cancer?
- Clinical signs are normally vague so,
- USS normally carried out and if suspect then,
- CT scan: however this is not diagnostic (raises suspicion) and diagnosis is usually carried out pathologically post resection
What is CA 125? How useful is this marker? Normal range?
- Marker used to detect ovarian cancer + breast cancer + colon/pancreatic
- While it is often elevated in ovarian cancer there are many other reasons it is elevated in pre menopausal women
- Therefore not that accurate a marker
- 0 - 30 is normal range
What are the accuracy rates of CA 125?
- 80% of women with ovarian cancer have a raised CA 125
- 50% of women with stage 1 disease
- Used in detecting and monitoring epithelial ovarian tumours
What is the RMI and how do we calculate it?
Risk of malignany index
RMI = U (ultrasound) x M (menopausal status) x CA 125
USS features:
- Multi locular
- Solid areas
- bilateral
- ascites
- intra abdominal
How is ovarian cancer staged?
Staging
- Limited to ovaries with capsule intact/ cytology
- One or both ovaries with pelvic extension
- One or both ovaries with peritoneal implants outside pelvis or + nodes
- Distant metastases
Which nodes does ovarian cancer normally spread to?
Para-aortic nodes
What is the treatment of ovarian cancer?
- Gold standard: Surgical resection and the adjuvant chemotherapy
- There has been talk of flipping this round but this is current way, such as neo-adjuvant chemo
What is the surgery undertaken? And roles of the surgery?
Laparotomy
- Midline incision
- Obtain tissue diagnosis
- Stage disease
- Disease clearance
- Debulk disease (try reduce to 1cm)
What is the first line chemo? When administered?
- Platinum and taxane (Taxol)
- Within 8 weeks post surgery
What are the cure rates for each stage?
- [stage] 85%
- [stage] 47%
- [stage] 15%
- [stage] 10%
Which stage is likely to recurre and what is the treatment?
- Stage 4 is most likely to recurre.
- Chemo
- Palliation: symptomatic recurrance
- Platinum if > 6mths
- ?surgery
- Tamoxifen
What are the features of benign ovarian cysts?
- More common than malignant ones
- Will have a smooth surface over a defined area
- Serous cysts
What is an intermediate between benign and malignant ovarian cysts?
Borderline ovarian cysts: they can be mucinous or serous
Where do most ovarian cancers arrise?
- Fallopian tube
- Often will be able to see changes in epithelium of fallopian tube that is pre cancerous
What is important to note about BRCA?
- Inheritted in autosomal dominant fashion
- Need to think about offspring and sisters and other fam members.
- 15-45% risk if you carry this gene of lifetime risk of ovarian cancer – these ladies tend to develop them earlier stage
What are the current guidelines on ovarian cancer screening?
- Population screening is not proven
- High risk women: cancer gene mutation carriers, 2 or more relatives
- Carry out a pelvic examination
- US scan of ovaries
- CA 125
What are the downsides of ovarian cancer screening?
- Not recommended
- Limited sensitivity and specificity
- FIGO stages of cancer detected
- For high risk women
- Prophylactic oophorectomy
- Residual risk of primary peritoneal cancer
