CPC of the Ovary

Question 1

5 year survival for ovarian ca

Answer 1

30%

Question 2

why has the incidence of ovarian ca decreased?

Answer 2

contraceptive pill

Question 3

in what age group is ovarian ca rare?

Answer 3

<30

Question 4

familial forms of ovarian ca

Answer 4

HNPCC
BRCA 1
BRCA 2

Question 5

why are pregnancy, breast feeding and the COC protective against ovarian ca?

Answer 5

stops ovulation

Question 6

symptoms of ovarian ca

Answer 6

• Vague
• Indigestions/early satiety/poor appetite
• Altered bowel habit/pain
• Bloating/discomfort/weight gain
• Pelvic mass
o Asymptomatic
o Pressure symptoms

Question 7

diagnosis of ovarian ca

Answer 7

• Surgical/pathological
• USS abdomen and pelvis
• CT scan
• CA 125

Question 8

normal CA125

Answer 8

0-35

Question 9

what is CA125?

Answer 9

glycoprotein antigen

Question 10

what malignancies is CA125 associated with?

Answer 10

ovary
colon/pancreas
breast

Question 11

what benign conditions is CA125 associated with?

Answer 11

menstruaton/endometriosis/PID

liver disease/recent surgery/effusions

Question 12

uss in ovarian ca

Answer 12

• Multi-locular
• Solid areas
• Bilateral
• Ascites
• Intra-abdominal

Question 13

ovarian ca stages: when is it staged?

Answer 13

normally after surgery

Question 14

ovarian ca stages: 1

Answer 14

limited to ovaries with capsule intact/-ve cytology

Question 15

ovarian ca stages: 2

Answer 15

one or both ovaries with pelvic extension

Question 16

ovarian ca stages: 3

Answer 16

one or both ovaries with peritoneal implants outside pelvis (diapgragm, omentum) or +ve nodes

Question 17

ovarian ca stages: 4

Answer 17

distant metastasis (liver, spleen, chest)

Question 18

treatment of ovarian ca

Answer 18

• Surgery – remove all naked eye disease
• Chemotherapy
o Adjuvant
o Neo-adjuvant

Question 19

chemo in ovarian ca

Answer 19

• First line platinum (cisplatin) and taxane (Taxol)
• Within 8 weeks of surgery
• Complete/partial response
• Cure unlikely
• Average response of 2 years

Question 20

treatment of recurrence of ovarian ca

Answer 20

• Chemotherapy
• Palliation – symptomatic recurrence
• Platinum if > 6 months
• ? surgery
• Tamoxifen

Question 21

screening for ovarian ca

Answer 21

• Population screening not proven
• High risk women
o Cancer gene mutation carriers
o 2 or more relatives
o Prophylactic oophorectomy and salpingectomy
§ Residual risk of primary peritoneal cancer
• Pelvic examination
• USS of ovaries
• CA125
• Not recommended as no precancer changes
• Limited sensitivity and specificity
• FIGO stages of cancer detected