CPC of the Ovary Flashcards
5 year survival for ovarian ca
30%
why has the incidence of ovarian ca decreased?
contraceptive pill
in what age group is ovarian ca rare?
<30
familial forms of ovarian ca
HNPCC
BRCA 1
BRCA 2
why are pregnancy, breast feeding and the COC protective against ovarian ca?
stops ovulation
symptoms of ovarian ca
• Vague • Indigestions/early satiety/poor appetite • Altered bowel habit/pain • Bloating/discomfort/weight gain • Pelvic mass o Asymptomatic o Pressure symptoms
diagnosis of ovarian ca
- Surgical/pathological
- USS abdomen and pelvis
- CT scan
- CA 125
normal CA125
0-35
what is CA125?
glycoprotein antigen
what malignancies is CA125 associated with?
ovary
colon/pancreas
breast
what benign conditions is CA125 associated with?
menstruaton/endometriosis/PID
liver disease/recent surgery/effusions
uss in ovarian ca
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
ovarian ca stages: when is it staged?
normally after surgery
ovarian ca stages: 1
limited to ovaries with capsule intact/-ve cytology
ovarian ca stages: 2
one or both ovaries with pelvic extension
ovarian ca stages: 3
one or both ovaries with peritoneal implants outside pelvis (diapgragm, omentum) or +ve nodes
ovarian ca stages: 4
distant metastasis (liver, spleen, chest)
treatment of ovarian ca
• Surgery – remove all naked eye disease
• Chemotherapy
o Adjuvant
o Neo-adjuvant
chemo in ovarian ca
- First line platinum (cisplatin) and taxane (Taxol)
- Within 8 weeks of surgery
- Complete/partial response
- Cure unlikely
- Average response of 2 years
treatment of recurrence of ovarian ca
- Chemotherapy
- Palliation – symptomatic recurrence
- Platinum if > 6 months
- ? surgery
- Tamoxifen
screening for ovarian ca
• 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
