CPC ovary Flashcards
epidemiology of ovarian cancer
600 cases p/a scotland
400 deaths p/a
5YS all stages 40-45%
most present with advanced disease
how common is ovarian cancer
rare <30y/o
who are the high risk families for ovarian cancer
5-10% of all cases
early onset presentation
HNPCC/Lynch type II familial cancer syndrome
BRCA1
BRCA2
incessant ovulation
what can be protective for ovarian cancer
OCP
breast feeding
numerous pregnancies
origins of ovarian cancer
most cases originate from the fimbrial end of fallopian tube
some derive from pre-existing benign ovarian cysts (often low grade cancers)
ovarian cancer origins and pathogenesis - molecular alterations
P53 BRCA1 and 2 ARID1A PIK3CA PTEN BRAF KRAS NRAS ERBB2
pathogenesis of ovarian cancer
what mutation causes an aggressive ovarian cancer
p53 mutations
role of pathology in ovarian cancer
type of tumour (epithelial, stromal, sex cord; benign, borderline, malignant), tumour grade and stage determines treatment and prognosis
what type of tumour is this
how common
commonest epithelial tumour type
serous cystadenoma
benign
describe the appearance of serous cystademonas
unilocular cyst
thin wall
flat epithelial lining
what tumour type is shown here
borderline serous tumour
tree like area on left
atypical epithelium
describe the features of borderline serous tumours
develop from benign cysts and mutate and proliferate
tree like papillary excrescences - overgrowth of epithelial lining of a cyst
can develop areas of invasive disease
concerning but not as aggressive as high grade carcinomas
what is shown here
which is high grade and which is low grade
serous carcinoma
low - top
high - bottom
features of high grade carcinomas
often serous carcinomas
more solid tumours
involvement of omentum - present at high stage disease
nuclearpleomorphism and prominent nucleoli
invasion into stroma
high mitotic rate
in what grade carcinomas are psammoma bodies seen
low grade carcinomas
they are calcifications
ovarian cancer symptoms
vague
indigestion, early satiety, poor appetite
altered bowel habit/pain
bloating, discomfort, weight gain
pelvic mass - asymptomatic, pressure symptoms
be aware of these symptoms presenting for the first time, esp if 50-60y/o
ovarian cancer diagnosis
surgical/pathological USS abdo and pelvis CT scan - chest, abdo, pelvis - extent of disease CA125 surgery - gold standard
what is CA 125
glyco-protein antigen
tumour marker
non-specific
what malignancies is CA125 associated with
ovary
colon/pancreas
breast
also lung
e.g. anything that causes disease in peritoneal cavity
what benign conditions is CA125 associated with
menstruation, endometriosis, PID
liver disease, recent surgery, effusions
how is CA125 used in the diagnosis of ovarian cancer
80% of women w/ ovarian ca have raised CA125
50% of women w/ stage 1 disease
used in detecting and monitoring epithelial ovarian tumours
ovarian cancer RMI
used in all women who present with ovarian masses
RMI = U x M x CA125
risk of malignancy index
U = US features
M = menopausal status (pre = 1, post = 3)
CA125 level
RMI >200 - suggestive of ovarian malignancy
US features for RMI
1 point for 1 feature, 3 points for >1: multi-locular solid areas bilateral ascites intra-abdominal
stage 1 ovarian cancer
limited to ovaries w/ capsule intact/cytology
stage 2 ovarian cancer
one or both ovaries w/ pelvic extension
stage 3 ovarian cancer
one or both ovaries with peritoneal implants outside pelvis or +ve nodes
stage 4 ovarian cancer
distant mets or complications
ovarian cancer treatment
surgical
chemotherapy - adjuvant, neoadjuvant
gold standard = surgery followed by chemo
laparotomy for ovarian cancer
obtain tissue diagnosis
stage disease
disease clearance
debulk disease - if not possible to remove all visible disease
chemotherapy for ovarian cancer
1st line: platinum + taxane (Taxol) post-op: within 8wks of surgery complete/partial response cure unlikely - esp stage 3 avg response 2yrs (i.e. relapse in stage 3 disease following remission)
cure rates for ovarian cancer
1 - 85%
2 - 47%
3 - 15%
4 - 10%
management of recurring disease
chemotherapy palliation for symptomatic recurrence platinum if >6mths since last recurrence ?surgery if 1st recurrence and able to remove all disease tamoxifen - if unable to manage chemo
normal CA125
up to 35
ovarian cancer screening
population screening not proven
high risk women (cancer gene mutation carriers, ≥2 relatives) - little positive evidence
pelvic exam, USS ovaries, CA 125
difficult to detect women in precancerous stage
no prognostic/survival benefit
what can be offered to high risk women to prevent ovarian cancer
prophylactic laparoscopic bilateral salpinogoophorectomy
removal of tubes and ovaries following completion of families
residual risk of 1y peritoneal cancer
potential for risk reducing early salpingectomy and delayed oophorectomy
why is ovarian cancer screeening not recommended
limited sensitivity and specificity
FIGO stages of cancer detected rather than pre-cancerous change
