Gynae: Ovarian Cancer Flashcards
what is ovarian cancer
cancer of the ovaries
why is ovarian cancer associated with a poor prognosis?
presents late due to non-specific symptoms and more than 70% of patients with ovarian cancer present after it has spread beyond the pelvis
what are the types of ovarian cancer?
- epithelial cell tumours
- dermoid cysts/germ call tumours
- sex cord-stroma tumours
- metastasis
what are epithelial cell tumours of the ovary and how common are they?
name some subtypes
- arise from the epithelial cells of the ovary and are the most common type
- subtypes are:
- serous tumours
- endometrioid carcinomas
- clear cell tumours
- mucinous tumours
- undifferentiated tumours
what are dermoid cysts/germ cell tumours of the ovary?
- benign ovarian tumours
- they are teratomas meaning they come from germ cells
- they may contain various tissue types such as skin, teeth, hair, bone
- associated with ovarian torsion
- may cause raised alpha-fetoprotein and human chorionic gonatrophin
what are sex cord-stromal tumours of the ovary?
rare
benign or malignant
arise from stroma (connective tissue) or sex cords (embryonic structures associated with the follicles)
several types - Sertoli-Leydig cell tumours and granulosa cell tumours
metastasis
Ovarian tumours may be due to metastasis from a cancer elsewhere. A Krukenberg tumour refers to a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach.
Krukenberg tumours have characteristic “signet-ring” cells on histology, which look like signet rings on under a microscopy.
what are the risk factors for ovarian cancer?
- Age (peaks age 60)
- BRCA1 and BRCA2 genes (consider the family history)
- Increased number of ovulations
- Obesity
- Smoking
- Recurrent use of clomifene
Factors that increase the number of ovulations, increase the risk of ovarian cancer:
- Early-onset of periods
- Late menopause
- No pregnancies
what are some protective factors for ovarian cancer?
higher number of lifetime ovulations increases risk so factors which stop ovulation
- COCP
- breastfeeding
- pregnancy
how does ovarian cancer present?
can be non-specific presentation
may present as:
- Abdominal bloating
- Early satiety (feeling full after eating)
- Loss of appetite
- Pelvic pain
- Urinary symptoms (frequency / urgency)
- Weight loss
- Abdominal or pelvic mass
- Ascites
- Hip/groin pain - mass may press on obturator nerve
what 3 examination findings indicate need for 2 week wait referral for ovarian cancer?
- ascites
- pelvic mass
- abdominal mass
sometimes initial investigations can be done in primary care
carry out further investigations before referral in women presenting with symptoms of possible ovarian cancer starting with CA125 blood test. important in 50 years presenting with:
- New symptoms of IBS / change in bowel habit
- Abdominal bloating
- Early satiety
- Pelvic pain
- Urinary frequency or urgency
- Weight loss
what initial investigations can be done in primary care or secondary care?
- ca125 blood test (>35IU/ml is significant)
- pelvic ultrasound
the risk of malignancy index (RMI) estimates the risk of an ovarian mass being malignant taking into account what 3 things?
- menopausal status
- ultrasound findings
- CA125 level
what further investigations can be done in secondary care for ovarian cancer?
- CT scan to establish the diagnosis and stage the cancer
- Histology (tissue sample) using a CT guided biopsy, laparoscopy or laparotomy
- Paracentesis (ascitic tap) can be used to test the ascitic fluid for cancer cells
