Gynaecological Cancers

Question 1

What are some protective factors for ovarian cancer?

Answer 1

Oral contraceptive pill
Tubal ligation
Breast feeding
Ovulation suppression

Question 2

What are some genetic mutations pre-disposing to ovarian cancer?

Answer 2

BRCA 1- 15-45% risk of ovarian
BRCA 2- 10-20% risk of ovarian
HNPCC

Question 3

What are some pathological types of ovarian cancer?

Answer 3

Serous (80%)
Endometrioid (10%)
Clear cell (5%)

Question 4

Symptoms of ovarian cancer?

Answer 4

Asymptomatic until late stage

Abdo pain, constipation, diarrhoea, urinary freq, vaginal bleeding, ascites

Question 5

Stage of ovarian cancer?

Answer 5

Stage 1 - confined to ovaries
Stage 2 - extension into pelvis
Stage 3 - extension into peritoneum
Stage 4 - distant metastases
Ascites = stage c

Stage 1-2 = early
Stage 2-3 = advanced

Question 6

Management of early stage ovarian cancer?

Answer 6

Surgical resection to remove all visible disease
- BSO + TAH, omenectomy, appendectomy, lymphadenectomy

Adjuvant chemotherapy recommended in high risk disease (greater then 1a - confined to 1 ovary, grade 3, clear cell)
Carboplatin and paclitaxel

Question 7

Management of advanced ovarian cancer?

Answer 7

Cytoreductive surgery cornerstone of management
- better cytoreduction = correlates with better survival

Can consider neo adjuvant or adjuvant chemotherapy with carbo/paclitaxel
Aiming for 6 cycles

Question 8

Management of relapsed disease?

Answer 8

Depends on progression free interval
Platinum refractory - relapse on treatment or within 4 weeks
Platinum resistant - within 6 months
Platinum sensitive - more then 12 months

Retrial platinum if sensitive
Otherwise use single sequential single agent chemotherapy

Question 9

What are risk factors for ovarian cancer?

Answer 9

Age - most common in post-menopausal women
Main risk factor is ovulation
- the more ovulation the highest risk
- nulliparous, early menarche, late menopause