Gynaecological cancers- Ovarian cancer

Question 1

types of ovarian cancer

Answer 1

epithelial cell tumours
dermoid cysts/germ cell tumours
sex cord stromal tumorus
metastasis

Question 2

ovarian cancer risk factors

Answer 2

Age (peaks age 60)
BRCA1 and BRCA2 genes (consider the family history)
Increased number of ovulations
Obesity
Smoking
Recurrent use of clomifene

increased number of ovulations:
Early-onset of periods
Late menopause
No pregnancies

Question 3

protective factors of ovarian cancer

Answer 3

Combined contraceptive pill
Breastfeeding
Pregnancy

(factors which stop ovulation)

Question 4

ovarian cancer presentation

Answer 4

can be non specific

Abdominal bloating
Early satiety (feeling full after eating)
Loss of appetite
Pelvic pain
Urinary symptoms (frequency / urgency)
Weight loss
Abdominal or pelvic mass
Ascites

referred hip or groin pain i ovarian mass presses on the obtruator nerve

Question 5

ovarian cancer referral

2 week wait

Answer 5

2-week wait:
ascites
pelvic mass (unless clearly due to fibroids)
abdominal mass

Question 6

ovarian cancer / carrying out initial investigations in primary care

Answer 6

FBC
urine and ascitic fluid
serum markers
USS
ca125 blood test
if >50 presenting with IBS/change in bowel habit
abdominal bleeding
early satiety
pelvic pain
urinary frequency or urgency
weight loss

Question 7

investigations for ovarian cancer (in 1’ or 2’ care)

Answer 7

CA125 blood test (>35 IU/mL is significant)
Pelvic ultrasound

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

women <40 with comple ovarian mass:
Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)

Question 8

ca125

Answer 8

CA125 is a tumour marker for epithelial cell ovarian cancer. It is not very specific, and there are many non-malignant causes of a raised CA125:

Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy

Question 9

ovarian cancer staging (FIGO)

Answer 9

Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)

Question 10

management of ovarian cancer

Answer 10

gynaecology oncology MDT
surgery
chemotherapy