Gynaecological Oncology & Screening - Ovarian Cancer

Question 1

Risk Factors of Ovarian Cancer (5).

Answer 1

1. Age : 60.
2. BRCA1 and BRCA2.
3. Increased Number of Ovulations.
4. Obesity & Smoking.
5. Recurrent Use of Clomifene.

Question 2

What factors can increase the number of ovulations? (3)

Answer 2

1. Early-Onset Periods.
2. Late Menopause.
3. No Pregnancies.

Question 3

Protective Factors of Ovarian Cancer (3).

Answer 3

Reduce Ovulation Number :

1. COCP.
2. Breastfeeding.
3. Pregnancy.

Question 4

Types of Ovarian Cancer (3).

Answer 4

1. Epithelial Cell Tumours (commonest).
2. Dermoid / Germ Cell Tumours.
3. Sex Cord-Stromal Tumours.

Question 5

Give 5 types of Epithelial Cell Ovarian Cancers.

Answer 5

1. Serous Tumours (commonest).
2. Endometrioid Carcinoma.
3. Clear Cell Tumour.
4. Mutinous Tumour.
5. Undifferentiated Tumour.

Question 6

What are Dermoid Tumours?

Answer 6

Benign Ovarian teratomas (arising from germ cells) containing various tissue types.

Question 7

Unique Features of Dermoid Tumours (2).

Answer 7

1. Association : Ovarian Torsion.

2. Raised a-FP, hCG.

Question 8

What is a Krukenberg Tumour?

Answer 8

Metastasis in the ovary, usually from a GI tract cancer (stomach).

Question 9

Unique Feature of Krukenberg Tumour.

Answer 9

Signet-Ring Cell on Histology.

Question 10

Clinical Features of Ovarian Cancer.

Answer 10

1. Constitutional Symptoms.
2. GI Effects : Abdominal Bloating, Early Satiety, Loss of Appetite, Ascites.
3. GU Effects : Pelvic Pain, Urinary Symptoms.

Question 11

How can Ovarian Cancer cause referred Hip/Groin Pain?

Answer 11

Ovarian mass compression of Obturator Nerve.

Question 12

Referral Criteria for Ovarian Cancer (3).

Answer 12

Suspicion + :

1. Ascites.
2. Pelvic Mass (Except Fibroids).
3. Abdominal Mass.

Question 13

Primary Care Investigations of Ovarian Cancer (2).

Answer 13

1. CA-125 Blood Test (>35IU/mL).

2. Pelvic US.

Question 14

Risk of Malignancy Index.

Answer 14

Estimate of the risk of an ovarian mass being malignant :

1. Menopausal Status.
2. US Findings.
3. CA-125 Level.

Question 15

Secondary Care Investigations of Ovarian Cancer (3).

Answer 15

1. CT Scan (Staging and Diagnosis).
2. Histology (CT-Guided Biopsy).
3. Paracentesis (Ascitic Tap).
4. aFP and hCG (Complex Ovarian Mass Below 40).

Question 16

Differential Diagnoses of Raised CA-125 (6).

Answer 16

1. Endometriosis.
2. Adenomyosis.
3. Fibroids.
4. Pelvic Infection.
5. Liver Disease.
6. Pregnancy.

Question 17

Staging of Ovarian Cancer.

Answer 17

FIGO :

1. Confined to Ovary.
2. Past Ovary but in Pelvis.
3. Past Pelvis but in Abdomen.
4. Past Abdomen.

Question 18

Management of Ovarian Cancer.

Answer 18

1. Gynaecology Oncology MDT.

2. Surgery + Chemotherapy (Platinum-Based).

Question 19

Prognosis of Ovarian Cancer.

Answer 19

Late Presentation + Diagnosis : Poor Prognosis.