ovarian ca

Question 1

What are the key epidemiological facts about ovarian cancer mortality?

Answer 1

Highest mortality rate among gynecological cancers. Lifetime risk in general population: 1:70. Primary reason for high mortality: vague symptomatology leading to late diagnosis.

Question 2

How does ovarian cancer incidence vary globally?

Answer 2

Highest rates (22-24/100,000): Scandinavia, Eastern Europe, Canada. Lower rates: Developing countries, Japan (notably low at 3/100,000).

Question 3

What are the three main categories of ovarian cancer?

Answer 3

Epithelial Cancers (90%), Germ Cell Tumors (5%), Sex Cord Stromal Tumors (8%).

Question 4

What are the key characteristics of epithelial ovarian cancers?

Answer 4

Originates from surface epithelium tissue. Comprises 90% of all ovarian cancers. Most common in post-menopausal women. Subtypes: Serous, Mucinous, Endometrioid, Transitional, Undifferentiated.

Question 5

What are the characteristics of germ cell tumors (GCTs)?

Answer 5

Origin: Primordial germ cells of ovary. Age: 80% diagnosed under age 30. Types: Dysgerminomas (most common), Yolk sac/endodermal sinus tumors, Immature teratomas, Embryonal carcinomas, Non-gestational choriocarcinomas. Often contain multiple histological types.

Question 6

What are the key features of sex cord stromal tumors?

Answer 6

Origin: Stromal connective tissue. Age: Affects all age groups. Types: Juvenile granulosa cell tumors, Adult granulosa cell tumors, Sertoli-Leydig cell tumors. Hormone production common: Estrogen, Inhibin, Progesterone, Testosterone.

Question 7

What are the hereditary risk factors for ovarian cancer?

Answer 7

Accounts for 10% of cases. Risk factors include: Personal/family history of breast cancer, Family history of ovarian cancer, History of endometrial cancer, History of prostate cancer, History of colon cancer. BRCA1/BRCA2 mutations: 20-50% lifetime risk, Earlier age of onset.

Question 8

What are the non-hereditary risk factors?

Answer 8

Reproductive factors: Uninterrupted ovulation, Multiple artificial ovulation inductions, Low parity, Non-use of combined oral contraception. Other factors: Increasing age, Diet (particularly in industrialized countries).

Question 9

Why is ovarian cancer often diagnosed late?

Answer 9

Anatomical reasons: Ovaries are intra-peritoneal organs, Can grow significantly before detection, Spreads in creeping fashion rather than direct invasion.

Question 10

What are the early ‘whisper’ symptoms of ovarian cancer?

Answer 10

Gastrointestinal: Changes in bowel habits, Mild dyspepsia, Fullness after meals. General: Abdominal distension, Slow weight loss, Fatigue. Gynecological: Pelvic pain/discomfort, Postmenopausal bleeding (10% of cases).

Question 11

What are the essential physical examination components?

Answer 11

Palpation of VT node, Check for pleural effusions, Abdominal examination for: Ascites, Peri-umbilical nodule, Masses. Thorough pelvi-rectal examination.

Question 12

What are the routine investigations needed?

Answer 12

Basic tests: Hemoglobin, Pregnancy test (reproductive age), Urine dipstick, Pap smear, Endometrial sampling (if bleeding).

Question 13

What tumor markers are important and what do they indicate?

Answer 13

CA 125: >500/ml suspicious for ovarian cancer, Raised in 80% of serous epithelial cancers, Only 50% of mucinous carcinomas. Alpha-fetoprotein: for yolk sac tumors. LDH: elevated in dysgerminomas. Beta-hCG: for choriocarcinomas. CEA: helps distinguish from bowel cancer.

Question 14

What are the stages and associated survival rates?

Answer 14

Stage I: Confined to ovaries (>90% 5-year survival). Stage II: Extended to pelvic organs. Stage III: Extended to bowel/peritoneum/lymph nodes. Stage IV: Distant metastases. Late stages (III/IV): <30% 5-year survival.

Question 15

What are the three main purposes of surgery?

Answer 15

To make the diagnosis, To stage the disease, To remove as much tumor as possible (debulking).

Question 16

What does standard surgical management include?

Answer 16

Vertical incision exploration, Peritoneal washings, Diaphragm wipes, Total abdominal hysterectomy, Bilateral salpingo-oophorectomy, Infracolic omentectomy, Tumor debulking.

Question 17

How does treatment vary by cancer type?

Answer 17

Epithelial: Primary surgery, Post-op chemotherapy (>70%). Germ Cell: Limited surgery (fertility preservation), Multiple agent chemotherapy primary. Sex Cord Stromal: Primary surgical treatment, Limited chemotherapy role.

Question 18

What is the epidemiological distribution of ovarian cancer?

Answer 18

Highest mortality rate among gynecological cancers. Highest incidence in: Scandinavia (22-24/100,000), Eastern Europe (22-24/100,000), Canada (22-24/100,000). Lower rates in developing countries. Japan has exceptionally low rates (3/100,000). Lifetime risk in general population: 1:70.

Question 19

What are the main types of ovarian cancers and their characteristics?

Answer 19

Epithelial Cancers (90% of cases): Originates from surface epithelium, Subtypes: serous, mucinous, endometrioid, transitional, undifferentiated, Most common in post-menopausal women, 90% survival rate in Stage I, but 75-80% diagnosed in Stages II-IV. Germ Cell Tumors (5% of cases): Originates from primordial germ cells, 80% diagnosed under age 30, Types: Dysgerminomas (most common), yolk sac tumors, immature teratomas, embryonal carcinomas, non-gestational choriocarcinomas, Often contain multiple histological types. Sex Cord Stromal Tumors (8% of cases): Affects all age groups, Originates from stromal connective tissue, Types: juvenile granulosa cell tumors, adult granulosa cell tumors, Sertoli-Leydig cell tumors, Often hormone-producing.

Question 20

What are the risk factors for ovarian cancer?

Answer 20

Hereditary factors (10% of cases): Personal/family history of breast, ovarian, endometrial, prostate, or colon cancer, BRCA1 or BRCA2 gene mutations (20-50% lifetime risk), Early-onset epithelial cancers. Other risk factors: Uninterrupted ovulation, Multiple artificial ovulation inductions (controversial), Low parity, Non-use of combined oral contraception, Increasing age, Diet (particularly in industrialized countries).

Question 21

What are the typical symptoms of ovarian cancer and why is diagnosis often delayed?

Answer 21

Anatomical reasons for late diagnosis: Ovaries are intra-peritoneal organs, Can grow significantly before becoming clinically evident, Disease spreads in a creeping fashion rather than direct invasion. Common symptoms (‘whispers’): Unexplained changes in bowel/bladder habits, Mild dyspepsia, Fullness after meals, Abdominal distension, Unexplained slow weight loss, Pelvic pain/discomfort, Fatigue, Postmenopausal bleeding (10% of cases).

Question 22

What are the key components of diagnosis for ovarian cancer?

Answer 22

Physical Examination: Palpation of VT node, Check for pleural effusions, Abdominal examination for: Ascites (fluid thrill/shifting dullness), Peri-umbilical nodule (Sr Mary Joseph nodule), Masses. Thorough pelvi-rectal examination. Essential Investigations: Hemoglobin, Pregnancy test (reproductive age), Urine dipstick, Pap smear, Endometrial sampling (if abnormal bleeding). Special Investigations: Imaging: Chest X-ray, ultrasound, CT abdomen/pelvis, Fluid analysis: Ascitic/pleural tap, Additional tests as needed: Mammogram, bowel investigations. Tumor markers: CA 125 (>500/ml suspicious), Alpha-fetoprotein (yolk sac tumors), LDH (dysgerminomas), Beta-hCG (choriocarcinomas), CEA (distinguish from bowel cancer).

Question 23

What are the stages of ovarian cancer and their survival rates?

Answer 23

Staging: Stage I: Confined to ovaries (>90% 5-year survival), Stage II: Extended to other pelvic organs, Stage III: Extended to bowel lining, abdominal peritoneum, or lymph nodes, Stage IV: Distant metastases (liver/chest), Stage III/IV: <30% 5-year survival.

Question 24

What is the surgical management of ovarian cancer?

Answer 24

Purposes of Surgery: Diagnosis, Staging, Debulking. Standard Surgical Procedure: Vertical incision for thorough exploration, Peritoneal washings and diaphragm wipes, Total abdominal hysterectomy (TAH), Bilateral salpingo-oophorectomy (BSO), Infracolic omentectomy, Debulking of visible tumor.

Question 25

How does treatment differ for various types of ovarian cancer?

Answer 25

Epithelial Cancers: Surgery is primary treatment, 70% require post-operative chemotherapy. Germ Cell Tumors: Surgery mainly for diagnosis, Fertility preservation important, Multiple agent chemotherapy is mainstay. Sex Cord Stromal Tumors: Surgery is primary treatment, Limited role for chemotherapy.