Ovarian CA (extra )

Question 1

What are the key statistics about ovarian cancer’s prevalence and diagnosis?

Answer 1

• Ranks as 7th most prevalent cancer in females

Median age at diagnosis: 60 years
Lifetime risk: approximately 1 in 70
Often diagnosed late due to non-specific symptoms
High lethality rate among gynecological cancers

Question 2

List and explain the major risk factors for ovarian cancer

Answer 2

1. Extended Ovulation:

Early menarche
Nulliparity

2. Obesity
3. Hormone Replacement Therapy (HRT)
4. Family History:

History of breast or ovarian cancer
BRCA1 or BRCA2 gene mutations

Question 3

What are the subtypes of epithelial ovarian cancer and their characteristics?

Answer 3

Epithelial Ovarian Cancer (90% of cases):

1. Serous (60-80%):

Most common
Origins in fallopian tube cells

2. Endometrioid (15-20%):

Favorable prognosis
Linked to endometriosis

3. Clear Cell (15%):

Chemotherapy resistant
Linked to endometriosis

4. Mucinous (5%):

May be metastatic from appendix/colon

5. Undifferentiated/Unclassified:

Poor prognosis

Question 4

Describe the non-epithelial types of ovarian cancer

Answer 4

1. Germ Cell Tumors (5% of cancers, 30% of tumors):

Most are benign teratomas
Types include: germomas, yolk sac tumors, choriocarcinoma

2. Sex Cord-Stromal Tumors (5%):

Include hormone-producing tumors
Example: granulosa cell cancers

Question 5

What are the main symptoms of ovarian cancer?

Answer 5

Gastrointestinal Symptoms:

Nausea, vomiting
Early satiety
Bloating, distension
Diarrhea, constipation

Other Symptoms:

Fatigue
Irregular menstruation
Dyspareunia (painful intercourse)
Increased urinary frequency/urgency
Pelvic/abdominal pain (more common in later stages)

Note: Early symptoms are often vague, leading to diagnostic delays

Question 6

What is the FIGO staging system for ovarian cancer?

Answer 6

Back: Stage I: Cancer limited to ovaries
Stage II: Cancer confined to pelvis
Stage III: Cancer beyond pelvis or in retroperitoneal lymph nodes
Stage IV: Distant metastases

Note: 70% diagnosed at stage IIIc (peritoneal deposits >2 cm)

Question 7

What comprises the initial diagnostic workup for ovarian cancer?

Answer 7

1. Physical Examination:

Check for ascites
Assess ovarian mass characteristics

2. Imaging:

Transvaginal ultrasound
CT or MRI

3. CA-125 Levels:

Tumor marker
Not reliable for screening

4. Risk of Malignancy Index (RMI):

• Based on ultrasound, menopausal status, CA-125
• 200 considered high risk
  Gold Standard: Direct visualization and biopsy via laparotomy/laparoscopy

Question 8

Describe the treatment approaches for ovarian cancer

Answer 8

Primary Treatment:

1. Debulking Surgery:

Remove as much cancerous tissue as possible
May follow chemotherapy in some cases

2. Adjuvant Chemotherapy:

Primarily platinum-based
Resistance if recurrence within 6 months

Specific Treatments:

1. PARP Inhibitors (e.g., Olaparib):
   - For BRCA mutations
   - For platinum-sensitive cases
2. Prophylactic Salpingo-oophorectomy for high-risk patients

Question 9

What is the prognosis for ovarian cancer?

Answer 9

Overall 5-year survival: 20-50%
Stage I 5-year survival: 90-95%
Factors affecting prognosis:

• Stage at diagnosis
• Cancer subtype
• Response to platinum-based therapy
• Completeness of surgical debulking