Ovarian Cancer Flashcards
What is the epidemiology of ovarian cancer?
- 600 cases per year in Scotland
- 400 deaths per year in Scotland
- 5year survival all stages 40-45%
- Most present with advanced disease
What is the origin of ovarian cancer?
- Most cases originate from the fallopian tube
- Some from pre-existing benign ovarian cysts (often low grade cancers)
What medication is protective in ovarian cancer?
OCP
In what age group is ovarian cancer rare?
<30 years
What families are at high risk?
Account for 5-10% of cases and include:
- HNPCC/Lynch type II familial cancer syndrome
- BRCA1
- BRCA2
What is the inheritance of BRCA genes?
Autosomal dominant
What are BRCA genes?
Tumour suppressor genes involved in DNA repair and cell cycle control
What are the symptoms of ovarian cancer?
VERY VAGUE
- Indigestion/early satiety/ poor appetite
- Altered bowel habit/pain
- Bloating/discomfort/weight gain
- Pelvic mass (asymptomatic or pressure symptoms)
How is ovarian cancer diagnosed?
- Surgical/Pathological
- US Scan abdomen and pelvis
- CT Scan
- CA 125
- Surgery
What is CA 125?
A glyco-protein antigen
What malignancies is CA 125 associated with?
- Ovarian
- Colon/pancreas
- Breast
What benign conditions is CA 125 associated with?
- Menstruation/endometriosis/PID
- Liver disease/recent surgery/effusions
What is the association between CA 125 and ovarian cancer?
- 80% of women with ovarian cancer have a raised CA 125
- 50% of women with stage 1 disease
What role does CA 125 play in ovarian cancer?
Used to detect and monitor epithelial ovarian tumour
What is used to determine risk of ovarian cancer?
Risk of malignancy index
What are the components of the risk of malignancy index?
- Ultrasound features
- Menopausal status
- CA 125 levels
What are the ultrasound features used in the RMI?
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
How is RMI calculated?
UxMxCA125
1 US feature= 1
2-5 US feature= 3
Pre-menopausal=1
Post-menopausal=3
How is ovarian cancer treated?
- Surgery
- Chemotherapy (adjuvant/neoadjuvant)
What is the gold standard treatment for ovarian cancer?
Surgery
What are the aims of laparotomy?
- Obtain tissue diagnosis
- Stage disease
- Disease clearance
- Debulk disease
How is chemotherapy used in ovarian cancer?
- First line Platinum and taxane (Taxol)
- Within 8 weeks of surgery
- Complete/partial response
- Cure unlikely
- Average response 2 years
What are the cure rate relevant to stage for ovarian cancer?
- Stage 1= 85%
- Stage 2= 47%
- Stage 3= 15%
- Stage 4= 10%
How can ovarian cancer recurrence be managed?
- Chemotherapy
- Palliation for symptomatic recurrence
- Platinum if > 6months
- ?Surgery
- Tamoxifen
Who is screened for ovarian cancer?
High risk women
- Cancer gene mutation carriers
- 2 or more relatives
How is ovarian cancer screened for?
- Pelvic examination
- US scanning of ovaries
- CA 125
Why is ovarian cancer not screened for in the general population?
- Not recommended
- Limited sensitivity and specificity
- Cannot pick up pre-cancerous changes
What can at risk women be offered?
Prophylactic oophorectomy and salpingectomy
What stage does it often present in?
Presents late at satge 3 or 4
What is the normal range of CA 125?
0-35
What RMI is highly suggestive of malignancy
> 200
What system is used for staging ovarian cancer?
FIGO staging
What are the FIGO stages of ovarian cancer?
- Stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer)
- Stage I: confined to the organ of origin
- Stage II: invasion of surrounding organs or tissue
- Stage III: spread to distant nodes or tissue within the pelvis
- Stage IV: distant metastasis
