Ovarian Cancer

Question 1

How common of a malignancy is ovarian cancer?

Answer 1

5th most common malignancy in females

Question 2

What age are women most commonly affected?

Answer 2

60 years old

Question 3

What is the prognosis of ovarian cancer and why?

Answer 3

Poor prognosis

Due to late diagnosis

Question 4

What is the main type of ovarian tumour?

Answer 4

Epithelial ovarian tumour

Question 5

Where does ovarian cancer originate?

Answer 5

It originates from the epithelium which lines the fimbria of the fallopian tubes or the ovaries

Question 6

What is the main risk factors of ovarian cancer?

Answer 6

Greater number of ovulations- Early menarche, late menopause

Question 7

What genes are associated with an increased risk of ovarian cancer?

Answer 7

BRCA 1 and BRCA 2

HNPCC/ Lynch type 2 familial cancer

Question 8

What is the problem with diagnosing ovarian cancer?

Answer 8

The symptoms are vague and present late

Question 9

What are clinical features of ovarian cancer?

Answer 9

• Abdominal distension and bloating
• Urinary symptoms- Urgency (pressure symptom)
• Early satiety (feel full after small amount of food)

Question 10

What can the ovarian tumour produce?

Answer 10

Vascular growth factors

Question 11

What do vascular growth factors do?

Answer 11

Increase vessel permeability

Cause ascites

Question 12

What is sometimes palpable with ovarian cancer?

Answer 12

A mass where the cancer is growing

Question 13

If the patient is symptomatic, what is the initial investigation?

Answer 13

CA 125 level

Question 14

What is classed as a raised CA 125?

Answer 14

More than 35IU/mL

Question 15

What is the initial investigation if the patient is asymptomatic?

Answer 15

An ultrasound scan

Question 16

What are the 2 uses for CA 125?

Answer 16

Diagnosis and monitoring

Question 17

How is an ovarian tumour diagnosed?

Answer 17

Diagnostic laparotomy

Question 18

What is stage 1 of ovarian cancer?

Answer 18

Limited to ovaries with capsule intact?

Question 19

What is stage 2 of ovarian cancer?

Answer 19

One or both ovaries with pelvic extension

Question 20

What is stage 3 of ovarian cancer?

Answer 20

One or both ovaries with peritoneal implants outside pelvis or positive lymph nodes

Question 21

What is stage 4 of ovarian cancer?

Answer 21

Distant metastasis

Question 22

What is the management of ovarian cancer?

Answer 22

Combination of
Surgery
Platinum based chemotherapy (platinum and taxane)

Question 23

What are other things that can raise CA 125?

Answer 23

Endometriosis
Menstruation
Benign ovarian cyst

Question 24

What would you do if the patients CA125 was more than 35?

Answer 24

Urgent US scan

Question 25

What other factors can increase the risk of ovarian cancer?

Answer 25

Obesity
Smoking

Question 26

What are protective factors for ovarian cancer?

Answer 26

Pregnancy
Breastfeeding
Early menopause
Combined oral contraceptive pill (COCP) use

Question 27

When would you refer a woman urgently (2 week wait) for suspected ovarian cancer?

Answer 27

Ascites
Unexplained pelvic/abdominal mass.

Question 28

How can ovarian cancer cause hip/groin pain?

Answer 28

An ovarian mass may press on the obturator nerve and cause referred hip or groin pain

Question 29

What type of ovarian tumor are women under the age of 40 usually affected by?

Answer 29

Germ cell tumour:

Question 30

What is the management of stage 2-4 ovarian cancer?

Answer 30

Surgical excision

Followed by chmotherapy