Ovarian Cancer Flashcards
What are the ovaries?
The ovum producing organs in the female reproductive system
What are the three pathological origins of ovarian cancer?
Fimbrae Origin
Ovarian Cyst Origin
Endometriosis Origin
What is the most common origin of ovarian cancer?
Fimbriae origin
Describe fimbriae origin of ovarian cancer
During ovulation, there is epithelial irritation
This can affect the fimbriae of the fallopian tube
This irritation causes serous tubal intraepithelial carcinoma (STIC), which can then seed into the ovary
What grade of serous carcinoma develops from the epithelium of the fimbrae?
High grade
What three mutations are associated with ovarian cancer from the epithelium of fimbrae?
p53 mutations
BRCA1 mutations
BRCA2 mutations
What type of ovarian cysts can lead to ovarian cancer? Are these benign or malignant?
Serous cystadenoma ovarian cysts
Benign
What grade of serous carcinoma develops from ovarian cysts?
Low grade
When do cysts possess a high risk of malignancy?
When they develop post menopause
Describe how endometriosis can develop into ovarian cancer
Endometriomas within the ovary can become atypical and develop into carcinoma over time
What are the seven risk factors of ovarian cancer?
Advanced Age > 60
Nulliparity
Early Menarche/Late Menopause
BRCA1 & BRCA2 Mutations
HNPCC (Lynch Syndrome)
Obesity
Smoking
What are the three protective risk factors against ovarian cancer? How?
Combined contraceptive methods
Multiparity
Breastfeeding
These factors stop ovulation or reduce the number of lifetime ovulations
Why are early menarche, late menopause and nulliparity risk factors of ovarian cancer?
These factors increase ovulation, which causes epithelial irritation and thus proliferative changes
What are the six clinical features of ovarian cancer?
Abdominal Bloating
Pelvic Pain
Early Satiety
Indigestion
Urinary Symptoms
Altered Bowel Habit
What are the four investigations used to diagnose ovarian cancer?
Blood Tests
Ultrasound Scan
Biopsy
Paracentesis
What is the first line investigation used to diagnose ovarian cancer?
Blood tests
What blood test is used to investigate ovarian cancer?
CA125
What is CA125?
A tumour marker for epithelial cell ovarian cancer
What grade of ovarian cancer is usually detected by CA125 bloods?
High grade
What level of CA125 is classed as elevated?
> 35 IU/mL
What is the disadvantage of using CA125 to diagnose ovarian cancer?
It is not very specific and is associated with many other pathologies
What are the five other conditions associated with elevated CA125 levels?
Endometriosis
Liver Disease
Pelvic Inflammatory Disease
Breast Cancer
Colon Cancer
What two other less common blood tests can be used to diagnose ovarian cancer? When are they conducted?
Alpha-fetoprotein
Human chorionic gonadotropin
In women under 40 years old who present with a complex ovarian mass
What type of ovarian cancer is associated with raised alpha-fetoprotein and human chorionic gonadotropin levels?
Germ cell
What are the five ultrasound scan features of ovarian cancer?
Multilocular Cyst
Solid Areas
Metastases
Ascites
Bilateral Lesions
In which two locations do we take a biopsy from to diagnose ovarian cancer?
Ovaries
Omentum, however this is only conducted if advanced disease is suspected
How is a biopsy used to investigate ovarian cancer?
It is used to diagnose the grade of the tumour, as well as the histological classification
What histological feature indicates serous ovarian cancer?
Positive WT-1 gene expression
What is paracentesis? How is it used to diagnose ovarian cancer?
A procedure that removes ascites from the abdomen
The fluid drained from the abdomen is cytologically examined for the presence of cancer cells
This is usually indicated by nuclear morphism
When would we conduct paracentesis to diagnose ovarian cancer?
To confirm whether the ovarian cancer has spread to the abdomen region, allowing us to stage the cancer
What scoring system is used to stratify the risk of ovarian cancer?
Risk of malignancy index (RMI)
What RMI score indicates ovarian cancer?
> 250
How do we calculate RMI?
RMI = U x M x CA125
U - ultrasound features
M - menopausal status
What M score is given to women in the premenopausal state? (RMI)
1 Point
What M score is given to women in the postmenopausal state? (RMI)
3 Points
What U score is given to 0 US scan features? (RMI)
0 points
What U score is given to 1 US scan feature? (RMI)
1 Point
What U score is given to >2 US scan features? (RMI)
3 Points
What staging system is used for ovarian cancer?
International Federation of Gynaecology and Obstetrics (FIGO) staging system
What two investigations are used to stage ovarian cancer?
CXRs
Abdomen/Pelvic CT scan
What is stage 1 ovarian cancer?
This is defined as carcinoma confined to the ovaries
What is stage 2 ovarian cancer?
This is defined as carcinoma spreading past the ovaries however inside the pelvic cavity
It usually involves the bowel or bladder
What is stage 3 ovarian cancer?
This is defined as carcinoma spreading past the pelvic cavity however inside the abdomen
It usually involves the stomach momentum and aortic nodes
What is stage 4 ovarian cancer?
This is defined as carcinoma with distant metastasis
It usually involves the chest, liver and spleen
How do we manage ovarian cancer?
We usually conduct surgical debulking of the tumour via laparotomy
This is followed by chemotherapy within eight weeks of surgery
What are the two first line chemotherapy agents for ovarian cancer?
Platinum
Taxane
How do we manage advanced ovarian cancer disease?
We prescribe chemotherapy treatment neo-adjuvantly
How successful is treatment of stage three and four ovarian cancer?
The treatment options are unlikely to be curative, with there being a high risk of reoccurrence
This remission period is usually for an average of two years
What is the general prognosis of ovarian cancer? Why?
Poor
Ovarian cancer patients tend to present with advanced disease – greater than stage three
This is due to the ‘non-specific’ symptoms of ovarian cancer, as well as the lack of screening available
