Ovarian Cancer Flashcards by amo x

What are the ovaries?

The ovum producing organs in the female reproductive system

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What are the three pathological origins of ovarian cancer?

Fimbrae Origin

Ovarian Cyst Origin

Endometriosis Origin

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What is the most common origin of ovarian cancer?

Fimbriae origin

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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

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What grade of serous carcinoma develops from the epithelium of the fimbrae?

High grade

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What three mutations are associated with ovarian cancer from the epithelium of fimbrae?

p53 mutations

BRCA1 mutations

BRCA2 mutations

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What type of ovarian cysts can lead to ovarian cancer? Are these benign or malignant?

Serous cystadenoma ovarian cysts

Benign

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What grade of serous carcinoma develops from ovarian cysts?

Low grade

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When do cysts possess a high risk of malignancy?

When they develop post menopause

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Describe how endometriosis can develop into ovarian cancer

Endometriomas within the ovary can become atypical and develop into carcinoma over time

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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

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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

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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

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What are the six clinical features of ovarian cancer?

Abdominal Bloating

Pelvic Pain

Early Satiety

Indigestion

Urinary Symptoms

Altered Bowel Habit

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What are the four investigations used to diagnose ovarian cancer?

Blood Tests

Ultrasound Scan

Biopsy

Paracentesis

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What is the first line investigation used to diagnose ovarian cancer?

Blood tests

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What blood test is used to investigate ovarian cancer?

CA125

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What is CA125?

A tumour marker for epithelial cell ovarian cancer

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What grade of ovarian cancer is usually detected by CA125 bloods?

High grade

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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