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Year Three - Reproductive System > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

What are the ovaries?

A

The ovum producing organs in the female reproductive system

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2
Q

What are the three pathological origins of ovarian cancer?

A

Fimbrae Origin

Ovarian Cyst Origin

Endometriosis Origin

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3
Q

What is the most common origin of ovarian cancer?

A

Fimbriae origin

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4
Q

Describe fimbriae origin of ovarian cancer

A

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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5
Q

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

A

High grade

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6
Q

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

A

p53 mutations

BRCA1 mutations

BRCA2 mutations

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7
Q

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

A

Serous cystadenoma ovarian cysts

Benign

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8
Q

What grade of serous carcinoma develops from ovarian cysts?

A

Low grade

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9
Q

When do cysts possess a high risk of malignancy?

A

When they develop post menopause

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10
Q

Describe how endometriosis can develop into ovarian cancer

A

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

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11
Q

What are the seven risk factors of ovarian cancer?

A

Advanced Age > 60

Nulliparity

Early Menarche/Late Menopause

BRCA1 & BRCA2 Mutations

HNPCC (Lynch Syndrome)

Obesity

Smoking

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12
Q

What are the three protective risk factors against ovarian cancer? How?

A

Combined contraceptive methods

Multiparity

Breastfeeding

These factors stop ovulation or reduce the number of lifetime ovulations

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13
Q

Why are early menarche, late menopause and nulliparity risk factors of ovarian cancer?

A

These factors increase ovulation, which causes epithelial irritation and thus proliferative changes

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14
Q

What are the six clinical features of ovarian cancer?

A

Abdominal Bloating

Pelvic Pain

Early Satiety

Indigestion

Urinary Symptoms

Altered Bowel Habit

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15
Q

What are the four investigations used to diagnose ovarian cancer?

A

Blood Tests

Ultrasound Scan

Biopsy

Paracentesis

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16
Q

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

A

Blood tests

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17
Q

What blood test is used to investigate ovarian cancer?

A

CA125

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18
Q

What is CA125?

A

A tumour marker for epithelial cell ovarian cancer

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19
Q

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

A

High grade

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20
Q

What level of CA125 is classed as elevated?

A

> 35 IU/mL

21
Q

What is the disadvantage of using CA125 to diagnose ovarian cancer?

A

It is not very specific and is associated with many other pathologies

22
Q

What are the five other conditions associated with elevated CA125 levels?

A

Endometriosis

Liver Disease

Pelvic Inflammatory Disease

Breast Cancer

Colon Cancer

23
Q

What two other less common blood tests can be used to diagnose ovarian cancer? When are they conducted?

A

Alpha-fetoprotein

Human chorionic gonadotropin

In women under 40 years old who present with a complex ovarian mass

24
Q

What type of ovarian cancer is associated with raised alpha-fetoprotein and human chorionic gonadotropin levels?

A

Germ cell

25
Q

What are the five ultrasound scan features of ovarian cancer?

A

Multilocular Cyst

Solid Areas

Metastases

Ascites

Bilateral Lesions

26
Q

In which two locations do we take a biopsy from to diagnose ovarian cancer?

A

Ovaries

Omentum, however this is only conducted if advanced disease is suspected

27
Q

How is a biopsy used to investigate ovarian cancer?

A

It is used to diagnose the grade of the tumour, as well as the histological classification

28
Q

What histological feature indicates serous ovarian cancer?

A

Positive WT-1 gene expression

29
Q

What is paracentesis? How is it used to diagnose ovarian cancer?

A

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

30
Q

When would we conduct paracentesis to diagnose ovarian cancer?

A

To confirm whether the ovarian cancer has spread to the abdomen region, allowing us to stage the cancer

31
Q

What scoring system is used to stratify the risk of ovarian cancer?

A

Risk of malignancy index (RMI)

32
Q

What RMI score indicates ovarian cancer?

A

> 250

33
Q

How do we calculate RMI?

A

RMI = U x M x CA125

U - ultrasound features

M - menopausal status

34
Q

What M score is given to women in the premenopausal state? (RMI)

A

1 Point

35
Q

What M score is given to women in the postmenopausal state? (RMI)

A

3 Points

36
Q

What U score is given to 0 US scan features? (RMI)

A

0 points

37
Q

What U score is given to 1 US scan feature? (RMI)

A

1 Point

38
Q

What U score is given to >2 US scan features? (RMI)

A

3 Points

39
Q

What staging system is used for ovarian cancer?

A

International Federation of Gynaecology and Obstetrics (FIGO) staging system

40
Q

What two investigations are used to stage ovarian cancer?

A

CXRs

Abdomen/Pelvic CT scan

41
Q

What is stage 1 ovarian cancer?

A

This is defined as carcinoma confined to the ovaries

42
Q

What is stage 2 ovarian cancer?

A

This is defined as carcinoma spreading past the ovaries however inside the pelvic cavity

It usually involves the bowel or bladder

43
Q

What is stage 3 ovarian cancer?

A

This is defined as carcinoma spreading past the pelvic cavity however inside the abdomen

It usually involves the stomach momentum and aortic nodes

44
Q

What is stage 4 ovarian cancer?

A

This is defined as carcinoma with distant metastasis

It usually involves the chest, liver and spleen

45
Q

How do we manage ovarian cancer?

A

We usually conduct surgical debulking of the tumour via laparotomy

This is followed by chemotherapy within eight weeks of surgery

46
Q

What are the two first line chemotherapy agents for ovarian cancer?

A

Platinum

Taxane

47
Q

How do we manage advanced ovarian cancer disease?

A

We prescribe chemotherapy treatment neo-adjuvantly

48
Q

How successful is treatment of stage three and four ovarian cancer?

A

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

49
Q

What is the general prognosis of ovarian cancer? Why?

A

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

Year Three - Reproductive System (52 decks)

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