Ovarian Cancer Flashcards
What symptoms if persistent in post menopausal women require further investigation?
What are those further invx?
Abdo bloating
Early satiety
Pelvic pain
Urinary freq/urgency
USS
Pelvic exam
Blood tests
How can it be examined?
Pelvic examination - normal examination does not rule it out
What is the tumour marker for ovarian cancer?
What is measured alongside?
How can the ratio of these two things indicate malignancy?
CA125
CEA - increase in malignancy that produce protein
CA125/CEA <25
What is RMI?
How is it calculated?
Risk of Malignancy Index
Pre/post menopause = A
- pre = 1
- post = 3
US findings = B - ascites - bilaterality - multiloculated - solid areas - mets 1 feature = 1 >1 = 3
CA125 absolute value = C
AxBxC
RMI <30 = v low risk
30-200 = 20%
>200 = 75%
What would mean an urgent (2wk referral)?
Ascietes
Pelvic mass
Abdo mass
To further investigate and stage the cancer who would get MRI over CT?
CT for postmenopausal
MRI for premenopausal - allows for better view to be able to establish what of ovaries can be saved
What are the 3 types of ovarian cancer which you can get?
- Epithelial - most common
- Germ cell
- Sex-cord stromal
What is the most common type of epithelial?
Serous
On histology of a tumour in the ovary you find signet ring cells.
What kind of tumour is this suggestive of?
What is a signet ring cell?
Kruckenburg tumour - secondary tumour - most commonly from GI
Nucleus is all at top of cell - see notes
Describe the difference between Stage 1-4
1 - confined to the ovary/ies
2- spread past the ovary but inside the pelvis
3 - spread past pelvis but inside abdominal
4 - spread outside abdo
In what circumstance would you give just surgery and not chemo as well?
If germline tumour
How may a gremline tumour present?
Teratoma - contains all 3 cell types of ovary -> can contain skin, hair etc. = dermoid cyst
Often large and present in younger patients
How do you treat ovarian cancer?
Surgery and chemo
Neoadjuvant chemo if advanced
