Ovarian Cancer Flashcards
What accounts for 65-70% of all ovarian tumours?
Epithelial ovarian tumours
3 most common subtypes of epithelial ovarian tumours?
- Serous tumours
- Mucinous tumours
- Endometroid tumours
Most common malignant tumour of the ovary?
Serous cystadenocarcinoma
What do mucinous tumours secrete?
Mucin
-Mucinous cystadenoma or mucinous cystadenocarcinoma
Endometroid tumours are usually?
Malignant
Other epithelial ovarian tumours include?
- Brenner’s tumours (essentially benign and show islands of transitional epithelium in a fibrous stroma)
- Clear cell carcinoma
What are sex cord/stromal tumours?
Tumours of the connective tissue of the ovary
What is a fibroma?
Commonest sex cord/stromal tumour
- Benign collagenous
- Does not produce oestrogen
- Spindle cell tumour
What is a thecoma?
Similar to fibroma but does secrete oestrogen
What is a granulosa cell tumour?
- Potentially malignant and secretes oestrogens
- Composed of cells resembling the granulosa cells lining the Graafian follicles
What is a sertoli Leydig cell tumour?
- Very rare
- May produce androgens causing virilization
- Usually small yellow tumour within the ovary
What would a small yellow tumour within the ovary be?
Sertoli Leydig cell tumour
What tumour encompasses 15-20% of all ovarian tumours?
Germ cell tumour
Types of germ cell tumour?
- Mature cystic teratomas
- Immature teratomas
- Yolk sac tumour
- Choriocarcinoma
- Dysgerminoma
What are mature cystic teratomas AKA?
Dermoid cyst
What percentage of germ cell tumours are dermoid cysts?
95%
Dermoid cysts are…?
Benign
-Can have sebum, hair, teeth, nervous tissue, respiratory tissue, intestinal epithelium and thyroid tissue
Why can dermoid cysts be so weird/spicy?
They have pluripotent potential
Immature teratomas are?
Malignant and typically made of primative nerve tissue and mesenchymal tissue
Aetiology of ovarian cancer?
- Older women
- Peak age = 75 y/o
- 5-10% of cases have genetic predisposition and FHx increases risk
Risk factors for ovarian cancers?
- No. of times someone ha ovulated= biggest RF (more=more risk)
- Nulliparity
- Endometriosis
COCP and Breast feeding increases/decreases risk of ovarian cancer?
Decreases
What are implicated in ovarian cancers?
- HNPCC/lynch syndrome
- BRCA1 & 2
Presentation of ovarian cancers?
- May be asymptomatic and often presents late as symptoms are non-specific
- Bloating, early satiety, abdo pain or swelling, constipation and menstrual changes
- Any woman with new onset IBS features who is >50 ovarian cancer must be suspected
What is raised in 80% of ovarian cancers?
Ca125
What is the issue with Ca125?
Raised in ovarian cancers but also many other conditions so lacks sensitivity and specificity when used alone
What is Ca125 good for?
Monitoring progression
What is Ca125 a marker of?
Peritoneal and pleural inflammation
What is Ca125 secreted by?
What is embryologically coelomic epithelium
What else can Ca125 be raised in?
Endometriosis Liver disease PID Pregnancy Fibroids Pleural effusions Pericardial effusions Any peritoneal cancer
What would not raise Ca125?
Renal stones (because retroperitoneal)
What else apart from Ca125 may be raised in ovarian cancer?
CEA (Carcino-embryonic antigen)
What do 60% of germ cell tumours produce?
A raised hCG and AFP
What is used to differentiate between benign and malignant ovarian cancers?
Risk of malignancy index
-USS score x menopausal score x Ca125
How is the US score scored?
1 point each for the following:
- Multilocular cysts
- Solid areas
- Mets
- Ascites
- Bilateral lesions
U= 0 if none, U=1 if one and U=3 if score 2-5
How is menopausal status scored?
1 for premenopausal
3 for postmenopausal
How is Ca125 included in risk of malignancy index?
Measurement of IU/ml
If risk of malignancy index is scored more than 200?
Chance of cancer is 75%
If the score in risk of malignancy risk index is <30?
The chance of cancer is 3%
What score would get someone referred to gynaecology?
> 200
Other investigations for ovarian cancer?
CT/MRI
Biopsy- for full diagnosis
Treatment for benign ovarain tumours?
Excision and drainage
Treatment for ovarian epithelial tumours?
Chemotherapy and surgery
To preserve fertility?
Conservative surgery (only removing 1 ovary)
Non-epithelial tumour are often sensitive to?
Chemotherapy (good for preserving fertility)
Prognosis of ovarian cancer?
5 year survival = around 40% overall
Germ cell tumours have a higher/lower survival rate than other ovarian cancers?
HIGHER
75%>40%
