Ovarian Cancer Flashcards
What are the risk factors of OC?
- **Increased lifetime ovulations - early menarche
- **brca1 gene and family hx
- **
What are the risk factors of OC?
- **Increased lifetime ovulations - early menarche
- **brca1 gene and family hx
- **
What are the protective factors for OC?
**ocp use
**breastfeeding
**TUBAL ligation
**chronic anovulation eg PCOS
Short reproductive life - late menarche early menopause
How does ovarian cancer spread?
Intraperitoneally
The ovaries are suspended on the mesovarium and there are no adjacent tissues. The malignant cells fall into the peritoneal fluid and are transported everywhere in the abdomen, behind the liver and spleen, around the bowel etc..
What is the 5 year survival rate of OC?
Stage 1. 90%
Stage 2. 45%
Stage 3. 15%
Stage 4. 5%
What is the management of A young woman of child bearing age with stage 1a ovarian cancer who has NOT completed child bearing?
- Unilateral salpingooopherectomy
- Advise child bearing asap
- Do a TAHBSO
What are the types of OC?
- **Epithelial
- **Germ cell
- **gonadoStromal and sex cord
How common is each type of OC?
***Epithelial 80% of cases
Occurs in older women - 69+
*** germ cell 15% - younger women
***Stedman 5% - any age
State the histology and tumor markers seen for each type of OC.
***Epithelial - serous most common, mucinous, endometroid, clearcell (CA125, CEA)
***germ cell - dysgerminoma (LDH), endoderm sinus, teratoma (AFP) choriocarcinoma- (HCG)
***stromal - granulaosa cell (estrogen) Sertoli-leydig cell (testosterone)
***metastatic- (from distant neoplasm) - bilateral in ovaries - krukenburg tumor - metastasis to ovaries from GI tract
How do you treat microscopic malignant cells in the peritoneum?
Radioactive phosphorus P32. Radiates to approximately 1 mm
What is the breakdown for stage 1?
- **1a –ONE OVARY - CAPSULE INTACT - CYTOLOGY NEG
- **1b- BOTH OVARIES - CAPSULE INTACT - CYTOLOGY NEG
- **1c- CAPSULE RUPTURED - CYTOLOGY POS
What is the management of a postmenopausal adnexal mass such as what may be illicited in late OC?
- ** history and exam
- **basic management- surgical exploration via laproscopy
- ** specific management - benign or malignant?
- **if benign conservative mngt = stop surgery aggressive management = TAH BSO
- **IF MALIGNANT = do Surgical staging, TAH BSO, omentectomy, debulking, chemotherapy
Staging in ovarian cancer?
***Stage 3 is the most common datge at which ovarian cancer is found
- **stage 1 - limited to ovaries
- ** stage 2- extends ro pelvis
- **stage 3 - peritoneal Mets and/or nodes
- **Stage 4 distant metastatic
Overall management of A post menopausal pelvic mass
- Rule out GI, Urinary and reproductive causes
- Preoperative workup- chestx ray, GXM,
- Do Tumor markers (epithelial - EA, CA125 germ cell- LDH, BETA HCG, AFP and gonadal-stromal - estrogen, testosterone)
- Staging Laparotomy to confirm and stage (most common stage 3)
- Cytology - peritoneal washing, biopsies
- Treatment - TAH BSO, omentectomy, debulking (improves survival rate)
- Chemotherapy (taxol, carboplatimun cisplatin?)NO RADIATION AS THIS WILL DESTROY INTERNAL ABDOMINAL ORGANS
What doe TAH BSO?
Total abdominal hysterectomy and bilateral salpingo-oopherctomy. It is the removal of the uterus, the cervix and both fallopian tubes and ovaries
