Ovarian Cancer

Question 1

What are the different classes of ovarian neoplasm?

Answer 1

• Epithelial
• Germ cell
• Sex rod-stromal
• Metastatic
• Miscellaneous

Question 2

What are the types and subtypes of epithelium neoplasms?

Answer 2

Question 3

What are the types and subtypes of germ cell neoplasms?

Answer 3

Question 4

What are the types of subtypes of sex cord-stroma neoplasms?

Answer 4

Question 5

Describe the epidemiology of ovarian cancer (age group)?

Answer 5

• Rare <30 years

Question 6

What are risk factors for ovarian cancer?

Answer 6

• Family history/genetics
  
  • HNPCC/Lynch type II familial cancer syndrome
  • BRCA1
  • BRCA2
• Never having children
• Hormonal therapy after menopause
• Fertility medication
• Obesity

Question 7

What genes put you more at risk of ovarian cancer?

Answer 7

• HNPCC/Lynch type II familial cancer syndrome
• BRCA1
• BRCA2

Question 8

Describe the pathophysiology of ovarian cancer?

Answer 8

• Most originate from fallopian tube
• Some derive from pre-existing benign ovarian cysts

Question 9

Where do most ovarian cancers originate?

Answer 9

• Most originate from fallopian tube
• Some derive from pre-existing benign ovarian cysts

Question 10

What is the presentation of ovarian cancer?

Answer 10

• Indigestion/early satiety (early fullness when eating)/poor appetite
• Altered bowel habit/pain
• Bloating/discomfort/weight gain
• Pelvis mass
  
  • Pressure symptoms

Question 11

What investigations are done for ovarian cancer?

Answer 11

• Diagnosed by
  
  • Surgical/pathological
  • US scan abdomen and pelvis
  • CT scan
  • Blood test – CA125 (glycol-protein antigen)
    
    • Indicator of malignancy for ovary (epithelial tumours), colon/pancreas or breast cancer), or benign conditions such as menstruation/endometriosis/PID, liver disease
  • Surgery

Question 12

What blood test is used to diagnose ovarian cancer?

Answer 12

• Blood test – CA125 (glycol-protein antigen)
  
  • Indicator of malignancy for ovary (epithelial tumours), colon/pancreas or breast cancer), or benign conditions such as menstruation/endometriosis/PID, liver disease

Question 13

What is CA 125 an indicator of?

Answer 13

• Indicator of malignancy for ovary (epithelial tumours), colon/pancreas or breast cancer), or benign conditions such as menstruation/endometriosis/PID, liver disease

Question 14

What are the different stages of ovarian cancer?

Answer 14

Question 15

Describe the management for ovarian cancer?

Answer 15

• Depends on type of tumour, grade and stage, guided by RMI score
  
  • RMI score is product of US score (multi-locular, solid areas, bilateral, ascites, intra-abdominal), menopausal status and CA 125 level)
• Surgery
  
  • Laparotomy (large incision on abdomen)
    
    • To obtain tissue diagnosis, stage disease, disease clearance, debulk disease
• Chemotherapy
  
  • Adjuvant and neo-adjuvant
  • First line is platinum and taxane (taxol)

Question 16

What does the management of ovarian cancer depend on?

Answer 16

• Depends on type of tumour, grade and stage, guided by RMI score
  
  • RMI score is product of US score (multi-locular, solid areas, bilateral, ascites, intra-abdominal), menopausal status and CA 125 level)

Question 17

What is RMI score?

Answer 17

• RMI score is product of US score (multi-locular, solid areas, bilateral, ascites, intra-abdominal), menopausal status and CA 125 level)

Question 18

Describe the prognosis of ovarian cancer?

Answer 18

• Depends on type of tumour (benign/malignant/borderline), tumour grade and tumour stage
• Worst prognosis for a cancer of female reproductive tract
• Cure rates by stage

Question 19

Who recieves screening for ovarian cancer?

Answer 19

Population screening not proven, only done for high risk woman:

• Cancer gene mutation carriers
• 2 or more relatives

Question 20

What does screening for ovarian cancer involve?

Answer 20

• Pelvic examination
• US scanning of ovaries
• CA 125