Ovarian Cancer

Question 1

Borderline ovarian tumours management

Answer 1

Confirm histology with pathologist
Clarify initial procedure that was done
Referral to GONC
TV USS (can have bilaterlarity)
Ca-125 (useful marker over time)
cystectomy - higher risk of recurrence
SO
Ensure staging procedure performed
F/U: 3/12 for 2 years then 6 monthly for 3 years and annually thereafter
TAH and BSO once family complete

Question 2

Increased risk of recurrence BOT features

Answer 2

papillary projections
mucinous
invasive implants

Question 3

Counsel patient about BOT

Answer 3

not a cancer, but has malignant potential (1-2%)

97% survival rate

Question 4

Stage 1 Ovarian cancer

Answer 4

Tumour confined to ovaries or fallopian tubes

Question 5

Stage 2 Ovarian cancer

Answer 5

Tumour one or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer

Question 6

Stage 3 Ovarian cancer

Answer 6

Tumour involves one or both ovaries or fallopian tubes, or peritoneal cancer, with cytologically or histologically
confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes

Question 7

Stage 4 Ovarian cancer`

Answer 7

Distant metastasis excluding peritoneal metastases

Question 8

Tumour markers age <40

Answer 8

Ca-125
AFP
LDH
hcg

Question 9

Tumour markers post menopausal

Answer 9

Ca-125
CEA
Ca 19-9

Question 10

Granulosa cell tumours and thecomas systemic effects

Answer 10

hyperoestrogenic
AUB
Precocious puberty
EH

Question 11

Sertoli-leydig systemic effects

Answer 11

hyperandrogenic state
hirsuitism
voice deepening
baldness
irregular menstruation

Question 12

Work up for Non-epithelial ovarian tumours

Answer 12

TV USS
CT Chest/Abdo Pelvis
?PET
CXR
BloodsEp
Tumour Markers

Question 13

MOGCTS and SCST survival

Answer 13

80% survival at 5 years even with distant mets

Question 14

Treatment NEOT

Answer 14

Surgery - midline lap
Staging
Adjuvant chemo if juvenile and 1c or greater
?HRT- not for SCST
Psychological support

Question 15

Epithelial ovarian cancers 5 year survival

Answer 15

1-80-90%
2-60-75%
3-25-60% (dependent on residual disease and platinum sensitivity
4- 10-15%

Question 16

Granulosa cell tumour explanation

Answer 16

Granulosa cell tumours are a rare tumour that often produce hormones and make the female hormone oestrogen. This can cause symptoms such as abnormal vaginal bleeding or breast tenderness. These are usually cancerous and require treatment.

Question 17

Sertoli-leydig tumour explanation

Answer 17

This is a rare sex-cord stromal tumour that often produces hormones that can cause hair growth, voice deepening, baldness and irregular periods. These have a potential to be cancerous and therefore require treatment

Question 18

ovarian cancer explanation

Answer 18

Ovarian cancer is when abnormal cells in the ovary begin to grow and divide in an uncontrolled way. They eventually form a growth (tumour). If not caught early, cancer cells gradually grow into the surrounding tissues. And may spread to other areas of the body.

Question 19

BRAC explanation

Answer 19

A BRCA mutation is a mutation in either of the BRCA1 and BRCA2 genes, which are tumour suppressor genes. When a BRCA gene is mutated, it may no longer be effective at repairing broken DNA and helping to prevent breast and/or ovarian cancer

Question 20

BRAC mutation risks

Answer 20

BRAC 1 - lifetime risk 50%, risk before 40- 2-3%, risk before 50- 10-20%
BRAC 2 - lifetime risk 20%, risk low until 45 and then begins to increase