Ovarian Cancer

Question 1

When does ovarian cancer tend to present?

Answer 1

Most tend to present in the late stages

Question 2

What is the 5-year survival for all stages?

Answer 2

40-45%

Question 3

What is the pathophysiology of ovarian cancer?

Answer 3

Start in the fallopian tube

Ovarian cyst turning malignant

Question 4

What genes are associated with ovarian cancer?

Answer 4

HNPCC

BRCA1/BRCA2

Question 5

What is the presentation of ovarian cancer?

Answer 5

Appetite changes: lower appetite, early satiety, indigesiton
GI symptoms: discomfort, bloating, weight gain
Altered bowel habits

Question 6

What are the investigations for ovarian cancer?

Answer 6

Bloods: CA125 (not diagnostic, but it's first-line)
US - transabdo/vaginal
CT scan
Needle biopsy 
Laparocopy/Laparotomy

Question 7

What is Stage 1 ovarian cancer?

Answer 7

Cancer limited to the ovary, capsule intact

Question 8

What is Stage 2 ovarian cancer?

Answer 8

Affects 1/2 ovaries, with some peritoneal spread

Question 9

What is Stage 3 ovarian cancer?

Answer 9

Affects 1/2 ovaries with extra-peritoneal spread/lymph involvement

Question 10

What is Stage 4 ovarian cancer?

Answer 10

Distant metastasis

Question 11

What are the different types of ovarian cancer?

Answer 11

Serous cystadenoma
Serous borderline tumour
Serous carcinoma

Question 12

What is the treatment for ovarian cancer?

Answer 12

Surgery

Helps to teat, stage and debulk the disease.

Question 13

What treatment should go alongside surgery?

Answer 13

Adjuvant chemotherapy.
First line is platinum and taxane, given within 8 weeks of the surgery.

Note that a cure is unlikely.

Question 14

What is the prognosis for ovarian cancer by stages?

Answer 14

Stage 1 - 87%
Stage 2 - 46%
Stage 3 - 15%
Stage 4 - 10%

Question 15

Is there any public screening for ovarian cancer?

Answer 15

No, it’s not proven to help

Question 16

Who is screening offered to?

Answer 16

High risk women:

• Cancer gene positive
• 2 or more family members with cancer

Question 17

What does ovarian cancer screening consist of?

Answer 17

Pelvic exam
Bloods: CA125
Imaging: Abdo US

Question 18

45 y/o woman comes in presenting with loss of appetite and indigestion. She has had altered bowel habit and her serum CA125 is raised. What is the next appropriate line of investigation?

Answer 18

Transvaginal/transabdominal ultrasound

Question 19

The same woman has now had surgery to remove her cancer. When should she be given adjuvant chemotherapy and what is the first-line drugs?

Answer 19

Within 8 weeks.

First line is platinum or taxane.