ovarian cancer Flashcards
what is the lifetime risk of ovarian cancer?
1.5%
What is the average age of people affected by ovarian cancer?
61y/o
List 4 risk factors for ovarian cancer
Nulliparity
endometriosis
obesity
Familial syndrome - BRCA 1 and 2 mutation, Lynch syndrome
List 5 factors that protect against ovarian cancer
Multiparity
breast feeding
COCP
Tubal ligation
hysterectomy
prophylactic surgery
What is the lifetime risk of ovarian cancer for those with BRCA 1, BRCA 2 mutations and Lynch syndrome respectively?
40%
20%
20%
Quantify the amount that breastfeeding reduces cancer risk
breast feeding for 18 months reduces ovarian cancer risk by 0.5%
which tumour markers would you test for in the work up of germ cell tumours?
LDH
aFP
bHCG
Which tumour markers would you test for in the work up of sex cord stromal tumours?
E2
Inhibin
FSH
Testosterone
how useful is Ca125 in the work up of ovarian cancer?
sensitivity of 78% and specificity of 78%
elevated in only 50% of stage 1 cancers
How useful is Ca19-9 as a marker for ovarian cancer?
Less sensitive and specific than Ca 125
elevated in 75% of mucinous and 25% of serous ovarian cancers
What does a raised CEA mean in work up of ovarian tumour?
CEA is raised in 37% of mucinous ovarian cancers - can be used in conjunction with other tumour markers
What does a raised HE4 tumour marker tell you?
raised in the majority of ovarian tumours that produce Ca 125 but also in 50% that do not
Not raised in common benign conditions (more sensitive for cancer?)
What is the derivation of epithelial ovarian cancers?
Derived from the coelomic epithelium
what proportion of ovarian cancers are epithelial ovarian ca?
90%
What is the epidemiology of epithelial ovarian cancer?
90% present in post menopausal women
the median age of presentation is 61
the lifetime risk is 1-1.4%
What is the RMI?
Risk of malignancy index
RMI = U x M x Ca125
U = USS findings 0, 1 or 3
M = Menopausal status, 1 or 3 pre or post
What is the treatment for stage 1 ovarian cancer?
Surgery
- laparotomy + radical hysterectomy + BSO
- washings
- exam all peritoneal surfaces
- biopsy of UV/POD/PSW/Paracolic gutters/hemi-diaphragms
- infra colic omentectomy
- adjuvant chemo for grade 3 stage 1 ovarian cancer
What is treatment for stage 2 ovarian cancer
- surgical
- staging surgery as per stage I
- 3-6 cycles of platinum based chemotherapy
What does platinum based chemotherapy refer to?
- cisplatin or carbplatin
usually in combination with Taxane - paclitaxel or docetaxel
What is an easy way of thinking of the stages of ovarian cancer?
1 - confined to ovary
2 - confined to pelvis
3 - peritoneal implants outside pelvis or +ve retroperitoneal nodes
4 - distant metastases
What is the grading of epithelial ovarian cancers?
Grade 1 - well differentiated
Grade 2- moderately differentiated
Grade 3 - poorly differentiated
what are the genetics of high grade and low grade serous ovarian cancers?
HGSOC - typically have a TP53 mutation
LGSOC - typically have KRAS or BRAF mutations
What is the lifetime risk of ovarian cancer if you have one first degree relative with ovarian cancer?
5%
What is the lifetime risk of ovarian cancer if you have two first degree relatives with ovarian cancer?
15%
what is the lifetime risk of ovarian cancer if you have a familial cancer syndrome?
30-50%
List 2 risk reducing measures to protect against ovarian cancer?
- COCP use
- bilateral salpingectomy
How effective is the COCP in reducing risk of ovarian cancer?
reduces risk by 50% after 5 years of use (RR of 0.5 after 5 years)
How effective is bilateral salpingectomy as a risk reducing strategy in someone with h/o BRCA mutation?
RR 0.25-0.4 (60%- 75% risk reduction)
What is the 4 stage principle for FIGO staging?
stage 1 - confined to organ
stage 2 - adjacent organs
stage 3 - neighbouring structures
stage 4 - distant metastases
each stage may be divided into a,b or c
better prognosis if early stage
