ovarian cancer

Question 1

what is the lifetime risk of ovarian cancer?

Answer 1

1.5%

Question 2

What is the average age of people affected by ovarian cancer?

Answer 2

61y/o

Question 3

List 4 risk factors for ovarian cancer

Answer 3

Nulliparity
endometriosis
obesity
Familial syndrome - BRCA 1 and 2 mutation, Lynch syndrome

Question 4

List 5 factors that protect against ovarian cancer

Answer 4

Multiparity
breast feeding
COCP
Tubal ligation
hysterectomy
prophylactic surgery

Question 5

What is the lifetime risk of ovarian cancer for those with BRCA 1, BRCA 2 mutations and Lynch syndrome respectively?

Answer 5

40%
20%
20%

Question 6

Quantify the amount that breastfeeding reduces cancer risk

Answer 6

breast feeding for 18 months reduces ovarian cancer risk by 0.5%

Question 7

which tumour markers would you test for in the work up of germ cell tumours?

Answer 7

LDH
aFP
bHCG

Question 8

Which tumour markers would you test for in the work up of sex cord stromal tumours?

Answer 8

E2
Inhibin
FSH
Testosterone

Question 9

how useful is Ca125 in the work up of ovarian cancer?

Answer 9

sensitivity of 78% and specificity of 78%

elevated in only 50% of stage 1 cancers

Question 10

How useful is Ca19-9 as a marker for ovarian cancer?

Answer 10

Less sensitive and specific than Ca 125
elevated in 75% of mucinous and 25% of serous ovarian cancers

Question 11

What does a raised CEA mean in work up of ovarian tumour?

Answer 11

CEA is raised in 37% of mucinous ovarian cancers - can be used in conjunction with other tumour markers

Question 12

What does a raised HE4 tumour marker tell you?

Answer 12

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?)

Question 13

What is the derivation of epithelial ovarian cancers?

Answer 13

Derived from the coelomic epithelium

Question 14

what proportion of ovarian cancers are epithelial ovarian ca?

Answer 14

90%

Question 15

What is the epidemiology of epithelial ovarian cancer?

Answer 15

90% present in post menopausal women
the median age of presentation is 61
the lifetime risk is 1-1.4%

Question 16

What is the RMI?

Answer 16

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

Question 17

What is the treatment for stage 1 ovarian cancer?

Answer 17

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

Question 18

What is treatment for stage 2 ovarian cancer

Answer 18

• surgical
• staging surgery as per stage I
• 3-6 cycles of platinum based chemotherapy

Question 19

What does platinum based chemotherapy refer to?

Answer 19

• cisplatin or carbplatin
  usually in combination with Taxane - paclitaxel or docetaxel

Question 20

What is an easy way of thinking of the stages of ovarian cancer?

Answer 20

1 - confined to ovary
2 - confined to pelvis
3 - peritoneal implants outside pelvis or +ve retroperitoneal nodes
4 - distant metastases

Question 21

What is the grading of epithelial ovarian cancers?

Answer 21

Grade 1 - well differentiated
Grade 2- moderately differentiated
Grade 3 - poorly differentiated

Question 22

what are the genetics of high grade and low grade serous ovarian cancers?

Answer 22

HGSOC - typically have a TP53 mutation
LGSOC - typically have KRAS or BRAF mutations

Question 23

What is the lifetime risk of ovarian cancer if you have one first degree relative with ovarian cancer?

Answer 23

5%

Question 24

What is the lifetime risk of ovarian cancer if you have two first degree relatives with ovarian cancer?

Answer 24

15%

Question 25

what is the lifetime risk of ovarian cancer if you have a familial cancer syndrome?

Answer 25

30-50%

Question 26

List 2 risk reducing measures to protect against ovarian cancer?

Answer 26

• COCP use
• bilateral salpingectomy

Question 27

How effective is the COCP in reducing risk of ovarian cancer?

Answer 27

reduces risk by 50% after 5 years of use (RR of 0.5 after 5 years)

Question 28

How effective is bilateral salpingectomy as a risk reducing strategy in someone with h/o BRCA mutation?

Answer 28

RR 0.25-0.4 (60%- 75% risk reduction)

Question 29

What is the 4 stage principle for FIGO staging?

Answer 29

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