Ovarian Cancer

Question 1

Types of Ovarian Cancer

Answer 1

Epithelial Cell Tumours (most common)

Dermoid Cysts / Germ Cell Tumours - teratomas

Sex Cord-Stromal Tumours

Question 2

Types of epithelial cell tumours

Answer 2

Serous tumours (the most common)
Endometrioid carcinomas
Clear cell tumours
Mucinous tumours
Undifferentiated tumours

Question 3

Teratoma

Answer 3

Come from the germ cells.

They may contain various tissue types, such as skin, teeth, hair and bone.

Associated with ovarian torsion.

Germ cell tumours may cause raised alpha-fetoprotein (α-FP) and human chorionic gonadotrophin (hCG).

Question 4

Sex Cord-Stromal Tumours

Answer 4

Rare

Benign or malignant

Arise from stroma - connective tissues or sex cord (embryonic structures associated with the follicles)

Sertoli–Leydig cell tumours and granulosa cell tumours

Question 5

Krukenberg tumour

Answer 5

Metastasis in the ovary, usually from a GI cancer, particularly the stomach.

Characteristic “signet-ring” cells on histology

Question 6

Risk factors for ovarian cancer

Answer 6

Age (peaks age 60)

BRCA1 and BRCA2 genes - FHx

Increased number of ovulations - early menses, late menopause, nulliparity

Obesity

Smoking

Recurrent use of clomifene

Question 7

Protective factors against ovarian cancer

Answer 7

Combined contraceptive pill
Breastfeeding
Pregnancy

Question 8

Presentation of ovarian cancer

Answer 8

Non-specific symptoms:

• Abdominal bloating
• Early satiety
• FLAW
• Pelvic pain
• Urinary symptoms (frequency / urgency)
• Abdominal or pelvic mass
• Ascites

Question 9

Referred hip or groin pain

Answer 9

An ovarian mass may press on the obturator nerve and cause referred hip or groin pain.

The obturator nerve passes along the inside of the pelvis, lateral to the ovaries, where an ovarian mass can compress it.

Question 10

Referral criteria for ovarian cancer

Answer 10

Refer directly on a 2-week-wait referral if a physical examination reveals:

• Ascites
• Pelvic mass (unless clearly due to fibroids)
• Abdominal mass

Question 11

When would you carry out further investigations for ovarian cancer before referring

Answer 11

Women over 50 years presenting with:

• New symptoms of IBS / change in bowel habit
• Abdominal bloating
• Early satiety
• Pelvic pain
• Urinary frequency or urgency
• Weight loss

Question 12

Investigations for ovarian cancer

Answer 12

CA125 blood test
Pelvic ultrasound
Calculate Risk of malignancy index (RMI)

Secondary care:

• CT scan - staging
• Histology of biopsy
• Paracentesis (ascitic tap) - test the ascitic fluid for cancer cells

Question 13

Risk of malignancy index (RMI)

Answer 13

Estimates the risk of an ovarian mass being malignant, taking account of three things:

• Menopausal status
• Ultrasound findings
• CA125 level

Question 14

Women under 40 years with a complex ovarian mass

Answer 14

Require tumour markers for a possible germ cell tumour:

• Alpha-fetoprotein (α-FP)
• Human chorionic gonadotropin (HCG)

Question 15

Causes of Raised CA125

Answer 15

Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy

Question 16

Management of ovarian cancer

Answer 16

Specialist gynaecology oncology MDT.

Surgery and chemotherapy