Ovarian cancer Flashcards
What is the age group of highest incidence for ovarian cancer?
75-79
53% >65y
List two types of ovarian tumours
epithelial
germ cell
ovarian stromal
Name one example of metastasis associated with ovarian cancer
Krukenburg tumour
What is the most common primary site for Krukenberg tumour?
GI tract
What are the two types of epithelial ovarian cancers?
High grade serous (fallopian tube type mucosa)
Ovarian surface epithelium- endometriod, clear cell, mucinous, low grade serous
List two modes of spread in ovarian cancer
direct extension= transcoelemic
exfoliation into the peritoneal cavity
lymphatic invasion
List three risk factors for ovarian cancer
smoking
early menarche
late menopause
low parity
Name one factor that is protective against ovarian cancer
oral contraceptive use >5 years
Is there screening for ovarian cancer?
no
Name four criteria for a population screening programme
- important health condition with good understanding and that is treatable
- cost effective
- simple safe and cost effective test available
- the test itself must be suitable for the pop (e.g. collection)
- further diagnostic testing available
- Proof of effective intervention, proof that screening provides better outcome
- Evidence outlining which patients should be screened and how often
- benefit should outweigh any harms
- Adequate facilities and testing resources available to staff to carry out screening
- Evidence for consequences of screening
List two familial ovarian cancers
BRCA1
BRCA2
Lynch syndrome/HNPCC
List one risk reducing surgery for ovarian cancer
prophylactic bilateral salpingo-oopherectomy
important to remove ovary AND entire fallopian tube
What are the symptoms of ovarian cancer?
vague and non specific altered bowel habit abdo pain/bloating feeling full quickly difficulty eating urinary/pelvic symptoms bowel obstruction
List two clinical signs of ovarian cancer
abdo distension- pelvic mass, ascites
upper abdo mass
pleural effusion
nodules on pelvic exam
Outline two investigations for ovarian cancer
USS
Ca125
RMI
What are the components of the RMI score?
=risk of malignancy index
The RMI is a product of the ultrasound scan score, the menopausal status and the serum CA125 level (IU/ml).
Name three malignancies in which CA 125 is raised
ovary, pancreas, breast, lung, colon
Name two benign gynae conditions in which CA 125 is raised
menstruation endometriosis PID pleural and pericardial effusion recent laparotomy Fibroids Adenomyosis Liver disease Pregnancy
How is RMI calculated?
U X M X CA 125
U= USS, M= menopausal status
Calculate the RMI score:
60y, Postmenopausal, CA125 is 300, Bilateral complex ovarian masses, solid areas, ascites.
U3 x M3 x 300= 2700
WHat are the USS components of the RMI score?
multilocular solid areas ascites intra abdominal metastasis 0=0 1=1 >2=3 points
What RMI score would warrant referral?
> 200
How is ovarian cancer diagnosed?
cytology- pleural/ascitic fluid
biopsy- percutaneous US/CT guided OR laparoscopic
What is the treatment of ovarian cancer?
mostly surgery
chemo- neoadjuvant and adjuvant
Which drug is used 1st line for adjuvant therapy for ovarian cancer?
carboplatin= platinum agent
Aside from carboplatin, which other chemo agents can be used?
antiangiogenesis
VEGF inhibitors
Hormonal therapy- tamoxifen/aromtase inhibitor
What is the triad in Meig’s syndrome?
Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites
(common MCQ!)
