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OBGYN > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

Why does ovarian cancer have a worse prognosis?

A

Presents late due to non-specific symptoms
- 70% of patients present when it has spread beyond the pelvis

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2
Q

What are the types of ovarian cancer?

A
  • epithelial cell tumours
  • dermoid cysts / germ cell tumours
  • sex cord-stromal tumours
  • metastasis
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3
Q

Where do epithelial cell tumours arise from?

A

Arising from epithelial cells of ovary

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4
Q

What is the most common type of ovarian cancer?

A

Epithelial cell tumours

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5
Q

What are the subtypes of epithelial cell tumours?

A
  • serous tumours (most common)
  • endometrioid carcinomas
  • clear cell tumours
  • mucinous tumours
  • undifferentiated tumours
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6
Q

What are dermoid cysts / germ cell tumours?

A

Benign ovarian tumours

They are teratomas meaning they come from the germ cells

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7
Q

What may dermoid cysts/ germ cell tumours contain?

A

Various tissue types, such as skin, teeth, hair and bone

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8
Q

What complication are dermoid cysts/ germ cell tumours esp a/w/?

A

Ovarian torsion

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9
Q

What markers may germ cell tumours cause to be raised?

A
  • alpha-fetoprotein (a-FP)
  • human chorionic gonadotrophins (hCG)
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10
Q

Are sex cord stromal tumours common?

A

No - rare

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11
Q

Are sex cord stromal tumours benign or malignant?

A

Can be either

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12
Q

Where do sex cord stromal tumours arise from?

A

The stroma (connective tissue) or sex cords (embryonic strictest a/w/ follicles)

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13
Q

What are some of the types of sex cord stromal tumours?

A
  • sertoli-leydig cell tumours
  • granulosa cell tumours
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14
Q

Can ovarian tumours be caused more indirectly?

A

Yes - metastasis from a cancer elsewhere

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15
Q

What is a krukenberg tumour?

A

Refers to a metastasis in the ovary, usually from a GIT cancer particularly the stomach

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16
Q

What is seen on histology of a Krukenberg tumour?

A

Characteristic “signet-ring” cells

17
Q

What are the risk factors of ovarian tumors?

A
  • age (peaks age 60)
  • BRCA1 & BRCA2 (family history)
  • increased number of ovulations
  • obesity
  • smoking
  • recurrent use of Clomifene
18
Q

What are some factors that increase the number of ovulations, thereby increasing the risk of ovarian cancer?

A
  • early-onset periods
  • late menopause
  • no pregnancies
19
Q

What are one protective factors for ovarian cancer?

A

Factors that stop ovulation or reduce the total lifetime ovulations:

  • combined oral contraceptive pill
  • breastfeeding
  • pregnancy
20
Q

What is the presentation of ovarian cancer?

A

Often non-specific symptoms:

  • abdominal bloating
  • early satiety
  • loss of appetite
  • pelvic pain
  • urinary symptoms (frequency/urgency)
  • weight loss
  • abdominal or pelvic mass
  • ascites
21
Q

Why may ovarian cancer present with hip or groin pain?

A

As tumour may press on obturator nerve that passes inside the pelvis, lateral to the ovaries

22
Q

What are the referral criteria for ovarian cancer?

A

The NICE “suspected cancer: recognition and referral” guidelines (2015) outlines the key referral criteria and red flags for ovarian cancer. They recommend either referring directly on a 2-week-wait urgent cancer referral or carrying out initial investigations in primary care depending on the presentation.

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

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

Carry out further investigations before referral in women presenting with symptoms of possible ovarian cancer, starting with a CA125 blood test. This is particularly important in 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

23
Q

What investigations are carried out in primary or secondary care for suspected ovarian cancer?

A
  • CA125 blood test (>35 IU/ml is significant)
  • pelvic ultrasound
24
Q

What does the risk of malignancy index (RMI) estimate?

A

Risk of an ovarian mass being malignant
Taking into account:
- menopausal status
- ultrasound findings
- CA125

25
Q

What further investigations in secondary care may be done for suspected ovarian cancer?

A
  • CT scan - establish the diagnosis and stage of the cancer
  • histology - using a CT guided biopsy, laparoscopy or laparotomy
  • paracentesis (ascites tap) - used to test ascites fluid for cancer cells
26
Q

What investigations can be done for women under 40 with a complex ovarian mass?

A

Tumour markers for a possible germ cell tumour:
- a-FP
- hCG

27
Q

What are causes of a raised CA125?

A
  • epithelial cell ovarian cancer
  • endometriosis
  • adneomyosis
  • pelvic infection
  • liver disease
  • pregnancy
28
Q

What is the staging of ovarian cancer?

A

The International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage ovarian cancer. A very simplified version of this staging system is:

Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)

29
Q

How is ovarian cancer managed?

A

Gynaecology oncology MDT - surgery and chemo

OBGYN (25 decks)

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