Ovarian Cancer Flashcards
Why does ovarian cancer have a worse prognosis?
Presents late due to non-specific symptoms
- 70% of patients present when it has spread beyond the pelvis
What are the types of ovarian cancer?
- epithelial cell tumours
- dermoid cysts / germ cell tumours
- sex cord-stromal tumours
- metastasis
Where do epithelial cell tumours arise from?
Arising from epithelial cells of ovary
What is the most common type of ovarian cancer?
Epithelial cell tumours
What are the subtypes of epithelial cell tumours?
- serous tumours (most common)
- endometrioid carcinomas
- clear cell tumours
- mucinous tumours
- undifferentiated tumours
What are dermoid cysts / germ cell tumours?
Benign ovarian tumours
They are teratomas meaning they come from the germ cells
What may dermoid cysts/ germ cell tumours contain?
Various tissue types, such as skin, teeth, hair and bone
What complication are dermoid cysts/ germ cell tumours esp a/w/?
Ovarian torsion
What markers may germ cell tumours cause to be raised?
- alpha-fetoprotein (a-FP)
- human chorionic gonadotrophins (hCG)
Are sex cord stromal tumours common?
No - rare
Are sex cord stromal tumours benign or malignant?
Can be either
Where do sex cord stromal tumours arise from?
The stroma (connective tissue) or sex cords (embryonic strictest a/w/ follicles)
What are some of the types of sex cord stromal tumours?
- sertoli-leydig cell tumours
- granulosa cell tumours
Can ovarian tumours be caused more indirectly?
Yes - metastasis from a cancer elsewhere
What is a krukenberg tumour?
Refers to a metastasis in the ovary, usually from a GIT cancer particularly the stomach
What is seen on histology of a Krukenberg tumour?
Characteristic “signet-ring” cells
What are the risk factors of ovarian tumors?
- age (peaks age 60)
- BRCA1 & BRCA2 (family history)
- increased number of ovulations
- obesity
- smoking
- recurrent use of Clomifene
What are some factors that increase the number of ovulations, thereby increasing the risk of ovarian cancer?
- early-onset periods
- late menopause
- no pregnancies
What are one protective factors for ovarian cancer?
Factors that stop ovulation or reduce the total lifetime ovulations:
- combined oral contraceptive pill
- breastfeeding
- pregnancy
What is the presentation of ovarian cancer?
Often non-specific symptoms:
- abdominal bloating
- early satiety
- loss of appetite
- pelvic pain
- urinary symptoms (frequency/urgency)
- weight loss
- abdominal or pelvic mass
- ascites
Why may ovarian cancer present with hip or groin pain?
As tumour may press on obturator nerve that passes inside the pelvis, lateral to the ovaries
What are the referral criteria for ovarian cancer?
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
What investigations are carried out in primary or secondary care for suspected ovarian cancer?
- CA125 blood test (>35 IU/ml is significant)
- pelvic ultrasound
What does the risk of malignancy index (RMI) estimate?
Risk of an ovarian mass being malignant
Taking into account:
- menopausal status
- ultrasound findings
- CA125
