Ovarian cancer Flashcards
Epithelial cell tumours
Most common type
Includes
- serous tumours (most common)
- endometrial carcinomas
- clear cell tumours
- undifferentiated tumours
Dermoid cysts/ germ cell tumours
Benign ovarian tumours
Teratomas
Contain various tissue types
Associated with ovarian torsion
Cause raised alpha fetoprotein and hCG
Sex cord stromal tumours
Can be benign or malignant
Arise from stroma or sex cords
Include sertoli-leydig cell tumours and graulosa cell tumours
Metastasis
Krukenberg tumour is metastasis usually from GI cancer (particularly stomach)
Have signet ring cells on histology
Risk factors
Family history of BRCA1 or BRCA2 gene
Many ovulations (early menarche, late menopause, nulliparity)
Age (peaks age 60)
Obesity
Smoking
Recurrent use of clomifene
Protective factors
COCP
Breastfeeding
Pregnancy
Clinical features
Abdominal distension and bloating
Abdominal and pelvic pain (groin pain if pressing on the obturator nerve)
Urinary symptoms
Early satiety
Diarrhoea
Weight loss
Ascites
2 week wait criteria
Ascites
Pelvic mass
Abdominal mass
Investigations
CA125 (if raised then urgent ultrasound of abdomen and pelvis)
Pelvic ultrasound
Risk of malignancy index (menopausal status, US findings, CA125 level)
Other causes of raised CA125
Endometriosis
Adenomyosis
Fibroids
Pelvic infection
Liver disease
Pregnancy
Menstruation
Benign ovarian cysts
Other inflammatory conditions
Further investigations
CT scan to establish diagnosis and stage
Histology using CT guided biopsy, laparoscopy or laparotomy
Paracentesis
Tests in women with complex ovarian mass under 40
Alpha-fetoprotein
Human chorionic gonadotropin
Staging
FIGO staging
1: confined to ovary
2: spread past ovary but inside pelvis
3: spread past pelvis but inside abdomen
4: spread outside the abdomen (distant metastasis)
Management
Combination of surgery and platinum based chemotherapy
Prognosis
80% women have advanced disease at presentation
5-year survival is 46%
