Ovarian Cancer Flashcards
What is ovarian cancer?
Why does it tend to have a worse prognosis?
- cancer of the ovaries
- it often presents late due to non-specific symptoms
- > 70% patients with ovarian cancer present after it has spread beyond the pelvis (stage 3/4)
- 5th most common cancer in women
- 2nd most common gynae cancer (after endometrial)
- most common cause of gynae cancer death
- 43% 5-yr survival
What is the most common type of ovarian cancer?
epithelial cell tumours
these include serous tumours, endometrioid, clear cell and mucinous tumours
What are the other types of tumours that can occur in the ovaries?
dermoid cysts / germ cell tumours:
- benign
- they are teratomas (contain various tissue types)
- can cause raised hCG + aFP and associated with ovarian torsion
sex cord stromal tumours:
- including Sertoli-Leydig cell / granulosa cell tumours
- arise from the stroma or sex cords
- benign or malignant
What is a Krukenburg tumour?
- an ovarian tumour that is due to metastasis from a cancer elsewhere
- usually from a GI tract cancer (stomach)
- “signet ring” cells on histology
What are the risk factors for ovarian cancer?
- age (peak age is 60)
- BRCA 1 + 2 genes
- increased number of ovulations
- obesity
- smoking
- recurrent use of clomifene
- endometriosis
- HRT
clomifene is a medication used to treat infertility in women who do not ovulate
What factors can increase the number of ovulations?
- early-onset periods
- late menopause
- nulliparity
What are the protective factors for ovarian cancer?
- factors that stop ovulation / reduce the number of lifetime ovulations
- COCP
- pregnancy
- breastfeeding
the risk of ovarian cancer is increased when there is a higher number of lifetime ovulations
How does ovarian cancer typically present?
non-specific symptoms:
- abdominal bloating
- early satiety
- loss of appetite
- pelvic pain
- urinary symptoms (freq / urgency)
- weight loss / GI upset
- ascites
- abdominal / pelvic mass
- dyspnoea
- abnormal vaginal bleeding
around 15% women remain asymptomatic at diagnosis
What type of referred pain can occur in ovarian cancer?
- referred pain to the hip or groin
- caused by an ovarian mass compressing the obturator nerve
What is important about considering ovarian cancer investigations in older women?
- always have a low threshold for considering further investigations
- ovarian cancer can present with very non-specific symptoms
When should patients be immediately referred via the 2WW referral?
- ascites
- pelvic mass (not due to fibroids)
- abdominal mass
revealed on physical examination
abdominal mass is due to an “omental cake” - metastatic disease on the omentum
What tumour markers are associated with ovarian cancer?
- CA125 (serous + endometrioid)
- CA19.9 (mucinous)
- carcinoembryonic antigen (CEA)
What are other concerning symptoms in women > 50?
What examination should be performed prior to 2WW referral?
- new symptoms IBS / change in bowel habit
- abdominal bloating
- early satiety
- pelvic pain
- urinary frequency / urgency
- weight loss
!! perform a CA125 blood test if ANY of these symptoms present in > 50 !!
What are the initial investigations for ovarian cancer?
- CA125 blood test
- pelvic USS
a reading > 35 IU/mL is significant for CA125
What is used to estimate the risk of an ovarian mass being malignant?
risk of malignancy index:
- this takes into account:
- pelvic US findings
- CA125 level
- menopausal status
What further investigations may be performed if pelvic US / CA125 raise suspicion?
CT scan:
- used to establish diagnosis + stage the cancer
histology:
- CT-guided biopsy, laparoscopy or laparotomy used to obtain tissue sample
paracentesis:
- to look for cancer cells in the ascitic fluid
What additional investigations should be performed in women < 40 with a complex ovarian mass?
- human chorionic gonadotropin (hCG)
- alpha-fetoprotein (aFP)
- these markers may be elevated in a germ cell tumour
What is the problem with using CA125 as a marker for epithelial cell ovarian cancer?
- it is a measure of epithelial irritation in the abdomen and can be raised in many conditions:
- irritable bowel syndrome
- endometriosis
- fibroids
- pregnancy
- liver disease
- pelvic infection
How can ovarian cancer be staged?
FIGO staging:
stage I:
- confined to the ovary
stage II:
- spread past the ovary but within the pelvis
stage III:
- spread past the pelvis but within the abdomen
stage IV:
- spread outside of the abdomen (distant mets)
What is involved in the management for ovarian cancer?
a combination of surgery + chemotherapy
