Ovarian Cancer Flashcards

1
Q

What is ovarian cancer?

Why does it tend to have a worse prognosis?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common type of ovarian cancer?

A

epithelial cell tumours

these include serous tumours, endometrioid, clear cell and mucinous tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the other types of tumours that can occur in the ovaries?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a Krukenburg tumour?

A
  • an ovarian tumour that is due to metastasis from a cancer elsewhere
  • usually from a GI tract cancer (stomach)
  • “signet ring” cells on histology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for ovarian cancer?

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What factors can increase the number of ovulations?

A
  • early-onset periods
  • late menopause
  • nulliparity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the protective factors for ovarian cancer?

A
  • 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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does ovarian cancer typically present?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of referred pain can occur in ovarian cancer?

A
  • referred pain to the hip or groin
  • caused by an ovarian mass compressing the obturator nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is important about considering ovarian cancer investigations in older women?

A
  • always have a low threshold for considering further investigations
  • ovarian cancer can present with very non-specific symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should patients be immediately referred via the 2WW referral?

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What tumour markers are associated with ovarian cancer?

A
  • CA125 (serous + endometrioid)
  • CA19.9 (mucinous)
  • carcinoembryonic antigen (CEA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are other concerning symptoms in women > 50?

What examination should be performed prior to 2WW referral?

A
  • 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 !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the initial investigations for ovarian cancer?

A
  • CA125 blood test
  • pelvic USS

a reading > 35 IU/mL is significant for CA125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is used to estimate the risk of an ovarian mass being malignant?

A

risk of malignancy index:

  • this takes into account:
  1. pelvic US findings
  2. CA125 level
  3. menopausal status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What further investigations may be performed if pelvic US / CA125 raise suspicion?

A

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
17
Q

What additional investigations should be performed in women < 40 with a complex ovarian mass?

A
  • human chorionic gonadotropin (hCG)
  • alpha-fetoprotein (aFP)
  • these markers may be elevated in a germ cell tumour
18
Q

What is the problem with using CA125 as a marker for epithelial cell ovarian cancer?

A
  • it is a measure of epithelial irritation in the abdomen and can be raised in many conditions:
  1. irritable bowel syndrome
  2. endometriosis
  3. fibroids
  4. pregnancy
  5. liver disease
  6. pelvic infection
19
Q

How can ovarian cancer be staged?

A

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)
20
Q

What is involved in the management for ovarian cancer?

A

a combination of surgery + chemotherapy