Ovarian cancer

Question 1

Why is ovarian cancer so dangerous

Answer 1

Late presentation due to non specific symptoms
70% spread beyond pelvis at presentation

Question 2

Types of ovarian cancer

Answer 2

Epithelail cell tumours
Dermoid cysts/germ cell tumours
Sex cord-stromal tumours
Metastasis from primary

Question 3

What are the most common ovarian cancers

Answer 3

Epithelial cell:
Serous tumours
Endometrioid carcinomas
Clear cell tumours
Mucinois tumours
Undifferentiated tumours

Question 4

What are dermoid cysts/germ cell tumours

Answer 4

Teratomas - various tissues types. Ass w ovarian torsion

Question 5

What are dermoid cysts/germ cell tumours

Answer 5

Teratomas - various tissues types. Ass w ovarian torsion

Question 6

What are sex cord-stromal tumours

Answer 6

Rare, benign or malignant arising from stroma (CT) or sec cords (embryonic structures ass w follicles)
incl sertoli-leydig cell and granulosa cell tumours

Question 7

What is a krukenberg tumour

Answer 7

Mestasis in the ovary, often from a GI tract cancer esp stomach

Question 8

What would a signet ring cell on histology signifiy

Answer 8

Krukenberg tumour - metastasis to ovary

Question 9

Risk factors for ovarian cancer

Answer 9

Age - peaks at 60
BRCA1/2 genes - FH
Increased no. ovulations
Obesity
Smoking
Recurrent use of clomifene

Question 10

What factors increase the number of ovulations and therefore risk of ovarian cancer

Answer 10

Early onset periods
Late menopause
No pregnancies

Question 11

Protective factors against ovarian cancer

Answer 11

Reduced no. ovulations
COCP
Breastfeeding
Pregnancy

Question 12

How does ovarian cancer present?

Answer 12

v non specific - low threshold for investigation
Abdominal bloating
Early satiety (full after eating)
Loss of appetite
Pelvic pain
urinary symptoms - frequency, urgnecy
Weight loss
Abdominal or pelvic mass
Ascites
Referred hip or groin pain

Question 13

What causes referred hip or groin pain in ovarian cancer?

Answer 13

Obturator nerve compression - passes inside pelvis, lateral to ovaries

Question 14

When do you refer directly for a 2 week wait for ovarian cancer investigation

Answer 14

Ascites
Pelvic mass unless clearly fibroids
Abdominal mass

Question 15

What further investigations before refer women with possible ovarian cancer

Answer 15

CA125 blood test
Pelvic US

Question 16

When do further investigations in women before referring to two week ovarian cancer pathway

Answer 16

New symptoms of IBS/change in bowel habit
Abdominal bloating
Early satiety
Pelvic pain
Urinary frequency or urgency
Weight loss

Question 17

What is a significant CA125 result

Answer 17

> 35 IU/mL

Question 18

What is the risk of malignancy index

Answer 18

Estimates risk of ovarina mass being maliganat
-Menopausal status
-US findings
-CA125 level

Question 19

Further investigations in secondary care for ovarian cancer

Answer 19

CT scan - estblisha and stage
Histology - CT guided biopsy, laparoscopy or otomy
Paracentesis

Question 20

What is paracentesis and what is it used for

Answer 20

Ascitic tap - used to test ascitic fluid for cancer cells

Question 21

What do women under 40 years with a complex ovarian mass require

Answer 21

Tumour markers for possible germ cell turnover
Alpha fetoprotein
HCG

Question 22

Causes of raised CA125

Answer 22

• Endometriosis
• Fibroids
• Adenomyosis
• Pelvic infection
• Liver disease
• Pregnancy

Question 23

Staging of ovarian cancer

Answer 23

FIGO
Simplified:
* 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)

Question 24

Management for ovarian cancer

Answer 24

Gynaecology oncology MDT
Surgery and chemotherapy