Ovarian cancer

Question 1

What is the epidemiology of ovarian cancer?

Answer 1

5th most common cancer in females
Peak 60y
Often poor prognosis due to late diagnosis

Question 2

Describe the pathophysiology of ovarian cancer

Answer 2

90% Epithelial
with 70-80% of cases being due to serous carcinomas

Question 3

What are the 3 types of ovarian cancer? list in decreasing frequency

Answer 3

Surface epithelial cells
Germ cell
Ovarian stroma (Sex cord)
Mets

Question 4

Give 3 types of surface epithelial tumours

Answer 4

Serous
Mucinous
Endometrioid

Question 5

Give 4 types of germ cell tumours

Answer 5

Mature teratoma
Dysgerminoma
Yolk sac
Choriocarcinoma

Question 6

Give 3 types of ovarian stromal tumours

Answer 6

Granulosa cell
Fibroma
Thecoma

Question 7

Give 5 risk factors for ovarian cancer

Answer 7

Age
Many ovulations: early menarche, late menopause, nulliparity
Obesity
FH ovarian/ breast cancer
BRCA1/ BRCA2

Question 8

List 5 symptoms of ovarian cancer

Answer 8

Bloating
Abdo/ pelvic pain
Urinary Sx: urgency
Early satiety
Diarrhoea

Question 9

Give 2 signs of ovarian cancer

Answer 9

Pelvic mass
Ascites

Question 10

What are the investigations for ovarian cancer?

Answer 10

TVUSS + Transabdominal
TMs
MRI/ CTCAP
Discuss in MDT

Question 11

What investigations are usually contraindicated in ovarian cancer?

Answer 11

Biopsy + FNA because can disseminate tumour cells into the peritoneum

Question 12

What tumour markers are checked in ovarian cancer?

Answer 12

Ca125: epithelial
HCG: choriocarcinoma
S-AFP: Yolk sac
LDH: Dysgerminoma
Serum inhibin: germ cell tumour

Question 13

What are the 4 stages of ovarian cancer?

Answer 13

I: 1 or both ovaries
II: 1 or both ovaries with pelvic extension
III: 1 or both ovaries with mets outside the pelvis +/- regional LN mets
IV: distant mets other than peritoneal e.g. pleural effusion, liver

Question 14

List 3 benign conditions that can cause rise in CA125

Answer 14

Endometriosis
Menstruation
Benign ovarian cysts

Question 15

What 3 features are used in the risk of malignancy index?

Answer 15

Serum CA125
Menopausal status
Ultrasound score

Question 16

What does the RMI predict?

Answer 16

Risk that an adnexal mass is malignant

Question 17

Describe the treatment options for each stage of ovarian cancer

Answer 17

I: TAH + BSO +/- chemo
II: Debulking surgery + chemo
III + IV: Debulking surgery, chemo + Bevacizumab or if surgery not possible platinum based chemo

Question 18

Can fertility be spared in ovarian cancer?

Answer 18

Unilateral saplingo-oophorectomy preserving the uterus + contralateral ovary possible in early stage, low grade malignancy

Question 19

What chemotherapy regime is usually used in ovarian cancer?

Answer 19

Carboplatin + Paclitaxel

Question 20

What is Bevacizumab?

Answer 20

Monoclonal antibody against VEGF
Inhibits angiogenesis
Available for recurrent disease

Question 21

What interventions can provide symptomatic relief in ovarian cancer?

Answer 21

Ascites: Ascitic drain
Constipation: Laxitives

Question 22

What does follow up of ovarian cancer involve?

Answer 22

CA125 measurement + clinical exam
CA125 tends to rise prior to onset of clinical evidence of disease recurrence