Ovarian cancer

Question 1

what is ovarian cancer?

Answer 1

a malignancy originating from various cell types found within the ovary.

Question 2

Most common type of ovarian cancer?

Answer 2

Epithelial ovarian tumours

Question 3

epithelial ovarian tumour features?

Answer 3

Originate from the epithelium which lines the fimbria of the fallopian tubes or the ovaries

Epithelial tumours are partially cystic, and the cysts can contain fluid

The initial metastatic spread typically involves the peritoneal cavity, with seeding particularly affecting the bladder, paracolic gutters and the diaphragm

Around 90% of ovarian cancers are epithelial ovarian tumours.

Question 4

germ cell tumour features?

Answer 4

Originate from the germ cells in the embryonic gonad

These tumours typically grow rapidly and spread predominantly via the lymphatic route

Germ cell tumours most commonly arise in young women, which is atypical for most cases of ovarian cancer

Tumour markers include alpha-fetoprotein and sometimes beta human chorionic gonadotrophin (B-HCG).

Question 5

Germ cell tumours/dermoid cysts are usually malignant. true/false?

Answer 5

false

Most types are benign, approx 1-2% of cases are malignant.

Question 6

Germ cell tumour markers?

Answer 6

Alpha-fetoprotein and beta human chorionic gonadotrophin (B-HCG).

Question 7

Are germ cell tumours regarded as teratomas?

Answer 7

Yes

They are teratomas, meaning they come from the germ cells. They may contain various tissue types, such as skin, teeth, hair and bone. They are particularly associated with ovarian torsion.

Question 8

Sex cord stromal tumour features?

Answer 8

Originate from connective tissue

They are rare, making up less than 5% of all ovarian tumours.

They are malignant tumours, but are much less aggressive than epithelial tumours

Additionally, ovarian cancer can be secondary to another cancer elsewhere, which has metastasised to the ovary. A Krukenberg tumour refers to a ““signet ring”” sub-type of tumour, typically gastrointestinal in origin, which has metastasised to the ovary.

Question 9

Examples of sex cord stromal tumour features?

Answer 9

arise from the stroma (connective tissue) or sex cords (embryonic structures associated with the follicles).

There are several types, including Sertoli–Leydig cell tumours and granulosa cell tumours.

Question 10

Sex cord stromal tumours can be benign or malignant. true/false?

Answer 10

True

Question 11

Risk factors of ovarian cancer?

Answer 11

Advanced age
Smoking
Increased number of ovulations (early menarche, late menopause)
Obesity
Hormone replacement therapy (HRT)
Genetic predisposition (BRCA 1 and 2 genes)

Question 12

protective factors of ovarian cancer?

Answer 12

Childbearing (parity)
Breastfeeding
Early menopause
Use of combined oral contraceptive pill (COCP)

Question 13

clinical features of ovarian cancer?

Answer 13

Abdominal discomfort
Bloating
Early satiety
Urinary frequency or change in bowel habits

Question 14

Late stage clinical features of ovarian cancer?

Answer 14

Ascites (due to vascular growth factors increasing vessel permeability)
Pelvic, back and abdominal pain
Palpable abdominal or pelvic mass

Question 15

Investigations for suspected ovarian cancer?

Answer 15

Blood test for CA-125
Pelvic and abdominal ultrasound scan

Question 16

Further investigations for ovarian cancer?

Answer 16

CT scans for staging

AFP and beta-hCG tests for younger women who may have germ cell cancers

Laparotomy for tissue biopsy

Question 17

Stage 1 ovarian cancer?

Answer 17

Stage I (limited to the ovaries):

Stage IA: limited to one ovary, the capsule is intact
Stage IB: limited to both ovaries, capsules intact.
Stage IC: tumour limited to one or both ovaries with any of the following: capsule ruptured, tumour on ovarian surface, malignant cells in ascites or peritoneal washings.

Question 18

Stage 2 ovarian cancer?

Answer 18

Stage II involving one or both ovaries with pelvic extension and/or implants:

Stage IIA: extension and/or implants on the uterus and/or Fallopian tubes. No malignant cells in ascites or peritoneal washings
Stage IIB: extension to and/or implants on other pelvic tissues. No malignant cells in ascites or peritoneal washings
Stage IIC: pelvic extension and/or implants (Stage IIA or Stage IIB) with malignant cells in ascites or peritoneal washings.

Question 19

Stage 3 ovarian cancer?

Answer 19

Stage III involving one or both ovaries with microscopically confirmed peritoneal implants outside the pelvis:

Stage IIIA: microscopic peritoneal metastasis beyond pelvis (no macroscopic tumour)
Stage IIIB: macroscopic peritoneal metastasis beyond pelvis <2 cm
Stage IIIC: peritoneal metastasis beyond pelvis >2 cm and/or regional lymph node metastasis.

Question 20

Stage 4 ovarian cancer?

Answer 20

Stage IV ovarian cancer is tumour involving one or both ovaries with distant metastasis.

Question 21

Surgical management of ovarian cancer?

Answer 21

In early disease surgery can include removal of the uterus, ovaries, Fallopian tubes and infracolic omentectomy

Question 22

Chemotherapy management of ovarian cancer?

Answer 22

Adjuvant chemotherapy in combination with surgery
Intraperitoneal chemotherapy may be performed at the time of operation

Question 23

Subtypes of epithelial cell tumours?

Answer 23

Serous tumours (the most common)
Endometrioid carcinomas
Clear cell tumours
Mucinous tumours
Undifferentiated tumours