Ovarian Cancer Flashcards
Why is it that ovarian cancer typically presents late?
It has very non-specific symptoms
What are the three types of ovarian tumours?
- epithelial cell tumours
- Germ cell tumours
- Sex cord stromal tumours
What is the most common type of ovarian tumour?
Epithelial cell tumours
What are the 5 subtypes of ovarian cancer?
- Serous tumours
- Endometrial tumours
- Clear cell tumours
- Mucinous tumours
- Undifferentiated tumours
Are ovarian germ cell tumours benign or malignant?
Benign
What is another name given to ovarian germ cell tumours?
Dermoid tumours / Teratoma
Describe the composition of ovarian germ cell tumours:
teratomas contain various tissue types such as skin, teeth, hair and bone
What two blood markers are ovarian germ cell tumours associated with?
1) alpha fetoprotein
2) human gonadotropin (hCG)
Are sex cord stromal tumours benign or malignant?
either
What are sex cord stromal tumours?
rare ovarian tumours that arise from connective tissue or sex cords
What are sex cords?
embryonic structures associated with follicles
Give two examples of sex cord stromal tumour subtypes:
1) Sertoli-Leydig cell tumours
2) granulosa cell tumours
What percent of ovarian tumours are epithelial?
85-90%
What percent of ovarian cancer are germ cell tumours?
5-7%
What percent of ovarian cancers are Sex-cord stromal?
5-7%
What is the breakdown of the epidemiology of epithelial tumours?
Serous – most common – about 50% of cases
Endometroid – 20%
Clear cell tumours – 6%
Mucinous – 10%
Brenner – rare
Undifferentiated
What are hormone factors that increase the risk of epithelial ovarian cancer?
- increased risk with low fertility
- Early menarche
- LAte menopause
- Use of HRT
What are lifestyle factors that increase the risk of epithelial ovarian cancer?
- Obesity
- Smoking
- Lack of exercise
- Talc powder used pre 1975
- Exposure to asbestos
What are previous medical history factors that increase the risk of epithelial ovarian cancer?
- pelvic inflammatory disease
- cancer of breast or bowel
- Increasing age
- endometriosis
What are genetic factors that increase the risk of epithelial ovarian cancer?
- Family history
- BRCA1, BRCA 2, HPNCC
What is a protective factor against ovarian cancer?
- Use of oestrogen containing contraceptives
What are some symptoms of ovarian cancer?
- Vague abdominal distention
- Urinary frequency
- Dysuria
- Fever
- Weight Loss
- Pelvic mass
- Acites
- Abnormal uterine bleeding
- Rupture/local peritonism
What is the name given to secondary tumours in the ovary?
Krukenberg tumours
Which primary tumours commonly give rise to ovarian cancer?
GI cancer (stomach)
What is the characteristic sign of a Krukenberg tumour on histology?
Signet ring
Give 6 risk factors for ovarian cancer:
1) age (peak incidence at 60)
2) BRCA1 and BRCA2
3) increased number of ovulation
4) obesity
5) smoking
6) repeat use of clomifene (infertility treatment)
Give 3 ovarian cancer red flag symptoms that warrant an immediate 2WW referral:
1) ascites
2) pelvic mass
3) abdominal mass
Give 6 symptoms that indicate the need for a CA125 blood test:
1) new symptoms of IBS
2) bloating
3) early satiety
4) pelvic pain
5) urinary frequency and urgency
6) weight loss
CA125 is not specific to ovarian cancer - give 6 other conditions where it may be raised:
1) fibroids
2) endometriosis
3) adenomyosis
4) pelvic infection
5) liver disease
6) pregnancy
What criteria is used to estimate risk of ovarian cancer?
Risk of Malignancy Index
What three factors does the Risk of Malignancy Index take into account when assessing risk of ovarian cancer?
1) menopausal status
2) ultrasound findings
3) CA125 level
In what instance would alpha-fetoprotein and HCG testing be indicated in the context of ovarian cancer?
if the patient is under 40 with a complex ovarian mass (this points towards a germ cell tumour which would produce alpha-FP and HCG)
What is the name of the ovarian cancer staging system?
FIGO staging
Summarise FIGO staging for ovarian cancer:
1) stage 1 - confined to the ovary
2) stage 2 - spread outside of ovary but inside pelvis
3) stage 3 - spread outside pelvis but inside abdomen
4) stage 4 - spread outside of the abdomen (distant metastases)
What is the typically treatment plan for ovarian cancer?
a combination of surgery and chemotherapy
what is the epidemiology of ovarian cancer?
60yrs
what is the prognosis of ovarian cancer?
poor
- usually advanced disease at presentation
