Ovarian cancer

Question 1

Ovarian cancer risk factors

Answer 1

• increasing age
• BRCA1 or BRCA2
• increased oestrogen exposure: early menarche, late menopause, nulliparity

Question 2

Ovarian cancer presentation

Answer 2

• abdominal distension or bloating
• abdominal or pelvic pain
• urinary symptoms, e.g. urgency
• diarrhoea
• red flags - weight loss, night sweats, fever, malaise

Question 3

Ovarian cancer differential diagnosis

Answer 3

• benign cysts
• endometriosis
• IBD - change in bowel habit, diarrhoea
• tubo-ovarian abscess

Question 4

Investigations for ovarian cancer

Answer 4

• history and exam including speculum and bimanual examination
• pregnancy test if reproductive age
• stool sample and MC&S - infection?
• markers - CA125, BRCA1, BRCA2
• if CA125 raised, urgent CT of abdomen and pelvis
• abdominal ultrasound - if normal, ?endometriosis, benign ovarian cysts
• CT or ultrasound guided biopsy
• if hard to reach - diagnostic laparotomy

Question 5

Ovarian cancer staging

Answer 5

• stage 1 - only in ovaries
• stage 2 - beyond ovaries, only in pelvis
• stage 3 - locally advanced, outside pelvis (retroperitoneal)
• stage 4 - distant metastasis

Question 6

Ovarian cancer management

Answer 6

• surgical - exploratory laparotomy
• tumour debulking and formal surgical staging
• a major procedure - hysterectomy, salpingo-oophorectomy, lymph node and ascites sampling
• 6 months of platinum based adjuvant chemotherapy
• radiotherapy not used often - resistant
• if metastatic - palliate with tumour debulking, chemoradiotherapy, symptom control

Question 7

Patient questions - ovarian

Answer 7

What tests are you going to do? Blood test (CA125), transvaginal ultrasound
What are you looking for? Raised CA125, ultrasound – mass or growth of ovaries
Will the tests show whether I have cancer? Indicate
Will you know what treatment I need when you have the results? Depends on staging
Are any of the tests painful? Local anaesthesia but puncture sites after
Do any of the tests have after-effects? As above
Can I have my tests as an outpatient? Yes, depending on outcome may need to stay overnight
Can I bring someone with me when I have the tests? yes
How long will the results take? 1-2 weeks
Who will give me the test results? Doctor