Ovarian Cancer Flashcards
What is the epidemiology of ovarian cancer?
400 deaths per year
5 year survival all stages 40-45%
Most present with advanced disease
What are some risk factors for ovarian cancer?
Rare under 30 years
High risk families - HNPCC/ lynch type II, BRCA1 and BRCA2
Incessant ovulation
OCP protection
What are the origins of ovarian cancer?
Most cases probably originate from the fallopian tube
Some derive from pre-existing benign ovarian cysts
What are some molecular alterations in ovarian cancer origin and pathogenesis?
P53, BRCA1 and BRCA2
ARID1a, PIK3CA and PTEN
BRAF, KRAS< NRAS and ERBB2
What is the pathogenesis of P53, BRCA1 and BRAC2 molecular alterations?
Fimbriae of fallopian tube - serous tubal intraepithelial carcinoma - high grade serous carcinoma
What can endometriosis lead to in pathogenesis of ovarian cancer?
Endometrioid carcinoma and clear cell carcinoma
What can ovarian surface epithelium lead to in ovarian cancer (BRAF, NRAS and KRAS)?
Cortical inclusion cysts - serous cystadenoma - serous borderline tumour - low grade serous carcinoma
What are the symptoms of ovarian cancer?
Vague symptoms
Indigestion/ early satiety/ poor appetite, altered bowel habit/ pain, bloating/ discomfort/ weight gain and pelvic mass
How is ovarian cancer diagnosed?
Surgical/ pathological
US scan abdomen and pelvis
CT scan
CA125
Surgery
Describe CA125 in ovarian cancer
Glyco-protein antigen
Can be increased in malignancy - ovary, colon/ pancreas and breast
Benign conditions - menstruation/ endometriosis/ PID and liver disease/ recent surgery/ effusions
How many people with ovarian cancer have a raised CA125?
80% of women with ovarian cancer have raised CA125
50% have stage 1
What is CA125 used for?
Used in detecting and monitoring epithelial ovarian tumours
What is included in the RMI score of ovarian cancer - formula for decision making process?
US features - multi-locular, solid, bilateral, ascites and intra-abdominal
Menopausal status
CA125 level
What is the staging of ovarian cancer?
1 - limited to ovaries with capsule intact
2 - one or both ovaries with pelvic extension
3 - one or both ovaries with peritoneal implants outside pelvis or nodes
4 - distant metastases
What is the treatment for ovarian cancer?
Surgery
Chemo - adjuvant and neo-adjuvant
What is the surgery for ovarian cancer?
Laparotomy
Obtain tissue diagnosis, stage disease, disease clearance and debulk disease
Describe chemotherapy for ovarian cancer
First line platinum and taxane
Within 8 weeks of surgery
Complete/ partial response
Cure unlikely
Average response 2 years
What are the cure rates of ovarian disease?
1 - 85%
4 - 10%
What are some recent developments in targeted therapies?
Poly ADP ribose polymerase inhibitors
Oral agents
Cytotoxic to cells with HRD
What are 3 PARPi approved for use in Scotland?
Olaparib, Niraparib and Rucaparib
All patients offered germaline and somatic BRCA testing
What is the management for recurrence of ovarian cancer?
Chemotherapy
Palliation - symptomatic
Platinum if more than 6 months
Surgery
Tamoxifen
