Ovarian Cancer

Question 1

What is the epidemiology of ovarian cancer?

Answer 1

400 deaths per year
5 year survival all stages 40-45%
Most present with advanced disease

Question 2

What are some risk factors for ovarian cancer?

Answer 2

Rare under 30 years
High risk families - HNPCC/ lynch type II, BRCA1 and BRCA2
Incessant ovulation
OCP protection

Question 3

What are the origins of ovarian cancer?

Answer 3

Most cases probably originate from the fallopian tube
Some derive from pre-existing benign ovarian cysts

Question 4

What are some molecular alterations in ovarian cancer origin and pathogenesis?

Answer 4

P53, BRCA1 and BRCA2
ARID1a, PIK3CA and PTEN
BRAF, KRAS< NRAS and ERBB2

Question 5

What is the pathogenesis of P53, BRCA1 and BRAC2 molecular alterations?

Answer 5

Fimbriae of fallopian tube - serous tubal intraepithelial carcinoma - high grade serous carcinoma

Question 6

What can endometriosis lead to in pathogenesis of ovarian cancer?

Answer 6

Endometrioid carcinoma and clear cell carcinoma

Question 7

What can ovarian surface epithelium lead to in ovarian cancer (BRAF, NRAS and KRAS)?

Answer 7

Cortical inclusion cysts - serous cystadenoma - serous borderline tumour - low grade serous carcinoma

Question 8

What are the symptoms of ovarian cancer?

Answer 8

Vague symptoms
Indigestion/ early satiety/ poor appetite, altered bowel habit/ pain, bloating/ discomfort/ weight gain and pelvic mass

Question 9

How is ovarian cancer diagnosed?

Answer 9

Surgical/ pathological
US scan abdomen and pelvis
CT scan
CA125
Surgery

Question 10

Describe CA125 in ovarian cancer

Answer 10

Glyco-protein antigen
Can be increased in malignancy - ovary, colon/ pancreas and breast
Benign conditions - menstruation/ endometriosis/ PID and liver disease/ recent surgery/ effusions

Question 11

How many people with ovarian cancer have a raised CA125?

Answer 11

80% of women with ovarian cancer have raised CA125
50% have stage 1

Question 12

What is CA125 used for?

Answer 12

Used in detecting and monitoring epithelial ovarian tumours

Question 13

What is included in the RMI score of ovarian cancer - formula for decision making process?

Answer 13

US features - multi-locular, solid, bilateral, ascites and intra-abdominal
Menopausal status
CA125 level

Question 14

What is the staging of ovarian cancer?

Answer 14

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

Question 15

What is the treatment for ovarian cancer?

Answer 15

Surgery
Chemo - adjuvant and neo-adjuvant

Question 16

What is the surgery for ovarian cancer?

Answer 16

Laparotomy
Obtain tissue diagnosis, stage disease, disease clearance and debulk disease

Question 17

Describe chemotherapy for ovarian cancer

Answer 17

First line platinum and taxane
Within 8 weeks of surgery
Complete/ partial response
Cure unlikely
Average response 2 years

Question 18

What are the cure rates of ovarian disease?

Answer 18

1 - 85%
4 - 10%

Question 19

What are some recent developments in targeted therapies?

Answer 19

Poly ADP ribose polymerase inhibitors
Oral agents
Cytotoxic to cells with HRD

Question 20

What are 3 PARPi approved for use in Scotland?

Answer 20

Olaparib, Niraparib and Rucaparib
All patients offered germaline and somatic BRCA testing

Question 21

What is the management for recurrence of ovarian cancer?

Answer 21

Chemotherapy
Palliation - symptomatic
Platinum if more than 6 months
Surgery
Tamoxifen