Ovarian Cancer

Question 1

ovarian cancer epidemiology

scotland ratres, 5 year survival,

Answer 1

• 600 cases per year in Scotland
• 400 deaths per year in Scotland
• 5 year survival all stages 40-45%
• most present with advanced disease

Question 2

what are some high risk genes that cause 5-10% of ovarian cancer cases?

Answer 2

• HNPCC/Lynch type II familial cancer
• BRCA1
• BRCA2

Question 3

what are the symptoms of ovarian cancer?

Answer 3

• vague!
• indigestion/early satiety/poor appetite
• altered bowel habit/pain
• bloating/discomfort/weight gain
• pelvic mass: asymptomatic, pressure symptoms

Question 4

ovarian cancer diagnostic investigations

Answer 4

• surgical/pathological
• US scan abdomen and pelvis
• CT scan
• CA125 antigen test
• tissue guided biopsy or at time of surgery

Question 5

describe CA125

Answer 5

• glyco-protein antigen
• used in detecting and monitoring epithelial ovarian tumours
• elevated in malignancy: ovary, colon/pancreas and breast
• can also be elevated with benign conditions: menstruation/endometriosis/PID, liver disease/recent surgery/effusions

Question 6

what % of women with ovarian cancer have a raised CA125?

Answer 6

80%
50% of women with stage 1 disease

Question 7

describe the risk of malignancy index (RMI)

Answer 7

• The RMI is a product of the ultrasound scan score, the menopausal status and the serum CA125 level (IU/ml).
• RMI = U x M x CA125

Question 8

describe ovarian cancer stages 1-4

Answer 8

1. limited to ovaries with capsule intact/-cytology
2. one or both ovaries with pelvic extension
3. one or both ovaries with peritoneal implants outside pelvis or +ve nodes
4. distant metastasis

Question 9

what are the treatment options for ovarian cancer?

Answer 9

• surgery: laparotomy
• chemotherapy - adjuvant or neo-adjuvant

Question 10

what are the goals of an ovarian cancer laparotomy?

Answer 10

• obtain tissue diagnosis
• stage disease
• disease clearance
• debulk disease

Question 11

describe ovarian cancer chemotherapy

Answer 11

• first line: Platinum and taxane (Taxol)
• within 8 weeks of surgery
• complete/partial response
• cure unlikely
• average response 2 years

Question 12

New therapeutic: Poly ADP Ribose polymerase inhibitors (PARPi). How do they work?

Answer 12

• oral agents
• cytotoxic to cells with HRD
• three PARPi approved for use in scotland: Olaparib, Niraparib, Rucaparib
• All patients offered germline and somatic BRCA testing

Question 13

what are the treatment options for recurrent ovarian cancer?

Answer 13

• chemotherapy
• palliation - symptomatic recurrence
• platinum > 6 months
• surgery in selected patients
• tamoxifen

Question 14

what is a normal CA125 level?

Answer 14

up to 35